title: Effect of Sucralfate on the Relative Bioavailability of Enrofloxacin and Ciprofloxacin in Healthy Fed Dogs.
abstract: BACKGROUND
  Sucralfate impairs absorption of ciprofloxacin and other fluoroquinolones in humans, but no sucralfate-fluoroquinolone interaction has been reported in dogs. Veterinary formularies recommend avoiding concurrent administration of these medications, which might impact compliance, therapeutic success, and resistance selection from fluoroquinolones.
  
  
  OBJECTIVE
  To determine whether a drug interaction exists when sucralfate is administered to fed dogs concurrently with ciprofloxacin or enrofloxacin, and whether a 2 hour delay between fluoroquinolone and sucralfate affects fluoroquinolone absorption.
  
  
  METHODS
  Five healthy Greyhounds housed in a research colony.
  
  
  METHODS
  This was a randomized crossover study. Treatments included oral ciprofloxacin (C) or oral enrofloxacin (E) alone, each fluoroquinolone concurrently with an oral suspension of sucralfate (CS, ES), and sucralfate suspension 2 hours after each fluoroquinolone (C2S, E2S). Fluoroquinolone concentrations were evaluated using liquid chromatography with mass spectrometry.
  
  
  RESULTS
  Drug exposure of ciprofloxacin was highly variable (AUC 5.52-22.47 h μg/mL) compared to enrofloxacin (AUC 3.86-7.50 h μg/mL). The mean relative bioavailability for ciprofloxacin and concurrent sucralfate was 48% (range 8-143%) compared to ciprofloxacin alone. Relative bioavailability of ciprofloxacin improved to 87% (range 37-333%) when sucralfate was delayed by 2 hours. By contrast, relative bioavailability for enrofloxacin and concurrent sucralfate was 104% (94-115%).
  
  
  CONCLUSIONS
  A possible clinically relevant drug interaction for the relative bioavailability of ciprofloxacin with sucralfate was found. No significant difference in bioavailability was documented for enrofloxacin with sucralfate. Further research is warranted in fasted dogs and clinical cases requiring enrofloxacin or other approved fluoroquinolones in combination with sucralfate.
authors.affiliation: Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS.
authors.forename: K
authors.initials: K
authors.lastname: KuKanich
authors.affiliation: Department of Anatomy and Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS.
authors.forename: B
authors.initials: B
authors.lastname: KuKanich
authors.affiliation: Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS.
authors.forename: S
authors.initials: S
authors.lastname: Guess
authors.affiliation: Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS.
authors.forename: E
authors.initials: E
authors.lastname: Heinrich
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D019540:Area Under Curve; D001682:Biological Availability; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000493:pharmacokinetics*; D018592:Cross-Over Studies; D004285:Dogs; D004334:Drug Administration Schedule; D004347:Drug Interactions; D000077422:Enrofloxacin; D024841:Fluoroquinolones / Q000008:administration & dosage / Q000493:pharmacokinetics*; D006207:Half-Life; D013392:Sucralfate / Q000008:administration & dosage / Q000493:pharmacokinetics*
chemical_list: D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D024841:Fluoroquinolones; D000077422:Enrofloxacin; D013392:Sucralfate; D002939:Ciprofloxacin
keywords: Canine; Drug interaction; Fluoroquinolone; Pharmacokinetics