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Zanaflex and Cipro FDA Dangerous Interaction Warning

TessGTTessG Posts: 23
edited 06/11/2012 - 8:21 AM in Back Surgery and Neck Surgery
I know a lot of folks here use Zanaflex, and I've heard wonderful things about it, so I wasn't too concerned when the surgeon gave my mom a script yesterday to replace the Flexeril, which wasn't touching her muscle spasms. This was her 6 wk checkup after fusion of L5-S1.

Got mom home, gave her a 4mg Zanaflex and about 20 minutes later she was deeply lethargic and slurrying her words. She said she felt like she was going to pass out. Later, she would tell me she felt like she was dying.

I got on the Internet and lo and behold, I find out the FDA issued a warning about the concomitant use of Zanaflex and Cipro. Mom's been on Cipro for several weeks to treat a UTI. I had given her the Cipro about 2 hours before the Zanaflex.

Cipro can potentiate the effects of Zanaflex "10 to 24 times", according to one article I found. By the time I got off the Internet to go back and tell mom what I'd found, she was for all intents and purposes, unconscious. I was a paramedic for 13 years, so, I took her blood pressure and it was nonexistent; took it 3 times. She had no radial pulse (at the wrist) and her respirations were very shallow.

I propped her feet up and about 5 minutes later had gotten her B/P up to 80/50 and she was more alert, but her speech was very, very slurred and she was deeply lethargic. She was in a deep sleep for the remainder of the night, as I monitored her vital signs.

You can Google "Zanaflex and Cipro" to find several references to the FDA warning. Here's a few:





Needless to say, I'm pretty irate that mom's surgeon didn't know about the FDA warning and mom's pharmacy didn't catch it either. I told the doctor's nurse yesterday, first thing, that she was on a new med, Cipro, since the last checkup; I again confirmed for the doctor that she was still being treated for the UTI, so he knew she was on it.

Moral of the story: Never take a new medication without doing your research first! No one else is looking out for your best interest. Be your own advocate.


  • That must have been very scary Tess. I am really surprised the pharmacy did not warn her about any potential interactions. My new prescriptions always include such info. Good thing that you were on the top of things and figured out in time what is wrong.

    Thank you for posting this experience together with the web references. These are most helpful.

    Wishing you both the best,

  • Tess,

    Thanks for the information. I take Zanaflex and it is a very strong drug just by itself. It has dropped my BP and PR dramatically. The information I was given with it from the pharmacy warned of that. I don't know if this will eventually stabilize since I am still on a build up to the daily dosage my doc wants. We are on a 9 week build up to 6-8 mg QID as the Baclofen is removed.

    The Zanaflex does do so much more for me than any other anti-spasmotic. You are right though, it is not a drug to be taken lightly. It needs to be respected!

    I'm glad that you were there for your mom! She's a lucky woman.

  • I am not familiar with Zanaflex dosing, but remember elderly people often need much smaller doses of drugs due to their decreased excretion/slower metabolism. Good-luck
  • Thanks, all. I have taken mom off the Cipro and we're getting a urinalysis today to make sure the infection's gone; otherwise, I guess we'll have to find another antibiotic while she's taking Zanaflex - or, maybe a new muscle relaxer! Sheesh! I've started giving her a 1/2 Zanaflex. It makes her sleep good and takes the edge off the muscle spasms without almost killing her in the process.

    If I can get her there, she has her first PT session today... I hope they can help her.
  • Thanks for the info Tess! I know A LOT of us take Zanaflex.
    I am glad your Mom is OK - thanks to YOU!
  • Lucky she has you there!

    Thanks so much for the warning.
  • I know a significant number of surgery patients come away with or develop urinary tract infections (presumably from the urinary catheters), and Cipro being one of the most popular antibiotics for treating those, I just wanted everyone here to be aware if you're ever prescribed Cipro while taking Zanaflex, beware.
  • I was very thankful for this old post last night. I also have a UTI (pre-op labs), and am having another ACDF on Wednesday. My doctor put me on Cipro. The pharmacist did not say a word to me about interactions. There is a sticker on the Cipro bottle warning the drug can cause dizziness. HA - what an understatement.

    Within about 20 mins of taking my Zanaflex (about an hour after taking Cipro) I could barely walk and talk. I could not understand what was going on and didn't know what to do! I was sure I had taken the wrong dose of something and had OD'd. Thank goodness my adult son was home. The first thing he asked me was 'what did you take?' and he promptly Googled :) Smart guy. He found this post, then he found the WebMD warning.

    We called the Kaiser Pharmacist and he confidently informed us that there are NO KNOWN INTERACTION ISSUES WITH CIPRO AND ZANAFLEX. Yep, that is what he really said to us. So, we called a 24 hr CVS and got the same answer. At the time I was afraid if I passed out I would never wake up!

    My son eventually found a few articles stating the effects would wear off after about three hours. At 2 hours I was starting to feel better. I did sleep like a log last night :)

    Thank goodness I am in relatively good health. If I had heart or other health issues my guess is this could have been very dangerous!!! I'm definitely going to have a word with my surgeon.

  • That happened to me tonight around six pm. I went to the pharmacy and picked up my Meds. I took then and the next thing I knew was I was slurring a few minutes later I was out. My little girl woke me at 11pm and I realized I was Very nauseous. That what made me look on the internet. Probably what happened in my case is my dr. wasnt on call and the one that was didn't know I was on zanaflex. But i'm surprised the pharmacy didn't catch it.
  • It's scary that the pharmacies aren't catching this, I typically trust my pharmacy to watch out for me when it comes to my medications. :(
    Microlaminectomy and discectomy at C7-T1 on April 26th.
  • Shannon3188SShannon3188 Posts: 1
    edited 06/29/2014 - 6:36 AM
    Well I found this way to late because I took my cipro for UTI and Zanaflex for Fibromyalgia along with a couple more of my meds. I am def not feeling well. Everytime I stand up I get so dizzy I cant see. I feel as though I am breathing a bit heavier but I do that anyway. I am 5'2 124 lbs. I am not sure about the other meds I mixed in that bunch is going to make this worse but I have taken all the other ones together every night to be exact. My ears have became clogged up and all I hear is a ringing sound. I feel unstable. I am sitting in my chair now not moving. If anyone could tell me just how bad this is going to get and should I go to hospital or try to ride it out and can anyone tell me whether my other meds is going to effect me. Those meds is lyrica and Elavil. Thank yall so much and pray. * EDITED who only said it would just make me sleepy more and certainly no thank to dr who put me on it and knows my current meds. Thanks for your help

    Post edited by Sandi- Please see the forum rules at the link below for more information.
    You agree not to post specific physician names health care facilities , companies, devices or product names on Spine-Health.com.


  • sandisandi Posts: 6,343
    edited 06/29/2014 - 6:34 AM
    If you feel unsteady and not able to breathe well, you should not be asking for medical advice on the forums, you should be on the way to be seen.
    Hopefully, you are feeling better. Pharmacies give out information with each prescription being filled that warns of interactions and side effects with certain medications. Patients should always review those information sheets every time they fill a new prescription to check for interactions and combined side effects.
  • I saw this post and Sandi's comments on read what the pharmacist includes, I had a reaction from going off gabapentin to topamax and had a 3 day reaction,called Dr called pharmacy and had my reactions charted as allergic to sulfa drug. After I was feeling better I did my own research and found out that there is a form of a sulfa drug in topamax. So long story short the pharmacist do not always catch drug interactions. I called them 3 times and once I did my own research I called them back and told them. Same thing happened when I switched from using a 15ng of Butrans to 20 and I had nightmares and insomnia and I called manufacturer and read the whole sheet included with the patch, manufacturer sent me to the pharmacist desk and out of 5000 people trials less the 1 percent had similar reactions but was not included in packet. My pharmacist was not aware of.
  • I had surgery yesterday and went to pick up my meds and cipro was my antibiotic and my insurance company wouldn't even fill it because of the reaction!! So happy they cought it because I take a lot of zanaflex...no doubt I'd probably have been really bad off or worse!!
  • Thank you so very much for your sharing and caring heart! I too had many complications with my B/P (blood pressure) dropping to the level of that of a severe trauma victim, and all of this was whilst I was in the hospital post-op back surgery #3, XLIF/PLIF with hardware insertion and removal (from a lower level and previous surgeries #1 and 2). Unshockingly enough, the exact same thing happened to me during EVERY other post-op back fusion that I had had, and I too had been treated for UTI prior to the surgeries (1 and 3). I was also administered prophylactic ABTs as most if not all surgical patients are, as a means of preventing and/or significantly decreasing the risk of post-op infection. I am concerned that it may not be just Ciprofloxacin that creates such reactions as what both your mother and myself experienced, but that there may be certain classes of antibiotics that contribute to the deft increase in the side effects of Tizanidine (Zanaflex).

    In reference to the doc that provided medical care and prescribed the Zanaflex, despite the FDA warning, I feel that as a health care professional myself, that it is truly within the ethical and legal responsibility and duty of all health care professionals to stay abreast of any relevant scientific, medical, and related technological changes that are constantly occurring. However, many docs are so busy and sadly forgetful of their ethical duty and responsibility to stay informed (such as through continuing education or something as simple as reading letters that reach their office from the FDA, CDC, etc. that are notifications of newly noted changes and data), that they place both themselves (license and liability) and especially their patients in harms way. I pray that your mother is now well, and that all complications were only temporary.
    -Many blessings to you and yours
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