i FLOKS a
Treatment of mild to moderate community-acquired pneumonia, acute bacterial
exacerbation of chronic bronchitis, and acute bacterial
No adequate or well-controlled studies in pregnant women. Should be used
during pregnancy only when the potential benefit justifies the potential risk to
the fetus. Moxifloxacin may be excreted in human breast milk. Breast-feeding is
Hypersensitivity to moxifloxacin, other quinolone antibiotics, or any
Use with caution in patients with significant bradycardia or acute myocardial
ischemia. Moxifloxacin causes a dose-dependent Q-T prolongation.
Coadministration of moxifloxacin with other drugs that also prolong the Q-T
interval or induce bradycardia (eg, beta-blockers, amiodarone) should be
avoided. Careful consideration should be given in the use of moxifloxacin in
patients with cardiovascular disease, particularly in those with conduction
abnormalities. Safety and effectiveness in pediatric patients (<18 years of
age) have not been established. Experience in immature animals has resulted in
permanent arthropathy. Use with caution in individuals at risk of seizures (CNS
disorders or concurrent therapy with medications which may lower seizure
threshold). Discontinue in patients who experience significant CNS adverse
effects (dizziness, hallucinations, suicidal ideation or actions). Not
recommended in patients with moderate to severe hepatic insufficiency. Use with
caution in diabetes; glucose regulation may be altered.
1% to 10%:
Central nervous system: Dizziness (3%), headache (2%)
Gastrointestinal: Nausea (8%), diarrhea (6%), abdominal pain (2%), vomiting
(2%), dyspepsia (1%), taste perversion (1%)
Hepatic: Abnormal liver function test (1%)
<1% (Limited to important or life-threatening symptoms): Asthenia,
moniliasis, pain, malaise, allergic reaction, leg pain, back pain, fever,
chills, chest pain, palpitation, vasodilation, tachycardia, hypertension,
peripheral edema, hypotension, insomnia, nervousness, anxiety, confusion,
hallucinations, depersonalization, hypertonia, incoordination, somnolence,
tremor, vertigo, paresthesia, dry mouth, constipation, anorexia, stomatitis,
gastritis, glossitis, cholestatic jaundice, GGTP increased, decreased
prothrombin time, increased prothrombin time, thrombocytopenia, eosinophilia,
leukopenia, increased amylase, hyperglycemia, hyperlipidemia, increased LDH,
arthralgia, myalgia, asthma, dyspnea, increased cough, pneumonia, pharyngitis,
rhinitis, sinusitis, rash, pruritus, sweating, urticaria, dry skin, tinnitus,
amblyopia, vaginitis, cystitis, abnormal renal function, Q-T prolongation (see
Potential symptoms of overdose may include CNS excitation, seizures, QT
prolongation, and arrhythmias (including torsade de pointes). Patients should be
monitored by continuous EKG in the event of an overdose. Management is
supportive and symptomatic. Not removed by dialysis.
Drugs which prolong QT interval (including Class Ia and Class III
antiarrhythmics, erythromycin, cisapride, antipsychotics, and cyclic
antidepressants) are contraindicated with moxifloxacin.
Metal cations (magnesium, aluminum, iron, and zinc) bind quinolones in the
gastrointestinal tract and inhibit absorption (by up to 98%). Antacids,
electrolyte supplements, sucralfate, quinapril, and some didanosine formulations
should be avoided. Moxifloxacin should be administered 4 hours before or 8 hours
after these agents.
Antineoplastic agents may decrease the absorption of quinolones.
Cimetidine, and other H2 antagonists may inhibit renal elimination
Digoxin levels may be increased in some patients by quinolones; monitor for
Foscarnet has been associated with an increased risk of seizures with some
Loop diuretics: Serum levels of some quinolones are increased by loop
diuretic administration. May diminish renal excretion.
NSAIDs: The CNS stimulating effect of some quinolones may be enhanced,
resulting in neuroexcitation and/or seizures. This effect has not been observed
Probenecid: Blocks renal secretion of quinolones, increasing concentrations.
Warfarin: The hypoprothrombinemic effect of warfarin is enhanced by some
quinolone antibiotics. No significant effect has been demonstrated for
moxifloxacin, however, monitoring of the INR during concurrent therapy is
recommended by the manufacturer.
Store at 25°C
Moxifloxacin is a DNA gyrase inhibitor, and also inhibits topoisomerase IV.
DNA gyrase (topoisomerase II) is an essential bacterial enzyme that maintains
the superhelical structure of DNA. DNA gyrase is required for DNA replication
and transcription, DNA repair, recombination, and transposition; inhibition is
Absorption: Well absorbed; not affected by administration with a high fat
meal or yogurt
Distribution: Vd: 1.7 to 2.7 L/kg; tissue concentrations often
exceed plasma concentrations in respiratory tissues, alveolar macrophages, and
Protein binding: 50%
Metabolism: Hepatic, via glucuronide (14%) and sulfate (38%) conjugation
Half-life: 12 hours
Elimination: Approximately 45% excreted as unchanged drug (20% in urine and
25% in feces). Sulfate conjugates are excreted in the feces, glucuronide
conjugates are excreted in the urine.
Chronic bronchitis, acute bacterial exacerbation: 400 mg every 24 hours for 5
Dosage adjustment in renal impairment: No dosage adjustment is
Dosage adjustment in hepatic impairment: No dosage adjustment is
required in mild hepatic insufficiency (Child-Pugh Class A). Not recommended in
patients with moderate to severe hepatic insufficiency.
Elderly: No dosage adjustments are required based on age.
WBC, signs of infection
|Dental Health: Local
No information available to require special precautions
Effects on Dental Treatment|
No effects or complications reported
May be taken with or without food. Drink plenty of fluids. Avoid direct
exposure to direct sunlight during therapy and for several days following. Do
not take antacids within 4 hours before or 8 hours after dosing. Contact your
physician immediately if signs of allergy occur. Contact your physician
immediately if signs of tendon inflammation or pain occur. Do not discontinue
therapy until your course has been completed. Take a missed dose as soon as
possible, unless it is almost time for your next dose.
Tablet: 400 mg
Balfour JA and Wiseman LR, "Moxifloxacin," Drugs, 1999, 57(3):363-73.
"Expanded Activity and Utility of the New Fluoroquinolones: A Review,"
Clinical Therapeutics, 1999, 21(1):3-40.
"Gatifloxacin and Moxifloxacin: Two New Fluoroquinolones," The Medical
Letter, 2000, Vol 42, 1072:15.
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