|
This information has been developed and provided by an independent third-party source. Merck & Co., Inc. does not endorse and is not responsible for the accuracy of the content, or for practices or
standards of non-Merck sources.
ALERT: U.S. Boxed Warning
The FDA-approved labeling includes a boxed warning. See Warnings/Precautions section for a concise summary of this information. For verbatim wording of the boxed warning, consult the product labeling or www.fda.gov.
Medication Safety Issues
Sound-alike/look-alike issues:
Avelox® may be confused with Avonex®
International issues:
Vigamox® may be confused with Fisamox® which is a brand name for amoxicillin in Australia
Pronunciation
(moxs i FLOKS a sin)
U.S. Brand Names
Index Terms
Generic Available
No
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Treatment of mild-to-moderate community-acquired pneumonia, including multidrug-resistant Streptococcus pneumoniae (MDRSP); acute bacterial exacerbation of chronic bronchitis; acute bacterial sinusitis; complicated and uncomplicated skin and skin structure infections; complicated intra-abdominal infections; bacterial conjunctivitis (ophthalmic formulation)
Use: Unlabeled/Investigational
Legionella
Pregnancy Risk Factor
C
Pregnancy Considerations
Adverse events have been observed in some animal studies; therefore, the manufacturer classifies moxifloxacin as pregnancy category C. Quinolone exposure during human pregnancy has been reported with other agents (see Ciprofloxacin, Ofloxacin, and Norfloxacin monographs). To date, no specific teratogenic effect or increased pregnancy risk has been identified; however, because of concerns of cartilage damage in immature animals exposed to quinolones and the limited moxifloxacin specific data, moxifloxacin should only be used during pregnancy if a safer option is not available.
Lactation
Excretion in breast milk unknown/not recommended
Breast-Feeding Considerations
It is not known if moxifloxacin is excreted into breast milk. Breast-feeding is not recommended by the manufacturer. Although there is no information on the use of moxifloxacin during breast-feeding, other quinolones are considered compatible. Nondose-related effects could include modification of bowel flora.
Contraindications
Hypersensitivity to moxifloxacin, other quinolone antibiotics, or any component of the formulation
Warnings/Precautions
Boxed Warnings:
• Tendon inflammation/rupture: See “Concerns related to adverse effects” below.
Concerns related to adverse effects:
• Altered cardiac conduction: Fluoroquinolones may prolong QTc interval; avoid use in patients with a history of QTc prolongation, uncorrected hypokalemia, hypomagnesemia, or concurrent administration of other medications known to prolong the QT interval (including Class Ia and Class III antiarrhythmics, cisapride, erythromycin, antipsychotics, and tricyclic antidepressants).
• CNS stimulation: Tremor, restlessness, confusion, and very rarely hallucinations or seizures may occur; use with caution in patients with known or suspected CNS disorder. Discontinue in patients who experience significant CNS adverse effects (eg, dizziness, hallucinations, suicidal ideations or actions).
• Glucose regulation: Fluoroquinolones have been associated with the development of serious, and sometimes fatal, hypoglycemia. These events have occurred most often in elderly patients with diabetes, but have also been reported in patients without a prior history of diabetes. Prompt identification and treatment of hypoglycemia is essential. Individual quinolones may differ in their potential to cause this effect. It was most evident with gatifloxacin (no longer marketed as s systemic formulation). Hyperglycemia has also been associated with the use of fluoroquinolones. Patients should be monitored closely for signs/symptoms of disordered glucose regulation.
• Hypersensitivity reactions: Severe hypersensitivity reactions, including anaphylaxis, have occurred with quinolone therapy. The spectrum of these reactions can vary widely; reactions may present as typical allergic symptoms (eg, itching, urticaria, rash, edema) after a single dose, or may manifest as severe idiosyncratic dermatologic (eg, Stevens-Johnson, toxic epidermal necrolysis), vascular (eg, vasculitis), pulmonary (eg, pneumonitis), renal (eg, nephritis), hepatic (eg, hepatic failure or necrosis), and/or hematologic (eg, anemia, cytopenias) events, usually after multiple doses. Prompt discontinuation of drug should occur if skin rash or other symptoms arise.
• Peripheral neuropathy: The use of quinolones has been linked to peripheral neuropathy (rare); discontinue if symptoms of sensory or sensorimotor neuropathy occur.
• Photosensitivity: Avoid excessive sunlight and take precautions to limit exposure (eg, loose fitting clothing, sunscreen); may rarely cause moderate-to-severe phototoxicity reactions. Discontinue use if phototoxicity occurs.
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
• Tendon inflammation/rupture: [U.S. Boxed Warning]: There have been reports of tendon inflammation and/or rupture with quinolone antibiotics; risk may be increased with concurrent corticosteroids, organ transplant recipients, and in patients >60 years of age. Rupture of the Achilles tendon sometimes requiring surgical repair has been reported most frequently; but other tendon sites (eg, rotator cuff, biceps) have also been reported. Strenuous physical activity may be an independent risk factor for tendonitis. Discontinue at first sign of tendon inflammation or pain. Tendon rupture may occur even after discontinuation of therapy.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with significant bradycardia or acute myocardial ischemia.
• Diabetes: Use with caution in patients with diabetes mellitus; glucose regulation may be altered.
• Hepatic impairment: Use with caution in patients with mild, moderate, or severe hepatic impairment or liver cirrhosis; may increase the risk of QT prolongation.
• Myasthenia gravis: Some quinolones may exacerbate myasthenia gravis, use with caution (rare, potentially life-threatening weakness of respiratory muscles may occur).
• Renal impairment: Use with caution in patients with renal failure; may increase risk of tendon rupture.
• Rheumatoid arthritis: Use with caution in patients with rheumatoid arthritis; may increase risk of tendon rupture.
• Seizures: Use with caution in individuals at risk of seizures (CNS disorders or concurrent therapy with medications which may lower seizure threshold). Potential for seizures, although very rare, may be increased with concomitant NSAID therapy.
Special populations:
• Elderly: Adverse effects (eg, tendon rupture, QT changes) may be increased in the elderly.
• G6PD deficiency: Hemolytic reactions may (rarely) occur with quinolone use in patients with latent or actual G6PD deficiency.
• Pediatrics: Safety and efficacy of systemically-administered moxifloxacin (oral, intravenous) have not been established in children.
Dosage form specific issues:
• Ophthalmic solution: Eye drops should not be injected subconjunctivally or introduced directly into the anterior chamber of the eye. Contact lenses should not be worn during therapy.
Adverse Reactions
Systemic:
2% to 10%:
Central nervous system: Dizziness (2%)
Endocrine & metabolic: Serum chloride increased (?2%), serum ionized calcium increased (?2%), serum glucose decreased (?2%)
Gastrointestinal: Nausea (6%), diarrhea (5%), amylase decreased (?2%)
Hematologic: Decreased serum levels of the following (?2%): Basophils, eosinophils, hemoglobin, RBC, neutrophils; increased serum levels of the following (?2%): MCH, neutrophils, WBC
Hepatic: Bilirubin decreased/increased (?2%)
Renal: Serum albumin increased (?2%)
Respiratory: PO2 decreased (?2%)
0.1% to <2%:
Cardiovascular: Cardiac arrhythmias, palpitation, QTc prolongation, tachycardia, vasodilation
Central nervous system: Anxiety, headache, insomnia, malaise, nervousness, pain, somnolence, vertigo
Dermatologic: Pruritus, rash (maculopapular, purpuric, pustular), urticaria
Gastrointestinal: Abdominal pain, amylase increased, anorexia, constipation, dyspepsia, flatulence, glossitis, lactic dehydrogenase increased, stomatitis, taste perversion, vomiting, xerostomia
Genitourinary: Vaginal moniliasis, vaginitis
Hematologic: Eosinophilia, leukopenia, prothrombin time prolonged, increased INR, thrombocythemia
Hepatic: GGTP increased, liver function test abnormal
Local: Injection site reaction
Neuromuscular & skeletal: Arthralgia, myalgia, tremor, weakness
Respiratory: Pharyngitis, pneumonia, rhinitis, sinusitis
Miscellaneous: Allergic reaction, infection, diaphoresis, oral moniliasis
<0.1%, postmarketing, and/or case reports: Abnormal dreams, abnormal gait, agitation, amblyopia, amnesia, anaphylactic reaction, anaphylactic shock, anemia, angioedema, aphasia, arthritis, asthma, atrial fibrillation, back pain, C. difficile-positive diarrhea, chest pain, cholestasis, confusion, depersonalization, depression, dysphagia, dyspnea, ECG abnormalities, emotional lability, face edema, gastritis, hallucinations, hepatic failure, hepatitis, hyperglycemia, hyperlipidemia, hyper-/hypotension, hypertonia, hyperuricemia, hypoesthesia, incoordination, INR decreased, jaundice (cholestatic), laryngeal edema, leg pain, nightmares, paresthesia, parosmia, pelvic pain, peripheral edema, peripheral neuropathy, photosensitivity/toxicity, prothrombin time decreased, pseudomembranous colitis, psychotic reaction, renal dysfunction, renal failure, seizure, sleep disorder, speech disorder, Stevens-Johnson syndrome, supraventricular tachycardia, syncope, taste loss, tendonitis, tendon rupture, thinking abnormal, thrombocytopenia, thromboplastin decreased, tinnitus, tongue discoloration, toxic epidermal necrolysis, ventricular tachyarrhythmias (including torsade de pointes and cardiac arrest [usually in patients with concurrent, severe proarrhythmic conditions]), vision abnormalities
Additional reactions with ophthalmic preparation: 1% to 6%: Conjunctivitis, dry eye, ocular discomfort, ocular hyperemia, ocular pain, ocular pruritus, subconjunctival hemorrhage, tearing, visual acuity decreased
Drug Interactions
Alfuzosin: May enhance the QTc-prolonging effect of QTc-Prolonging Agents. Risk C: Monitor therapy
Antacids: May decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of quinolones. Exceptions: Sodium Bicarbonate. Risk D: Consider therapy modification
Artemether: May enhance the QTc-prolonging effect of QTc-Prolonging Agents. Risk X: Avoid combination
Chloroquine: May enhance the QTc-prolonging effect of QTc-Prolonging Agents. Risk C: Monitor therapy
Ciprofloxacin: May enhance the QTc-prolonging effect of QTc-Prolonging Agents. Risk C: Monitor therapy
Corticosteroids (Systemic): Quinolone Antibiotics may enhance the adverse/toxic effect of Corticosteroids (Systemic). Risk of tendon-related side effects, including tendonitis and rupture, may be enhanced. Risk C: Monitor therapy
Didanosine: May decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of both agents (excludes enteric coated formulation of didanosine). Risk D: Consider therapy modification
Dronedarone: QTc-Prolonging Agents may enhance the QTc-prolonging effect of Dronedarone. Risk X: Avoid combination
Gadobutrol: May enhance the QTc-prolonging effect of QTc-Prolonging Agents. Risk D: Consider therapy modification
Insulin: May enhance the hyperglycemic effect of Quinolone Antibiotics. Insulin may enhance the hypoglycemic effect of Quinolone Antibiotics. Risk C: Monitor therapy
Iron Salts: May decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of both agents. Exceptions: Ferric Gluconate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Risk D: Consider therapy modification
Lumefantrine: May enhance the QTc-prolonging effect of QTc-Prolonging Agents. Risk X: Avoid combination
Magnesium Salts: May decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of both agents. Risk D: Consider therapy modification
Mycophenolate: Quinolone Antibiotics may decrease the serum concentration of Mycophenolate. Specifically, quinolones may decrease concentrations of the active metabolite of mycophenolate. Risk C: Monitor therapy
Nilotinib: May enhance the QTc-prolonging effect of QTc-Prolonging Agents. Risk X: Avoid combination
Nonsteroidal Anti-Inflammatory Agents: May enhance the neuroexcitatory and/or seizure-potentiating effect of Quinolone Antibiotics. Risk C: Monitor therapy
Pimozide: QTc-Prolonging Agents may enhance the QTc-prolonging effect of Pimozide. Risk X: Avoid combination
Probenecid: May increase the serum concentration of Quinolone Antibiotics. Risk C: Monitor therapy
QTc-Prolonging Agents: May enhance the adverse/toxic effect of other QTc-Prolonging Agents. Their effects can be additive, causing life-threatening ventricular arrhythmias. Risk D: Consider therapy modification
Quinapril: May decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of quinolones. Risk D: Consider therapy modification
QuiNINE: QTc-Prolonging Agents may enhance the QTc-prolonging effect of QuiNINE. QuiNINE may enhance the QTc-prolonging effect of QTc-Prolonging Agents. Risk X: Avoid combination
Sevelamer: May decrease the absorption of Quinolone Antibiotics. Risk D: Consider therapy modification
Sucralfate: May decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of quinolones. Risk D: Consider therapy modification
Sulfonylureas: Quinolone Antibiotics may enhance the hypoglycemic effect of Sulfonylureas. This appears to be particularly concerning early in the course of combination therapy. Quinolone Antibiotics may diminish the hypoglycemic effect of Sulfonylureas. With longer-term combination, there is a greater risk of hyperglycemia. Risk C: Monitor therapy
Tetrabenazine: QTc-Prolonging Agents may enhance the QTc-prolonging effect of Tetrabenazine. Risk X: Avoid combination
Thioridazine: QTc-Prolonging Agents may enhance the QTc-prolonging effect of Thioridazine. Risk X: Avoid combination
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Risk D: Consider therapy modification
Vitamin K Antagonists (eg, warfarin): Quinolone Antibiotics may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy
Zinc Salts: May decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of both agents. Risk D: Consider therapy modification
Ziprasidone: QTc-Prolonging Agents may enhance the QTc-prolonging effect of Ziprasidone. The risk of a severe arrhythmia may be increased. Risk X: Avoid combination
Ethanol/Nutrition/Herb Interactions
Food: Absorption is not affected by administration with a high-fat meal or yogurt.
Storage
Store at controlled room temperature of 25°C (77°F). Do not refrigerate infusion solution.
Compatibility
Stable in NS, D5W, D10W, SWFI, LR; do not add other medications to intravenous solution.
Mechanism of Action
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 bactericidal.
Pharmacodynamics/Kinetics
Absorption: Well absorbed; not affected by 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, abdominal tissues/fluids, and sinus tissues
Protein binding: ~30% to 50%
Metabolism: Hepatic (~52% of dose) via glucuronide (~14%) and sulfate (~38%) conjugation
Bioavailability: ~90%
Half-life elimination: Single dose: Oral: 12-16 hours; I.V.: 8-15 hours
Excretion: Urine (as unchanged drug [20%] and glucuronide conjugates); feces (as unchanged drug [25%] and sulfate conjugates)
Dosage
Usual dosage range:
Children ?1 year and Adults: Ophthalmic: Instill 1 drop into affected eye(s) 3 times/day for 7 days
Adults: Oral, I.V.: 400 mg every 24 hours
Indication-specific dosing:
Children ?1 year and Adults: Ophthalmic:
Bacterial conjunctivitis: Instill 1 drop into affected eye(s) 3 times/day for 7 days
Adults: Oral, I.V.:
Acute bacterial sinusitis: 400 mg every 24 hours for 10 days
Chronic bronchitis, acute bacterial exacerbation: 400 mg every 24 hours for 5 days
Intra-abdominal infections (complicated): 400 mg every 24 hours for 5-14 days (initiate with I.V.)
Pneumonia, community-acquired (including MDRSP): 400 mg every 24 hours for 7-14 days
Skin and skin structure infections:
Complicated: 400 mg every 24 hours for 7-21 days
Uncomplicated: 400 mg every 24 hours for 7 days
Elderly: No dosage adjustments are required based on age
Dosage adjustment in renal impairment: No dosage adjustment is required, including patients on hemodialysis, CRRT, or CAPD.
Dosage adjustment in hepatic impairment: No dosage adjustment is required in mild, moderate, or severe hepatic insufficiency (Child-Pugh class A, B, or C); however, use with caution in this patient population secondary to the risk of QT prolongation.
Administration: I.V.
Infuse over 60 minutes; do not infuse by rapid or bolus intravenous infusion
Monitoring Parameters
WBC, signs of infection
Test Interactions
Some quinolones may produce a false-positive urine screening result for opiates using commercially-available immunoassay kits. This has been demonstrated most consistently for levofloxacin and ofloxacin, but other quinolones have shown cross-reactivity in certain assay kits. Confirmation of positive opiate screens by more specific methods should be considered.
Dietary Considerations
May be taken without regard to meals. Take 4 hours before or 8 hours after multiple vitamins, antacids, or other products containing magnesium, aluminum, iron, or zinc.
Avelox® I.V. infusion (premixed in sodium chloride 0.8%) contains sodium 34.2 mEq (~787 mg)/250 mL.
Patient Education
Do not take any new prescription or OTC medications or herbal products during therapy without consulting prescriber. If administered by infusion: Report immediately any redness, swelling, or pain at infusion site; any swelling of mouth, lips, tongue, or throat; chest pain or tightness; respiratory difficulty; back pain; itching; skin rash; tingling; tendon pain; dizziness; abnormal thinking; or anxiety. May cause dizziness, lightheadedness, or confusion (use caution to avoid falls or injury); nausea or vomiting (request antiemetic from prescriber). Report any tendon pain, chest pain, palpitations, or other adverse reactions. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Breast-feeding is not recommended.
Oral: Take exactly as directed with or without food. Do not take antacids 4 hours before or 8 hours after taking this medication. Do not miss a dose (take a missed dose as soon as possible, unless it is almost time for your next dose). Take entire prescription even if feeling better. Maintain adequate hydration unless instructed to restrict fluid intake. Consult prescriber before having any vaccinations. May cause nausea, vomiting, or taste perversion (small, frequent meals, good mouth care, chewing gum, or sucking hard candy may help); headache; dizziness; insomnia; or anxiety (use caution when driving or engaging in tasks requiring alertness until response to drug is known). Avoid excessive sunlight and wear sunscreen during therapy. If you develop severe sunburn or sensitivity to sunlight, if inflammation or tendon pain occurs, or if you experience signs of an allergic reaction (eg, itching, urticaria, respiratory difficulty, facial edema or difficulty swallowing, loss of consciousness, tingling, chest pain, palpitations), discontinue use and contact prescriber immediately. Report persistent GI disturbances; CNS changes (eg, excessive sleepiness, agitation, tremors); skin rash; vision changes; respiratory difficulty; signs of opportunistic infection (eg, sore throat, chills, fever, burning, itching on urination, vaginal discharge, white plaques in mouth); persistent diarrhea (especially if it lasts after completing prescription); or other adverse reactions or worsening of condition.
Ophthalmic: Wash hands before instilling solution. Sit or lie down to instill. Open eye, look at ceiling, and instill prescribed amount of solution as directed. Do not touch tip of applicator or let tip of applicator touch eye. Do not wear contact lenses during therapy. Temporary stinging, blurred vision, or dry eyes may occur. Report persistent pain, burning, excessive tearing, decreased visual acuity, swelling, itching, or worsening of condition.
Geriatric Considerations
See Warnings/Precautions regarding tendon rupture in patients >60 years of age. No dosage adjustments are required based on age. Assess patient's ability to self-administer eye drops.
Anesthesia and Critical Care Concerns/Other Considerations
Clinical Pearls/Comments: Moxifloxacin causes a dose-dependent QT prolongation. Coadministration of moxifloxacin with other drugs that also prolong the QT 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, in those with conduction abnormalities.
Cardiovascular Considerations
Moxifloxacin causes a dose-dependent QT prolongation. Coadministration of moxifloxacin with other drugs that also prolong the QT 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.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Dry mouth, glossitis, stomatitis, and taste perversion.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
Moxifloxacin is one of the drugs confirmed to prolong the QT interval and is accepted as having a risk of causing torsade de pointes. The risk of drug-induced torsade de pointes is extremely low when a single QT interval prolonging drug is prescribed. In terms of epinephrine, it is not known what effect vasoconstrictors in the local anesthetic regimen will have in patients with a known history of congenital prolonged QT interval or in patients taking any medication that prolongs the QT interval. Until more information is obtained, it is suggested that the clinician consult with the physician prior to the use of a vasoconstrictor in suspected patients, and that the vasoconstrictor (epinephrine, mepivacaine and levonordefrin [Carbocaine® 2% with Neo-Cobefrin®]) be used with caution.
Dental Comment
Moxifloxacin is known to prolong the QT interval. The QT interval is measured as the time and distance between the Q point of the QRS complex and the end of the T wave in the ECG tracing. After adjustment for heart rate, the QT interval is defined as prolonged if it is more than 450 msec in men and 460 msec in women. A long QT syndrome was first described in the 1950s and 60s as a congenital syndrome involving QT interval prolongation and syncope and sudden death. Some of the congenital long QT syndromes were characterized by a peculiar electrocardiographic appearance of the QRS complex involving a premature atria beat followed by a pause, then a subsequent sinus beat showing marked QT prolongation and deformity. This type of cardiac arrhythmia was originally termed “torsade de pointes” (translated from the French as “twisting of the points”). Moxifloxacin is considered as having a risk of causing torsade de pointes. Since it is not known what effect vasoconstrictors in the local anesthetic regimen will have in patients with a known history of congenital prolonged QT interval or in patients taking any medication that prolongs the QT interval, a medical consult is suggested.
Mental Health: Effects on Mental Status
May cause dizziness, insomnia; may rarely produce abnormal thinking, agitation, anorexia, anxiety, asthenia, ataxia, confusion, depersonalization, depression, euphoria, hallucination, hostility, nervousness, panic attacks, paranoia, psychosis, sedation, somnolence, or stress
Mental Health: Effects on Psychiatric Treatment
Contraindicated with ziprasidone; may have potential to prolong QT interval; should avoid in patients with uncorrected hypokalemia, or concurrent administration of other medications known to prolong the QT interval (antipsychotics and tricyclic antidepressants)
Nursing: Physical Assessment/Monitoring
Assess results of culture and sensitivity tests and patient's allergy history before initiating therapy. Use caution with known or suspected CNS disorders; myasthenia gravis; current or potential for QT prolongation; hepatic impairment; or diabetes. Assess potential for interactions with other pharmacological or herbal agents patient may be taking. I.V.: See Administration for infusion specifics. Patient should be monitored closely; if an allergic reaction occurs (itching, urticaria, dyspnea or facial edema, loss of consciousness, tingling, cardiovascular collapse), drug should be discontinued immediately and prescriber notified. Evaluate results of laboratory tests, therapeutic effectiveness (resolution of infection), and adverse reactions (eg, hypersensitivity reactions [severe reactions, including anaphylaxis, have occurred with quinolone therapy], opportunistic infection, tendon rupture, persistent diarrhea [C. difficile-associated colitis can occur up to 2 months post treatment]) regularly during prolonged therapy. Teach patient proper use (according to formulation), possible side effects/appropriate interventions, and adverse symptoms to report.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Infusion, premixed in sodium chloride 0.8% [preservative free]:
Avelox® I.V.: 400 mg (250 mL) [contains sodium ~787 mg (34.2 mEq)/250 mL]
Solution, ophthalmic:
Vigamox®: 0.5% (3 mL)
Tablet:
Avelox®: 400 mg
Avelox® ABC Pack: 400 mg (5s)
Pricing: U.S. (www.drugstore.com)
Solution (Vigamox)
0.5% (3): $83.25
Tablets (Avelox)
400 mg (30): $483.42
References
Balfour JA and Wiseman LR, “Moxifloxacin,” Drugs, 1999, 57(3):363-73.
Blondeau JM, “Expanded Activity and Utility of the New Fluoroquinolones: A Review,” Clin Ther, 1999, 21(1):3-40.
Friedrich LV and Dougherty R, “Fatal Hypoglycemia Associated With Levofloxacin,” Pharmacotherapy, 2004, 24(12):1807-12.
Frothingham R, “Glucose Homeostasis Abnormalities Associated With Use of Gatifloxacin,” Clin Infect Dis, 2005, 41(9):1269-76.
“Gatifloxacin and Moxifloxacin: Two New Fluoroquinolones,” The Medical Letter, 2000, Vol 42, 1072:15.
Gavin JR 3rd, Kubin R, Choudhri S, et al, “Moxifloxacin and Glucose Homeostasis: A Pooled-Analysis of the Evidence From Clinical and Postmarketing Studies,” Drug Saf, 2004, 27(9):671-86.
Graumlich JF, Habis S, Avelino RR, et al, “Hypoglycemia in Inpatients After Gatifloxacin or Levofloxacin Therapy: Nested Case-Control Study,” Pharmacotherapy, 2005, 25(10):1296-302.
Khaliq Y and Zhanel GG, “Fluoroquinolone-Associated Tendinopathy: A Critical Review of the Literature,” Clin Infect Dis, 2003, 36(11):1404-10.
Lawrence KR, Adra M, and Keir C, “Hypoglycemia-Induced Anoxic Brain Injury Possibly Associated With Levofloxacin,” J Infect, 2006, 52(6):e177-80.
Malone RS, Fish DN, Abraham E, et al, “Pharmacokinetics of Levofloxacin and Ciprofloxacin During Continuous Renal Replacement Therapy in Critically Ill Patients,” Antimicrob Agents Chemother, 2001, 45(10):2949-54.
Mohr JF, McKinnon PS, Peymann PJ, et al, “A Retrospective, Comparative Evaluation of Dysglycemias in Hospitalized Patients Receiving Gatifloxacin, Levofloxacin, Ciprofloxacin, or Ceftriaxone,” Pharmacotherapy, 2005, 25(10):1303-9.
Park-Wyllie LY, Juurlink DN, Kopp A, et al, “Outpatient Gatifloxacin Therapy and Dysglycemia in Older Adults,” N Engl J Med, 2006, 354(13):1352-61.
Szarfman A, Chen M, and Blum MD, “More on Fluoroquinolone Antibiotics and Tendon Rupture,” N Engl J Med, 1995, 332(3):193.
Trotman RL, Williamson JC, Shoemaker DM, et al, “Antibiotic Dosing in Critically Ill Adult Patients Receiving Continuous Renal Replacement Therapy,” Clin Infect Dis, 2005, 41(8):1159-66.
Wang S and Rizvi AA, “Levofloxacin-Induced Hypoglycemia in a Nondiabetic Patient,” Am J Med Sci, 2006, 331(6):334-5.
Zacher JL and Givone DM, “False-Positive Urine Opiate Screening Associated with Fluoroquinolone Use,” Ann Pharmacother, 2004, 38:1525-28.
International Brand Names
Lexi-Comp.com
Last full review/revision December 2009
Content last modified December 2009
| 
