CriticalFluoroquinolone antibacterials×SNRI
Updated · Methodology
Mechanism
Ciprofloxacin is a potent CYP1A2 inhibitor, the main duloxetine metabolic route. Duloxetine plasma levels rise 6-fold. Nausea, sedation, and serotonergic effects emerge.
Symptoms
Serotonin syndrome: agitation, confusion, tremor, myoclonus, hyperreflexia. Autonomic features: sweating, tachycardia, hypertension, fever. First signs appear within hours of co-administration.
Management
The AEMPS label for duloxetine lists the combination with ciprofloxacin as contraindicated: ciprofloxacin, a strong CYP1A2 inhibitor, sharply raises duloxetine exposure. Alternative antibiotics without CYP1A2 effect: a cephalosporin, nitrofurantoin, or fosfomycin.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Cymbalta section 7 (2017)– ; DailyMed setid 2f7d4d67-10c1-4bf4-a7f2-c185fbad64ba
- AEMPS: Ficha técnica: Duloxetina (nº registro 86282), sección 4.3 (2026)– AEMPS, CIMA, nº registro 86282, sección 4.3