Does ciprofloxacin interact with levetiracetam?

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Ciprofloxacin and Levetiracetam Interaction

Ciprofloxacin does not have a clinically significant interaction with levetiracetam, making this combination safe to use without dose adjustments or additional monitoring. 1

Evidence Summary

Safety of Levetiracetam with Ciprofloxacin

  • Levetiracetam is not known to have clinically significant pharmacokinetic interactions with other medications, including ciprofloxacin 2
  • Levetiracetam is specifically mentioned as a safer antiepileptic choice when drug interactions are a concern 1
  • Unlike other antiepileptic drugs, levetiracetam does not interact with cytochrome P450 enzymes, which are affected by ciprofloxacin 3

Known Ciprofloxacin Interactions with Other Medications

  • Ciprofloxacin is known to interact with theophylline by inhibiting hepatic microsomal enzymes, increasing theophylline levels 4
  • Ciprofloxacin in combination with warfarin increases bleeding risk 1
  • Ciprofloxacin in combination with phenytoin increases the risk of phenytoin toxicity 1
  • Ciprofloxacin can increase the risk of theophylline toxicity 1

Antiepileptic Drug Considerations

  • Unlike levetiracetam, enzyme-inducing antiepileptic drugs (EIAEDs) like carbamazepine, oxcarbazepine, phenobarbital, and phenytoin should be avoided with ciprofloxacin due to potential interactions 1
  • Levetiracetam is specifically recommended as a safer alternative to other antiepileptic drugs when drug interactions are a concern, such as in patients with brain metastases who require antiepileptic medication 1
  • Levetiracetam has a favorable side effect profile compared to older antiepileptic drugs 5

Clinical Implications

When to Use This Combination

  • Levetiracetam can be safely used in patients requiring ciprofloxacin for infection treatment 1
  • This combination is particularly advantageous in patients with brain tumors or metastases who require both antibiotics and seizure control 1
  • Levetiracetam is well-tolerated in patients with brain tumors and does not affect survival outcomes 1

Monitoring Recommendations

  • No special monitoring is required for the combination of ciprofloxacin and levetiracetam 2
  • Regular monitoring for common side effects of each individual medication should continue as usual 5

Common Side Effects to Be Aware Of

  • Levetiracetam: somnolence, dizziness, nervousness/irritability, and asthenia/fatigue 5
  • Ciprofloxacin: gastrointestinal effects, CNS effects, and potential tendon issues in elderly patients 1

Important Distinctions from Other Anticonvulsants

Avoid These Combinations

  • Ciprofloxacin with phenytoin (increases risk of phenytoin toxicity) 1
  • Ciprofloxacin with theophylline (increases risk of theophylline toxicity) 1, 4
  • Ciprofloxacin with warfarin (increases bleeding risk) 1

Rare Potential Pharmacodynamic Interactions

  • While a pharmacodynamic interaction between levetiracetam and carbamazepine has been reported 6, no such interactions have been documented between levetiracetam and ciprofloxacin

Conclusion

Levetiracetam can be safely administered with ciprofloxacin without dose adjustments or special monitoring. This combination avoids the potentially problematic interactions seen with other antiepileptic medications.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Clinical pharmacology of levetiracetam for the treatment of epilepsy.

Expert review of clinical pharmacology, 2009

3
Research

Piracetam and levetiracetam: close structural similarities but different pharmacological and clinical profiles.

Epileptic disorders : international epilepsy journal with videotape, 2000

4
Research

Drug interactions of ciprofloxacin with other non-antibiotic agents.

The American journal of medicine, 1987

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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