Dangerous interaction between the antibiotic ciprofloxacin and the muscle relaxant tizanidine
Researchers from Finland have found that the antibiotic ciprofloxacin (brand names Ciproxin, Ciprofloxacin etc.) greatly increases the concentrations of tizanidine (Sirdalud, Zanaflex) in blood. Concomitant use of ciprofloxacin and tizanidine results in severe and prolonged decrease in blood pressure and greatly enhances central nervous system effects.
This previously unrecognised interaction can be dangerous, particularly in elderly patients, and the concomitant use of the two agents must be avoided. Tizanidine is widely used for treatment of musculoskeletal pain associated with increased muscle tension or chronic spasticity.
The concentrations of tizanidine in blood were increased on average 10-fold by ciprofloxacin in a carefully controlled study in healthy volunteer subjects. The volunteers ingested the usual 500-mg dose of ciprofloxacin (or placebo) twice daily for 3 days, and then a single 4-mg dose of tizanidine. The interaction was observed in each of the ten subjects; the greatest increase in tizanidine concentration by ciprofloxacin was 24-fold.
Ciprofloxacin enhanced greatly also the effects of tizanidine. In particular, the decrease in systolic (“upper”) blood pressure, to the level of 90-mm Hg or even less, was an alarming finding. Such hypotension can be dangerous, eg in elderly subjects and in patients who have heart problems. Also the central nervous system effects of tizanidine were greatly enhanced by ciprofloxacin: all ten subjects were somnolent and dizzy for about 3 hours after tizanidine intake.
Both tizanidine and ciprofloxacin are widely used drugs in many countries. E.g. in Finland (population 5 200 000) about 136 000 patients used tizanidine and about 60 000 patients used ciprofloxacin during the year 2003. Therefore, it is likely that ciprofloxacin and tizanidine can be coadministrered, if the risk of the interaction is not recognised by clinicians.
The interaction results from inhibition of the liver metabolism of tizanidine by ciprofloxacin. The same mechanism causes a serious interaction also between the antidepressant fluvoxamine and tizanidine, which was uncovered earlier this year. Further studies are being carried out to study whether there are other unrecognised interactions between tizanidine and other drugs.
The study was conducted at the Department of Clinical Pharmacology, University of Helsinki, by an independent group of researchers led by Professor Pertti J Neuvonen, MD, PhD, and Dr. Janne T Backman, MD, PhD. The study was published in the December issue of Clinical Pharmacology & Therapeutics, the leading scientific journal within the clinical pharmacology and therapeutics area.
Paivi Lehtinen | alfa
The most recent press releases about innovation >>>
Die letzten 5 Focus-News des innovations-reports im Überblick:
What is the mass of a proton? Scientists from Germany and Japan successfully did an important step towards the most exact knowledge of this fundamental constant. By means of precision measurements on a single proton, they could improve the precision by a factor of three and also correct the existing value.
To determine the mass of a single proton still more accurate – a group of physicists led by Klaus Blaum and Sven Sturm of the Max Planck Institute for Nuclear...
A bacterial enzyme enables reactions that open up alternatives to key industrial chemical processes
The research team of Prof. Dr. Oliver Einsle at the University of Freiburg's Institute of Biochemistry has long been exploring the functioning of nitrogenase....
Larsen C Ice Shelf rift finally breaks through
A one trillion tonne iceberg - one of the biggest ever recorded -- has calved away from the Larsen C Ice Shelf in Antarctica, after a rift in the ice,...
Physics supports biology: Researchers from PTB have developed a model system to investigate friction phenomena with atomic precision
Friction: what you want from car brakes, otherwise rather a nuisance. In any case, it is useful to know as precisely as possible how friction phenomena arise –...
In 2013, Amazon was one of the first to declare the intention to work towards the automated delivery of goods by small autonomous helicopters. A multi-disciplinary research team at the Alpen-Adria-Universität assembled by Christian Bettstetter and Friederike Wall is due to deliver initial insights on the efficient operation of (self-organised) delivery of goods. Doctoral student Pasquale Grippa will present the results at the conference “Robotics: Science and Systems”, which is scheduled to take place at the Massachusetts Institute of Technology (MIT) from July 12th.
“We are analysing a system in which customers order goods that are stored in depots and the subsequent deliveries are made by drones”, Christian Bettstetter...