Valdoxan (Agomelatine) and Ciprobay (Ciprofloxacin) Interaction
No clinically significant pharmacokinetic interaction is expected between agomelatine and ciprofloxacin, and these medications can generally be used together safely. 1
Metabolic Pathways and Interaction Risk
Agomelatine is primarily metabolized by CYP1A2 (90%) and CYP2C9/2C19 (10%), making it susceptible to interactions with strong CYP1A2 inhibitors like fluvoxamine, which is contraindicated. 1
Ciprofloxacin does not significantly inhibit CYP1A2 at therapeutic doses, unlike fluvoxamine which is the only antidepressant specifically contraindicated with agomelatine. 1, 2
Ciprofloxacin's main documented drug interactions involve theophylline metabolism inhibition and chelation with antacids, not interactions with the cytochrome P450 pathways that metabolize agomelatine. 2
Specific Monitoring Considerations
Monitor for CNS effects including dizziness, sedation, or sleep disturbances when using these medications together, as both can affect central nervous system function. 3
Maintain liver function test monitoring for agomelatine at baseline, 3 weeks, 6 weeks, 12 weeks, and 24 weeks as required by the Summary of Product Characteristics, regardless of ciprofloxacin co-administration. 1
Watch for ciprofloxacin-specific adverse effects including tendinopathy, QTc prolongation, and CNS effects (confusion, dizziness), particularly in older adults. 3, 4
Clinical Caveats
The only absolute contraindication for agomelatine co-administration is fluvoxamine, which is a potent CYP1A2 inhibitor that increases agomelatine levels 60-fold. 1
Ciprofloxacin should be taken separately from antacids (at least 2 hours before or 6 hours after) to avoid chelation and reduced absorption, but this does not affect agomelatine. 2
In older adults, exercise general caution with multiple CNS-active medications as the combination may increase fall risk, though neither drug specifically requires dose adjustment when used together. 3