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Topical fusidic acid stewardship — GPhC CRA MCQ

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HardInfectionsTopical fusidic acid stewardshipGPhC CRA

A patient taking tizanidine 4 mg three times daily presents a new prescription for ciprofloxacin. Blood pressure is 108/66 mmHg and they drive for work. Which interaction-management recommendation is correct?

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Correct answer: A — Ciprofloxacin–tizanidine co-administration is contraindicated; arrange an alternative antibiotic

Ciprofloxacin inhibits CYP1A2 and substantially increases tizanidine exposure, potentiating hypotension and sedation. The combination is contraindicated, so the prescription should be queried before supply and an alternative antimicrobial considered. Separating administration cannot prevent metabolic inhibition. Waiting for syncope is unsafe, and empirical dose reduction does not remove the labelled contraindication. A blood-pressure check after treatment is too late and does not address impaired driving or acute central nervous system effects.

Reference: Ciprofloxacin 250 mg tablets SmPC. https://www.medicines.org.uk/emc/product/4341/smpc