title: Effects of paracetamol on the pharmacokinetics of ciprofloxacin in plasma using a microbiological assay.
abstract: OBJECTIVE
  Pharmacokinetic drug interactions may result in a decrease or increase in the oral bioavailability of some drugs. Therefore, co-administration of drugs should be avoided, or at least undertaken only when careful therapeutic drug monitoring is possible. Because of the common practice of co-administering paracetamol (acetaminophen) for fever in patients taking the antibacterial ciprofloxacin for infection, we investigated the influence of paracetamol on the pharmacokinetics of ciprofloxacin.
  
  
  METHODS
  In a randomised, two-way crossover study, 10 healthy male volunteers received a single oral dose of ciprofloxacin 500 mg or ciprofloxacin 500 mg plus paracetamol 500 mg. Pharmacokinetic parameters were measured in plasma samples using a microbiological assay.
  
  
  RESULTS
  No significant differences were found as a result of concomitant administration of paracetamol in the ciprofloxacin pharmacokinetic parameters oral clearance (CL/F) and apparent volume of distribution (Vd/F). However, the ratio of the area under the concentration-time curves (AUCs) suggested that paracetamol increases ciprofloxacin concentrations on average by 16%. Concomitant administration of paracetamol slightly increased ciprofloxacin AUC(infinity) from 14.37 +/- 0.91 to 16.71 +/- 0.99 microg . h/mL (p = 0.073) and ciprofloxacin maximum plasma concentration (C(max)) from 2.52 +/- 0.18 to 2.61 +/- 0.24 microg/mL (p = 0.113), while slightly decreasing time to ciprofloxacin C(max) from 1.5 to 1.3 hours (p = 0.376).
  
  
  CONCLUSIONS
  The results confirm an increased concentration-time profile of ciprofloxacin when the latter is co-administered with paracetamol. We believe that a pharmacokinetic interaction may have occurred.
authors.affiliation: Pharmaceutical Analytical Chemistry Department, Alaqsa University, Gaza, Palestine.
authors.forename: Mahmoud Mohamed
authors.initials: MM
authors.lastname: Issa
authors.forename: R'afat Mahmoud
authors.initials: RM
authors.lastname: Nejem
authors.forename: Naser Said
authors.initials: NS
authors.lastname: El-Abadla
authors.forename: Mohamed Khamis
authors.initials: MK
authors.lastname: El-Naby
authors.forename: Abeer Ahmed
authors.initials: AA
authors.lastname: Roshdy
authors.forename: Zainab Assan
authors.initials: ZA
authors.lastname: Kheiralla
mesh_terms: D000082:Acetaminophen / Q000494:pharmacology*; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000494:pharmacology*; D000900:Anti-Bacterial Agents / Q000097:blood* / Q000493:pharmacokinetics*; D019540:Area Under Curve; D001681:Biological Assay; D002138:Calibration; D002939:Ciprofloxacin / Q000097:blood* / Q000493:pharmacokinetics*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015610:Serum Bactericidal Test
chemical_list: D018712:Analgesics, Non-Narcotic; D000900:Anti-Bacterial Agents; D000082:Acetaminophen; D002939:Ciprofloxacin