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Brand Name :
BRAND NAME IN US Dec-avelox, Moxeza, Vigamox. BRAND NAME IN CANADA, AG-Moxifloxacin, APO-Moxifloxacin, Auro-Moxifloxacin, Avelox [DSC], BIO-Moxifloxacin, JAMP-Moxifloxacin, M-Moxifloxacin, Mar-Moxifloxacin, Priva-Moxifloxacin [DSC], RIVA-Moxifloxacin [DSC], SANDOZ Moxifloxacin, TEVA-Moxifloxacin.
Synonyms :
Avelox , BAY 12-8039, BAY12-8039, Moxifloxacin HCl , Moxifloxacin hydrochloride, NSC 758875, UNII-C53598599T , Vigamox , Izilox, Moxifloxacin, Moxifloxacino , Moxeza
Class :
Fluoroquinolones; Bioterrorism; Leprosy (Hansen Disease); Tuberculosis (TB).
Brand Name :
BRAND NAME IN US Dec-avelox, Moxeza, Vigamox. BRAND NAME IN CANADA, AG-Moxifloxacin, APO-Moxifloxacin, Auro-Moxifloxacin, Avelox [DSC], BIO-Moxifloxacin, JAMP-Moxifloxacin, M-Moxifloxacin, Mar-Moxifloxacin, Priva-Moxifloxacin [DSC], RIVA-Moxifloxacin [DSC], SANDOZ Moxifloxacin, TEVA-Moxifloxacin.
Synonyms :
Avelox , BAY 12-8039, BAY12-8039, Moxifloxacin HCl , Moxifloxacin hydrochloride, NSC 758875, UNII-C53598599T , Vigamox , Izilox, Moxifloxacin, Moxifloxacino , Moxeza
Class :
Fluoroquinolones; Bioterrorism; Leprosy (Hansen Disease); Tuberculosis (TB).
ADULT DOSING
Injectable
400mg/250ml
Tablet
400 mg
Acute Exacerbation of Chronic Bronchitis
Dose : Oral/IV
400 mg orally or IV every day for 5-7 days
Note: This is reserved for patients such as after 65 years of age, FEV1 less than 50%, significant comorbidities, frequent exacerbations but having low risk of pseudomonas infection
Endophthalmitis, Acute, severe bacterial postcataract
Dose: Oral
400mg once daily for 5-7 days combination with appropriate intravitreal antibiotics.
Bite Wound infection, Prophylaxis of high-risk bite or treatment/alternative for patients cannot receive beta-lactams antibiotics)
Dose: Oral/IV
400mg once daily
Prophylaxis
3 to 5 days
Established Infection
5 to 14 days
Note: Varies based on clinical response patient-specific factors.
Diabetic Foot Infection/ alternative for patients cannot receive beta-lactams antibiotics
Dose: Oral/IV
Moderate/Severe: 400 mg once daily. ( Use as part of an appropriate combination regimen)
Patient with limited Skin/Soft tissue infection: 1-2 week
The infection required surgical debridement: 2 to 4 weeks without osteomyelitis.
Note: For the patient at low risk of Pseudomonas aeruginosa. Duration of treatment depends upon the patient outcome.
Intra-abdominal Infection, Mild to moderate/patient without risk factor for resistance or treatment failure( alternative agent)
Dose: Oral/IV
400mg once daily for 4-5 days
Uncomplicated Appendicitis
400mg once daily for 7 to 10 days
Note: Avoid moxifloxacin due to the high Bacteroides .spp resistance rate. Reserve this for patients intolerant to beta-lactams and metronidazole. For mild to moderate infection, oral forms of the drug are appropriate. The patient may switch from IV to Oral forms when the patient’s condition can tolerate oral diet and in condition to complete the course of antibiotics.
Bacterial Meningitis (Alternative agent) (Off label use)
Dose: IV
400mg once a daily for 7-12 days depending upon causative pathogens and clinical response
Note: Reserve for patients with severe allergy and impossible to use beta-lactams or carbapenem or resistant organisms. Appropriate.
Ureaplasma extragenital infections and Mycoplasma hominis
Dose: 400mg once daily
Note: For a patient with an impaired immune system. Some experts recommend doxycycline. Duration of therapy depends upon the severity of disease, Patient immune system, site of infection, and patient response toward therapy.
Plague treatment ( Yersinia pestis)
Dose: Oral/IV
400mg once daily for 7-14 days at least for 2 days after the patient shows the decreased temperature of the patient to normal.
Note: Reserve fluoroquinolones for a patient who cannot tolerate aminoglycoside or tetracyclines.
Community-Acquired Pneumonia
Dose: Oral /IV
400 mg Oral/ IV once every day for 5-10 days
Note: Reserve uses for an inpatient with severe pneumonia or risk factors for MRSA. Avoid use in patients with risk factors for P.aeruginosa. The patient should be clinically stable with a normal vital signs before treatment discontinue.
Rhinosinusitis-Acute bacterial
Dose: Oral/IV
400mg once daily for 5-7 days.
Note: Initial observation symptom management without antibiotic therapy is appropriate for inpatients with uncomplicated acute bacterial rhinosinusitis. Reserve use of an antibiotic if no follow-up or lack of improvement over the observation period and when no alternative medicine is available.
Sexually transmitted Infection ( Off Label)
Mycoplasma genitalism
Does Oral
400 mg once daily for 7-14 days.
Pelvic Inflammatory disease
Mild to moderate ( Out-Patient)
Dose: Oral
400 mg once daily for 14 days.
Note: Reserve for a patient who cants use first-line options and is at low risk for fluoroquinolones resistant Neisseria gonorrhoeae when prevalence is less than 5% at the site of infection.
Skin & soft tissue infection
Dose: Oral/I.V
400mg once daily.
Note: Reserve uses for polymicrobial like anaerobes organisms.
Surgical Prophylaxis ( off-label use)
Dose: IV
400mg within 120min before surgery with the appropriate antibiotic combination.
Note: Alternative for hysterectomy or pelvic reconstruction surgery inpatient intolerant for beta-lactams.
Tuberculosis (off label use)
Drug susceptible tuberculosis ( alternative agent)
Dose: Oral/IV
400 mg once daily
Tips: Use appropriate antituberculosis agents.
Drug-Resistant Tuberculosis
Dose: Oral/IV
400 mg once daily.
Tips: In elevated minimum inhibitory concentration or malabsorption dose range is 600mg or 800 mg once daily.
Duration: depend upon various factors like rapidity of culture conversion, patient-specific factors, the extent of disease, clinical response, and toxicity.
If missed dose, administer dose more than 8 hrs until next scheduled dose or wait for next dose.
Dosage adjustment requires concomitant therapy and consult a doctor to avoid drug-drug interaction.
Anthrax (off-label use)
Postexposure prophylaxis ( Inhalational) alternative agent.
Dose: Oral
400 mg once daily
Note: Duration depend upon anthrax vaccine status,series completion,age,immune status,pregnancy,breastfeeding status. The patient who had not previously received an anthrax vaccine duration 42 to 60 days.
Cutaneous treatment
Dose: Oral
400 mg once daily for 60 days ( Biological weapon-related event)
400mg once daily for 7-10 days naturally acquired infection.
Note: For systemic, treat patients with extensive edema or cutaneous lesions of the head or neck with a parenteral regimen recommended. Anthrax vaccine should be administered to exposed individuals.
Systemic treatment ( With or without meningitis, alternative agent)
Dose: IV
400 mg once daily for more than 2-3 weeks or clinically stable.
Note: In suspected systemic anthrax, antitoxin should be administered in patients. For systemic anthrax infection with meningitis, follow IV combination therapy exposed patient to aerosolized spore require oral monotherapy to complete 60 days.
Neutropenic Fever( In cancer patient with low risk, MASCC Score>21, patient do not take beta-lactam agent)
Dose: Oral
400mg once daily
Tips:
Note: Avoid in patients who receive fluoroquinolone prophylaxis.
DOSING IN HEPATIC IMPAIRMENT
No dose adjustment is required. Use caution—the risk of QT prolongation in the patient.
DOSING IN RENAL IMPAIRMENT
No dose adjustment is required in altered kidney function, Hemodialysis ( thrice-weekly), Peritoneal dialysis, CRRT, PIRRT.
PEDIATRIC DOSING
Anthrax systemic (meningitis)
Infant more than 3 months and children less than 2 years
IV route 6mg/kg/dose every 12 hrs
Maximum dose: 200 mg/dose
Children 2 to 5 years
IV route 5mg/kg/dose every 12 hrs
Maximum dose: 200 mg/dose
Children 6 to 11 years
IV route 4mg/kg/dose every 12 hrs
Maximum dose: 200 mg/dose
Children and adolescents 12 to 17 years
Body weight less than 45kg
IV route 4mg/kg/dose every 12 hrs
Maximum dose: 200 mg/dose
Bodyweight more than 45kg
IV route 400mg every 24 hrs
Note: Take triple therapy for 2 -3 weeks or longer until clinically stable; from the onset of illness, require prophylaxis to complete an antimicrobial course up to 60 days.
Tuberculosis; multidrug resistant:
Infant,children, adolescent less than 15 years
Oral/IV : 10mg/kg/dose every 24hr
Maximum Dose: 400mg/dose
Infant, children, adolescents more than 15 years
Oral/IV: 400 mg every 24 hours.
Note: Use in combination with 2-3 additional anti-TB agents. Dose and duration depend upon susceptibility profile or patterns; if any query regarding dose, refer to WHO, current TB guideline. According to the study, higher doses in infants and children must meet pharmacokinetic levels, similar to that of adult dosing. Consult your physician to avoid drug-drug interaction or modify therapy by reducing dose or frequency.
Pneumonia, Community-acquired (M.pneumoniae, C.pneumoniae, C.trachomatis)
Mild infection/step down therapy
Oral:400mg once daily
Tips: Adolescents with skeletal maturity, the limited information available.
Surgical prophylaxis ( Perioperative)
Adolescents with skeletal maturity
IV:10mg/kg within 120 min prior to surgery.
Maximum dose :400mh/dose
Note: Not preferred in pediatric patients because fluoroquinolones have the risk of tendon rupture with single-dose prophylaxis.
DOSING IN RENAL IMPAIRMENT
No dosage adjustment is required.
DOSING IN HEPATIC IMPAIRMENT
No dosage adjustment is required. Hepatic insufficiency because of metabolic disturbance leads to QT interval prolongation.
moxifloxacin is from Fluoroquinolone/Quinolone antimicrobial Category. moxifloxacin is used to treat infections caused by the following bacteria.
Aerobic, Gram-positive microorganisms: Corynebacterium species, Micrococcus luteus, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus warneri, Streptococcus pneumoniae, and Streptococcus viridans group.
Aerobic, Gram-negative microorganisms: Acinetobacterlwoffii, Haemophilus influenzae, and Haemophilus parainfluenzae. Other microorganisms: Chlamydia trachomatis.
Aeromonas hydrophila, Bacillus anthracis, Bacteroides fragilis, Bacteroides the taiotaomicron, Campylobacter jejuni, Citrobacter, diversus, Citrobacter freundii, Clostridium perfringens, Escherichia coli, Enterobacter spp, Haemophilus influenzae, Hafnia alvei, Klebsiella pneumoniae, Legionella pneumophila, Morganella morganii, Moraxella catarrhalis, Mycobacterium pneumoniae, Mycobacterium tuberculosis, Neisseria gonorrhoeae, Peptostreptococcus spp, Proteus mirabilis, Proteus Vulgaris, Providencia spp, Pseudomonas aeruginosa, Salmonella typhi, Shigella spp, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus anginosus, Streptococcus constellatus, Streptococcus pneumoniae, Vibrio cholerae, Yersinia pestis
First-line therapy: C jejuni; no unanimity on others (e.g., L pneumophila, M morganii)
BRAND DISCONTINUED IN U.S
CNS
Headache(4%),dizziness (3%),insomnia(2%)
Endocrine & Metabolic:
Decrease serum glucose(>2%),hyperchloremia(>2%),increase serum albumin(>2%),hypokalemia(1%)
GIT
Nausea(7%),diarrhea(6%),decreased amylase(>2%),constipation(2%),vomiting(2%),abdominal pain(1-2%),dyspepsia(1%).
Hematologic and oncologic
Decreased basophils(>2%),Decreased RBC (>2%),eosinopenia(>2%),increase MCH(>2%),increase
neutrophils(>2%),leukocytosis(>2%),prolonged prothrombin time (>2%),anemia(1%)
Hepatic
decrease serum bilirubin(>2%),increase serum bilirubin (>2%),increase alanine aminotransferase(1%).
Immunologic
Increased serum globulins(>2%)
Renal
Increase serum calcium(>2%)
Respiratory
Hypoxia(>2%)
Miscellaneous
Fever
Less than 1% postmarketing or case reports related with following adverse effect
BRAND DISCONTINUED IN U.S
CNS
Headache(4%),dizziness (3%),insomnia(2%)
Endocrine & Metabolic:Decrease serum glucose(>2%),hyperchloremia(>2%),increase serum albumin(>2%),hypokalemia(1%)
GIT
Nausea(7%),diarrhea(6%),decreased amylase(>2%),constipation(2%),vomiting(2%),abdominal pain(1-2%),dyspepsia(1%).
Hematologic and oncologic
Decreased basophils(>2%),Decreased RBC (>2%),eosinopenia(>2%),increase MCH(>2%),increase neutrophils(>2%),leukocytosis(>2%),prolonged prothrombin time (>2%),anemia(1%)
Hepatic
decrease serum bilirubin(>2%),increase serum bilirubin (>2%),increase alanine aminotransferase(1%).
Immunologic
Increased serum globulins(>2%)
Renal
Increase serum calcium(>2%)
Respiratory
Hypoxia(>2%)
Miscellaneous
Fever
Less than 1% postmarketing or case reports related with following adverse effect
Agitation,abdominal distention,abdominal distress,abnormal gait,abnormal liver function test,agranulocytosis,allergic dermatitis,anaphylaxis,anaphylactic shock,
angina pectoris,angioedema,anorexiaaplastic,anemia,anxiety,asthma,ataxiaatrial fibrillation,auditory impairment,back pain,blurred vision,bronchospasm,candidiasis,cardiac puncture ,chest pain,chills,cholestatic hepatitis,CDAD,confusion,deafness,decrease appetite,dehydration,delirium,depression,disorientation,disturbance in attention,drowsiness,dysesthesia,dysgeusia,dyspnea,dysuria,edema,facial pain,fatigue,flatulence,fungal infection,gastritis,gastroenteritis , hallucination,GIT reflux disease ,hemolytic anemia,hepatic failure,hepatic necrosis,hepatitis,hepatotoxicity (idiosyncratic),hyperglycemia,hyperhidrosis,hyperlipidemia,hypersensitivity pneumonitis,hypersensitivity reaction,hypertension,hypoesthesia,intracranial hypertension,increase amylase,increase blood urea nitrogen,increased gamma glutamyl transferase,, increase intracranial pressure,increase lactate dehydrogenase,increase serum creatinine,increased alkaline phosphatase,serum aspartate aminotransferase, increased serum lipase,increased serum triglycerides,increased in uric acid,interstitial nephritis, jaundice,laryngeal edema,ethargy,leukopenia,limb pain,loss of consciousness,malaise,memory impairment,muscle spasm,musculoskeletal pain,myalgia,myasthenia,nervousness,neutropenia,nightmares,night sweats,pain,palpitations,pancytopenia,paranoid ideation,paresthesia,peripheral neuropathy,pharyngeal edema,phlebitis,phototoxicity, polyneuropathy,prolonged partial thromboplastine timeprolonged QT interval,renal failure syndrome, renal insufficiency,restlessness,rupture of tendon,seizure,serum sickness,skin photosensitivity,skin rash,Stevens johnson syndrome,suicidal thoughts,suicidal tendencies,syncope,tachycardia,tendinopathy,thrombocythemia,thrombocytopenia,
thrombotic thrombocytopenic purpura,tingling sensation,tinnitus,torsades de pointes,toxic epidermal necrolysis,toxic psychosis,tremor ,urticaria,vaginal infection,vasculitis,ventricular tachyarrhythmia,vertigo,vision loss,vulvovaginal pruritus,wheezing,xerostomia.
BRAND DISCONTINUED IN U.S
IRREVERSIBLE ADVERSE EFFECTS:
Fluoroquinolones have been associated with disabling and potentially irreversible severe adverse reactions that have occurred together with tendinitis and tendon rupture, peripheral neuropathy, and CNS effects.
Tendinitis/tendon rupture may occur during treatment or months after discontinued treatment and risk all ages.
Risk increased in older patients aged more than 60 years.
Strictly Avoided inpatient on Corticosteroids and Kidney/Heart/Lung transplant patients.
Avoid in Myasthenia Gravis patients leads to exacerbating muscle weakness.
RESERVE USE FOR PATIENTS WITH NO ALTERNATIVE OPTIONS
ACUTE BACTERIAL SINUSITIS
ACUTE BACTERIAL EXACERBATION OF CHRONIC BRONCHITIS
UNCOMPLICATED UTI
Hypersensitivity to moxifloxacin or other members of the quinolones of antibiotic class. Fluoroquinolones show a permanent adverse severe reaction from different body systems in the patient. Discontinue the treatment immediately at the first sign or symptoms of following such as tendinitis, tendon rupture, arthralgia, myalgia, peripheral neuropathy, hallucination, anxiety, depression, insomnia, severe headache confusion.
Fluoroquinolones associated with an increase in the risk of tendinitis and tendon rupture in all ages include Achilles tendon, rotator cuff the shoulder, the hand, biceps, thumb.
Prolonged or repeated use of antibiotics leads to periodic evaluation of renal, hepatic, hematopoietic system function.
Avoid excessive sunlight, which leads to a phototoxicity reaction.
Peripheral neuropathy resulting in hypothesis, dysesthesias paresthesias, weakness reported with initial drug and potentially permanent.
Hypoglycemia reported in patients without any clinical survey (Shows with gatifloxacin)Monitor glucose levels in patients with diabetes; discontinue therapy and use an alternative treatment.
One of the side effects is QT interval prolongation which increases the risk of ventricular arrhythmias, torsade the pointes, acute myocardial ischemia, patients with hypomagnesemia or hypokalemia.
Without infection of organism suspected; avoid using any antibiotic that produces resistance in the patients.
IF clostridium difficile associated diarrhea is reported, an ongoing antibiotic, which is not directed for CDAD, stop the treatment. This condition requires the correct antibiotic treatment, fluid & electrolyte management, protein supplement, and surgical evaluation.
Discontinue the treatment with the first sign of skin rash, hypersensitivity, and jaundice.
EFFECT ON CNS
FQ shows an increased risk of CNS effects like intracranial pressure increase, convulsion, toxic. Psychosis, nervousness, insomnia, agitation, dizziness, confusion, tremors, hallucination, depression, suicidal ideation/thoughts, and self-injurious behavior such as attempted or completed suicide. If any of these reactions occur, discontinue treatment and consult your physician. FQ increase seizure or lower the seizure threshold.
According to FDA safety alert issued in 12.20.2018
After two months of use of fluoroquinolones in elderly patients with fluoroquinolones for systemic use IV OR oral, increase the rate of aortic aneurysm include peripheral atherosclerotic vascular disease, hypertension, some genetic disorder Marfan syndrome, Ehlers-Danlos. The patient immediately seeks medical help if any symptoms occur. Discontinue the treatment immediately .reserve the use of fluoroquinolones when no alternative drug is available.
According to FDA safety alert issued in 07.10.2018
BRAND DISCONTINUED IN U.S
IRREVERSIBLE ADVERSE EFFECTS
Fluoroquinolones have been associated with disabling and potentially irreversible severe adverse reactions that have occurred together with tendinitis and tendon rupture, peripheral neuropathy, and CNS effects.
Tendinitis/tendon rupture may occur during treatment or months after discontinued treatment and risk all ages.
Risk increased in older patients aged more than 60 years.
Strictly Avoided inpatient on Corticosteroids and Kidney/Heart/Lung transplant patients.
Avoid in Myasthenia Gravis patients leads to exacerbating muscle weakness.
RESERVE USE FOR PATIENTS WITH NO ALTERNATIVE OPTIONS
ACUTE BACTERIAL SINUSITIS
ACUTE BACTERIAL EXACERBATION OF CHRONIC BRONCHITIS
UNCOMPLICATED UTI
The FDA warns prescribing FQ to the clinician, decreasing blood glucose and particularly adverse mental health. In elderly patients, hypoglycemia results in oral antidiabetic drugs or insulin coma. Instruct the elderly patients if symptoms of hypoglycemia occur. Safety alert affects systemic formulations like early signs, confusion, dizziness, unusual hunger, headache, irritability, pale skin, pounding heart or high-speed pulse, sweating, trembling, weakness or unusual anxiety, feeling shaky. This also included mental health issues like disturbances in attention, disorientation, agitation, nervousness, memory impairment, delirium. Immediately discontinue the treatment if any CNS-related adverse effects increase blood glucose level or potential risk of adverse psychiatric reactions after the initial dose. Consult your doctor for other antibiotic therapy.
Pregnancy Warning:
Moxifloxacin crosses the placenta. During pregnancy, physiologic changes occur, which alter the ADME of moxifloxacin in pregnant women. Moxifloxacin with multidrug-resistant tuberculosis does not require dose adjustment(off-label use) shoes adverse fetal outcome, intrauterine growth restriction, low birth weight, preterm birth, perinatal death, and mother also shows adverse effects like anemia and cesarean delivery. Based on susceptibility testing, moxifloxacin is used to treat multidrug-resistant tuberculosis during pregnancy when needed.
Moxifloxacin is used off-label to reduce the incidence of disease progression of inhalational anthrax. Untreated anthrax infection during pregnancy shows preterm labor, fetal distress, fetal loss. Anthrax treatment is not recommended in pregnant patients as well as in postpartum patients.
Breastfeeding Warnings:
Data is not available until now for the use of moxifloxacin on breastfeeding mothers. Use alternative drugs to avoid side effects on infants.
Mechanism Of Action.
Fluoroquinolones inhibit the enzyme bacterial DNA gyrase ( Primarily active in gram-negative bacteria), which nicks double-stranded DNA, introduces negative supercoils, and then reseals the neaked ends, needed to prevent supercoiling of strands. At the same time, they separate to permit replication or transcription. The DNA gyrase consists of Two A and Two B subunits: The A subunits carry nicking DNA, the B subunit introduces negative supercoils & then the A subunit reseals the strands. Fluoroquinolones bind to A subunits with high affinity and interfere with its strand cutting and resealing function.
In gram-positive bacteria, the primary target of Fluoroquinolones action is a similar enzyme topoisomerase IV which nicks and DNA replicates & separates daughter DNA strands from it. Higher the topoisomerase IV affinity confer higher potency against gram-positive bacteria. The bactericidal action probably results from the digestion of DNA by exonucleases whose production is signaled by the damaged DNA.
Absorption
Well absorbed; absorption is not affected by high-fat meal or yogurt
Bioavailability: 90%
Distribution
Protein bound:30% to 50%
Adult
Vd: 1.7-2.7 L/kg; tissue concentrations often exceed plasma concentrations in respiratory tissues, alveolar macrophages, and sinus tissues
Pediatric
Infant more than 3 months of age and adolescents less than 13 years of age Vd:1.5 to 2.3L /kg
Metabolism
Metabolized in the liver via glucuronide (14%) and sulfate (38%) conjugation
Elimination
Adult
Half-life: PO, 12 hr; IV:8.2 to 15.4 hr
Excretion: Feces (25%), urine (20% as unchanged drug)
Sulfate conjugate metabolites are excreted in feces, glucuronide conjugate metabolites in urine
Pediatric patients Single dose IV
Infant more than 3 months of age and children less than 2 years of age:5.9 to 6.8 hrs.
Children more than 2 and less than 6 years of age:5.7 to 6 hrs
Children more than 6 years and adolescents less than 13 years of age:6.2 to 7.9 hrs.
IV Preparation
Dilution is not required for IV infusion.
IV Administration
Avoid infusion of two drug in same tubing simultaneously infuse over 1 hr.
Generic Name: Moxifloxacin( Oral)
Pronounced: mox- is- flox’ a sin
Why do we use Moxifloxacin?
Moxifloxacin is used in bacterial infections, pneumonia, skin infection, and abdominal infections. Moxifloxacin treats and prevents plague, bronchitis, or sinus infection.
WARNING
Moxifloxacin may cause a severe permanent effect on tendon-like tendon rupture, tendonitis, nerve problem in the leg & arm ( peripheral neuropathy), and nervous system problem like depression seizures. Contact your physician if you are on Ciprofloxacin and observe the following symptoms: Pain/numbness/burning/tingling/weakness in arms/hands/legs/feet, changes in senses touch, pain, temperature, vibration, body position, severe or lasting headache, vision changes, shaking ( tremors), mental/mood changes like agitation, anxiety, confusion, hallucination, depression, rare thoughts of suicide. If you observe any sign like pain or swelling in joints/muscles, stop exercising, take a rest and seek medical help. Avoid patients with age more than 60yr and patients taking prednisolone ( Corticosteroids), patients with transplant (kidney, heart, lung), which leads to increased tendon problems. Ciprofloxacin worsens Myasthenia gravis condition. Consult your doctor if you have new or worsening muscle weakness such as drooping eyelids, unsteady walk, or trouble breathing. Talk to the doctor before using this medicine.
HOW TO USE
Moxifloxacin took with or without food once a day for 5 to 21 days. Duration of treatment depends upon the type and severity of infection decided by the physician/Doctor. Take medicine at the same time. If you don’t understand any part of moxifloxacin use, please consult a doctor/Pharmacist. Follow doctor instructions taking medication. Call your doctor if you should begin to feel better during the first few days of treatment with Moxifloxacin or symptoms do not improve. Do not stop medication even you feel better. It’s always better to complete a course of antibiotics to avoid resistance to antibiotics.
OTHER USES FOR THIS MEDICINE
Moxifloxacin is used to treat T.B., sexually transmitted diseases, endocarditis, anthrax when no alternative medicine is available. This drug is also used for salmonella infection, which causes diarrhea, shigella infection, which causes severe diarrhea in HIV patients. Tell your doctor about risk conditions for using this medicine. If you need information about the drug, ask your doctor/Pharmacist.
SIDE EFFECT
Avoid Moxifloxacin in children younger than 18 years old, which leads to problems in bones, joints, and tissues around joints in children. If you find other side effects that are not mentioned, contact your doctor/pharmacist or directly report the side effects to the manufacturing company or FDA official website.
Severe diarrhea watery or blood in stools occur with or without fever and stomach cramps occur up to 2 months or more after treatment, rash, itching, peeling or blistering of the skin, fever, hives, swelling of the eyes, face, mouth, lips, tongue, throat, hands, feet ankles, hoarseness or sore throat, difficulty breathing or swallowing, yellow skin or eyes, pale skin, dark urine or light color stool, powerful thrust or hunger, fast or fluttering heartbeat, frequent urination, trembling, blurred vision, loss of consciousness unusual anxiety, fainting, decreased urination, unusual bruising or bleeding, sudden pain in the chest, stomach or back, nausea, vomiting, stomach pain, diarrhea. If you observe this symptom, immediately stop the drug and call your doctor.
PRECAUTIONS
Tell your doctor/Pharmacist to show allergic reaction to moxifloxacin or other quinolones other fluoroquinolones like Cipro, delafloxacin, Gemifloxacin, levofloxacin, ofloxacin, nutritional, vitamins, other supplements, the herbal product you are taking or plan to take. Glipizide, glyburide, tolazamide, and tolbutamide, for irregular heartbeat including amiodarone such as Nexterone, Pacerone disopyramide like Norpace, procainamide, quinidine, and sotalol such as Betapace, Betapace AF, Sorine, Sotylize in this condition your doctor need to change doses of medication, monitor, carefully. If you’re taking an antacid like aluminum or magnesium or didanosine, sucralfate, administer Moxifloxacin at least 4 hrs before or 8hrs after this medication.
IMPORTANT WARNING
Anticoagulants such as warfarin, Coumadin, Jantoven, Antidepressants, antipsychotics, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen as Advil, Motrin, others and naproxen as Aleve, Naprosyn, others; cisapride as Propulsid, diuretics, erythromycin, insulin or other medicine to treat diabetes such as chlorpropamide, glimepiride glipizide, glyburide, tolazamide, and tolbutamide; certain medications for irregular heartbeat including amiodarone Nexterone, Pacerone, disopyramide, procainamide, quinidine, and sotalol. Consult your doctor immediately for changing doses of your medicine and monitor to prevent side effects.
Tell your doctor if you or your family history of prolonged QTc interval means any heart-related diseases or rare heart problem or sudden death, irregular heartbeat, aortic aneurysm, B.P., peripheral vascular disease, Marfan syndrome, Ehlers-Danlos syndrome, low potassium or magnesium level, diabetes or low sugar level, liver condition.
Before administering Moxifloxacin, tell your doctor if you are pregnant or nursing an infant or toddler to avoid risk in infants or infants.
Avoid driving, machine operator, or any other activity that needs alertness or coordination until you know how Moxifloxacin affects you. Also, unnecessary exposure to sunlight or U.V. light, wear protective clothes, sunglasses, sunscreen because Moxifloxacin shows phototoxicity as a side effect.
DRUG-DRUG INTERACTION
Drug-drug interaction may change how your medications work, increase your risk for a severe side effect, or require patient monitoring. This document does not claim all possible drug-drug interactions. Before visiting the doctor, keep a list of all products you use, including prescribed drugs, OTC, and herbal products; share this with your doctor or Pharmacist. Without your doctor’s approval, don’t stop, change, or start the medicine. Some products like acenocoumarol, warfarin, strontium may interact with Ciprofloxacin.Many drugs like amiodarone,dofetilide,quinidine,procainamidesotalol prolonged QTc interval besides ciprofloxacin . Drugs like duloxetine, flibanserin, lomitapide, pirfenidone, tasimelteon, tizanidine removal of this drug slow down by Ciprofloxacin. Avoid caffeine intake, OTC product that contains caffeine; this medicine increases the effect of caffeine.
OVERDOSE
The patient overdosed and has severe symptoms of passing out or breathing; in the U.S., call 911 and call a poison control center immediately. Other countries call an ambulance and are admitted to the hospital.
NOTES
Do not share your medicine with others. Medicine selection depends upon types of microorganism, site of infection, the severity of infection decision, lab test, CBC, cultures, kidney function taken by doctors only. This medicine is prescribed only for the present condition, so do not administer it for future use, producing resistance against microorganisms. This should be monitored closely for progress or to check the side effects. Consult your doctor for more details about the medication. Don’t change the brand of medicine without consulting the doctor; not all brands have the same effects.
OTHER INFORMATION
Visit a doctor and the laboratory regularly. Sometimes the doctor may order another test to see how your body reacts to Moxifloxacin. If you have diabetes and taking the antidiabetic drug or insulin, talk to your doctor about that and constantly monitor sugar levels in the body when on Moxifloxacin.
Do not share your medicine with others. Your dose is not refillable. If there is no improvement in the symptoms, immediately talk to your doctor.
Always keep a list of prescribed, nonprescribed OTC drugs supplement or plan to be on treatment when you visit a clinic or at the time of hospital admission. This will be helpful for a doctor in an emergency condition.
MISSED DOSE
If you miss a dose, If it’s less than 6 hours before the next dose, skip the missed dose. Do not double the dose to level up the missed dose. Take the following amount at the regular time.
STORAGE
Keep the medicine in an air-tight container at room temperature and out of reach of children and pets. Avoid storing at the place of excess heat or moisture. Before discarding, consult the doctor/physician if you have any doubts or queries.
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