The People's Pharmacy - The People's Pharmacy

Most of us have learned how much coffee we can handle before getting into trouble with jitters, insomnia or heart palpitations. But some drugs may interact with caffeine to give us more of a java jolt than expected. Coffee and Cipro (ciprofloxacin) could be a problem as the drug appears to slow elimination of caffeine from the body. That could produce unexpected stimulation.

An Unexpected Coffee and Cipro Interaction:

Q. My doctor prescribed the antibiotic Cipro for an infection. I took the first dose with breakfast, and the rest of the morning I felt as if I had caffeine zooming through my veins.

After my second dose, I ate some chocolate ice cream. That also made me feel wired.

Neither my doctor nor pharmacist warned me not to drink coffee or eat chocolate. They also did not caution me to avoid dairy when taking Cipro. Is there a safer alternative to this antibiotic?

A. Ciprofloxacin (Cipro) and similar fluoroquinolone antibiotics are usually reserved: "for use in patients who have no alternative treatment options" for certain common infections. Your physician and pharmacist should have warned you to avoid all caffeinated beverages, including soft drinks. Caffeine is also found in some pain relievers like Excedrin.

Cipro slows the elimination of caffeine from the body and may trigger nervousness and a rapid heart rate. Chocolate may also pose a problem.

On the other hand, ice cream and other dairy products may interfere with the absorption of this antibiotic. Antacids also interact to make ciprofloxacin less effective. Ask your doctor about an alternate treatment.

Other Sources of Caffeine:

Caffeine can crop up in some unexpected places. We suspect that most people no longer take a lot of time to read drug labels. They buy familiar brands for what ails them and don't even try to discover what's in the preparation. Here are some examples:

Bayer Back and Body: Aspirin 500 mg; Caffeine 32.5 mg. 2 caplets every 6 hours

BC MAX Strength Fast Pain Relief Powders: Aspirin 500 mg; Acetaminophen  500; Caffeine 65 mg. 1 powder on tongue every 6 hours.

Excedrin Extra Strength Caplets: Aspirin 250 mg; Acetaminophen 250 mg; Caffeine 65 mg. 2 caplets every 6 hours.

Midol Complete: Acetaminophen 500 mg; caffeine 60 mg; pyrilamine 15 mg. 2 caplets every 6 hours.

No Doz: Caffeine 200 mg. 1/2 to 1 pill every 3-4 hours.

Vivarin: Caffeine 200 mg. 1 tablet not more often than every 3 to 4 hours.

Coffee and Cipro and Other Interactions:

Caffeine, whether in drugs or coffee, can interact with other drugs besides ciprofloxacin. Coffee and Cipro is an interaction between caffeine and a fluoroquinolone antibiotic.

Other FQs (fluoroquinolones) that might interact with caffeine include norfloxacin (Noroxin) and enoxacin (Penetrex). The result could be a more intense caffeine effect.

Thyroid medication (levothyroxine, Synthroid, etc) may not be absorbed well in the presence of coffee or tea. You can read more about this interaction at this link.

Food and Drug Interactions:

People should not ignore other food and drug interactions, although they may not know many of them. Dairy products can impede absorption of some antibiotics. For example, tetracyclines are affected by milk and other dairy. Ciprofloxacin and norfloxacin may also be affected by dairy products. In some instances, only 50% of the drug will be absorbed. That's enough to sabotage their effectiveness.

People who don't swallow pills well may sometimes take their medicine crushed or mixed with food. A research team in San Antonio discovered that it made a big difference whether that food was applesauce or vanilla pudding.

Some ingredient in the pudding interfered with the absorption of Dilantin Infatabs (phenytoin) so that the appropriate dose of the anti-seizure  drug did not get into the bloodstream adequately (Pediatrics, Nov. 1986). Applesauce was not so much of a problem.

The Bran Muffin Interaction:

It's hard to imagine how a bran muffin could impede drug absorption. And yet the case of the bran muffin breakfast led to serious depression. You can read about this unusual interaction at this link.

To learn more about such incompatibilities, you may wish to read our free eGuide to Drug & Food Interactions. This downloadable pdf may be found under the Health eGuides tab.