Brukinsa and Ciprofloxacin

[MyCLLJourney]

I'm currently taking Brukinsa and was just prescribed Ciprofloxacin antibiotic for a UTI. Does anyone know if it's ok to take the Cipro while also taking the Brukinsa? Since it's new years eve, the pharmacy where I'd normally ask that question is closed.

[Newdawn Administrator]

My view on this is purely a personal and non medical one but in truth, nothing would possess me to take Cipro or any fluoroquinolone unless I had an infection so serious that no other antibiotic could be considered. Please read the plethora of warnings and advice on the use of fluoroquinolones including the FDA Black Box warning.

I’m also on Zanubrutinib but would seriously be asking for an alternative antibiotic. However, your doctor may have compelling reasons for prescribing this drug. It’s rarely given in the U.K. for all but highly resistant and serious infections. We have members on this site who have unfortunately suffered very serious side effects from the use of quinolones including tendon rupture. Here is the U.K. guidance;

gov.uk/drug-safety-update/f...

Best wishes,

Newdawn

[70s-80s-overlander]

I hope that your medical physician can propose an option to using ciprofloxacin. I was on it for about 6 weeks in June-July & the SEVERE constipation just about killed me; indeed, it directly caused an inguinal hernia. Fortunately, in my case, clindamycin sufficed.

When I had sepsis 7+ years ago, ceftriaxone iv twice made me delirious then unconscious.

When I had a serious wound 10 years ago, levofloxacin gave me tendonitis (calmed down with multiple doses of oral magnesium).

I have essentially no immunoglobulins -- so I understand that the docs get a bit scared whenever I get an ugly-looking infection -- but powerful antibiotics can be powerful in more than one way.

There may be situations in which only a fluoroquinolone antibiotic will save your life, but I would try to avoid such unless you really are at risk of death otherwise.

>>> As I have said over & over, no matter what a medical physician proposes, always -- politely -- say with a smile:

"That is Plan A. What is Plan B?" A good doc always has a Plan B. <<<

[AussieNeil Partner Administrator]

Seems that through discussion with your doctor, you may need to either reduce your Brukinsa/zanubrutinib dose, temporarily discontinue taking it, or find something else other than ciprofloxacin. Drugs.com drugs.com/interactions-chec...

states;

Ciprofloxacin can significantly increase the blood levels of zanubrutinib. This may increase side effects such as rash, diarrhea, constipation, cough, hemorrhage, development of other cancers, abnormal heart rhythm, and impaired bone marrow function resulting in low numbers of different types of blood cells. You may also be more likely to develop anemia, bleeding problems, or infections due to low blood cell counts. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose interruption or more frequent monitoring to safely use both medications. Contact your doctor if you develop paleness, fatigue, dizziness, fainting, unusual bruising or bleeding, fever, chills, diarrhea, sore throat, muscle aches, shortness of breath, blood in phlegm, weight loss, red or inflamed skin, body sores, and pain or burning during urination. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

That doesn't necessarily rule out taking ciprofloxacin, since as Newdawn noted, "your doctor may have compelling reasons for prescribing this drug." despite the general concerns as well as the interaction issue. I've been in the situation where I decided to refuse ciprofloxacin when recommended it as well as IV antibiotics for the emergency treatment of a cellulitis infection. That was due to my concerns about the risky side effect profile of the fluoroquinolone drug class raised in this community. My situation was a complicated one, but thankfully without the challenge of being in treatment for my CLL with an interacting drug. My CLL/SLL had severely compromised my immune system, so that I had both chronic neutropenia and low immunoglobulin counts. I had also been wrongly advised to avoid penicillin antibiotics decades earlier, which restricted the choice of antibiotics available to treat the cellulitis. That situation of incorrectly believing you are allergic to penicillin antibiotics unfortunately common. See healthunlocked.com/cllsuppo...

After almost a week in hospital, I was discharged when the cellulitis had apparently been eliminated. It came back with a vengeance a few weeks later. My GP prescribed ciprofloxacin, which I took with trepidation. My CLL specialist warned me that the cellulitis could again recur, but it never did. Years later, after another hospital admission for IV antibiotics, a doctor wisely questioned if I actually did have an allergy to penicillin and I subsequently determined that I wasn't, That has made it much easier to find antibiotics to help me fight off infections.

I hope you are able to find a lower risk way to eliminate your UTI. You were wise to question if you had an appropriate prescription for your UTI management.

Neil