Calcium-enriched Orange Juice not for pill taking anymore

[Guest guest]

Hi,

don't know whether Becki has posted this already, but it's worth to

be read twice. Since many pwcf take Cipro this may be important for

some of you.

Peace

Torsten

Ciprofloxacin absorption decreased 41% when taken with calcium-

fortified

orange juice.

Calcium-enriched OJ not for pill taking anymore

Vitamin and mineral additives have generally been beneficial, but

researchers are concerned that some may interfere with the

effectiveness

of medication, as shown in a study of ciprofloxacin.

By Stagg Elliott, AMNews staff. Oct. 14, 2002.Drug

interactions

are already a considerable concern in the practice of medicine. But

the

fortified-food trend may add an entirely new wrinkle to the challenges

physicians face in educating patients about what might or might not

mix

with their medications. The latest rub results from the good-for-you

vitamins and minerals that are added to everyday food and drink items

in

almost every kitchen -- in this case, orange juice -- and how these

additions may impact certain antibiotics. In general, it is an issue

that

some experts say could become much more far-reaching. For now,

researchers found that orange juice with added calcium may interfere

with

the effectiveness of specific germ killers. This finding results from

several studies released over the past few months by a research group

at

Bassett Healthcare in stown, N.Y. The group published a study in

the April Journal of Clinical Pharmacology finding that when

ciprofloxacin was administered to healthy volunteers along with

calcium-fortified orange juice, the amount of drug in the blood stream

was decreased by more than 40%.

Last month, the group presented two studies at the Interscience

Conference on Antimicrobial Agents and Chemotherapy in San Diego

finding

that the breakfast drink could also impact absorption of two other

quinolones -- gatifloxacin and levofloxacin -- although less

dramatically. " You can look at the calcium itself and say, 'that's a

great idea because most Americans don't get enough calcium,' " said

Anne

Nafziger, MD, MHS, who assisted with the research and is co-director

of

the clinical pharmacology research center at Bassett. " But if you

don't

look at the big picture and the fact that they're also taking their

medicines with their orange juice with the calcium, they could really

get

into trouble. " Manufacturers of the drugs did not comment on the

studies

at press time, but labels for all these medications already say that

they

should not be taken with calcium supplements. The label for

ciprofloxacin

also adds that the drug should not be taken with milk or

calcium-fortified juice by itself, although the drug can be taken

with a

meal containing these drinks. Raising awareness, asking questions

Researchers hope to raise public awareness of the impact of additional

minerals and vitamins added to food and eventually influence Food and

Drug Administration guidelines for testing food-drug interactions.

They

also concede, though, that these studies are far from conclusive. The

studies were small and did not determine if this reduction in

absorption

would result in treatment failure and therefore be clinically

relevant.

" We don't know enough about how food interacts with medication, " said

Dr.

Nafziger. " And certainly when you look at fortified foods, there's a

lot

more reason to be even more concerned, and we're seeing more and more

fortified foods. " Researchers are concerned enough about the issue,

however, that a memo has been sent to all prescribers and pharmacists

connected with Bassett recommending that patients be advised to take

the

drugs on an empty stomach. The drug labels advise that taking the

medications with or without food is appropriate. Physicians say this

is

yet another issue to consider when advising patients about drug

interactions such as those with other medications or supplements.

" There's an awful lot of detail to medicine, and this is just one more

we're going to have to look out for, " said Tim Gorski, MD, an

Arlington,

Texas, ob-gyn. " We know that you can't take milk with some

antibiotics,

but what if you make orange juice more like milk? Or will it create

its

own problems? " Still, most people do not consider fortification a bad

thing. They, along with many public health experts, agree that in most

instances it has generally been for the best. According to a study

published in the Journal of the American Medical Association last

year,

the addition of folic acid to flour was followed by a 19% decrease in

neural tube defects. Vitamin D in milk has been credited with

eliminating

rickets. And, although there are some concerns that because calcium is

added to so many foods some may get too much, most feel that many

people

don't get enough of the mineral. " Additives in one way or another have

been part of the health picture for years, " said Levinson, MD,

DPH, associate executive director of the American Public Health

Assn. " If

all additives were wiped out, I think we'd be in very serious trouble.

The issue is not: Should you continue additives or not. The issue is:

If

certain additives can interfere with substances that you need,

[physicians] need to be aware of it to advise people. " In the future,

Bassett researchers plan to study the interaction of antibiotics with

a

more typical breakfast including the calcium-fortified orange juice

and

cereals with large amounts of vitamins and minerals. ADDITIONAL

INFORMATION: Not a good mix

Objective: Characterize and compare the bioequivalence of

ciprofloxacin

when administered with water, orange juice or calcium-fortified orange

juice.

Method: Fifteen healthy volunteers took three 500 mg tablets of

ciprofloxacin with three different liquids: water, orange juice and

orange juice fortified with calcium. Blood samples were drawn before

taking the medication and 15 times over the next 24 hours.

Results: When the drug was taken with regular orange juice, the

amount of

drug in the blood decreased by 23%. When it was taken with calcium-

added

orange juice, the amount was decreased by 41%.

Conclusion: Ciprofloxacin is marginally bioequivalent when

administered

with orange juice, according to Food and Drug Administration

standards,

but is not equivalent when the orange juice has added calcium. Source:

Journal of Clinical Pharmacology,