Moxifloxacin (As Hydrochloride)

Mechanism of Action
Inhibits A subunits of DNA gyrase, resulting in inhibition of bacterial DNA replication and transcription 
Pharmacokinetics
Well absorbed, absorption is not affected by high-fat meal or yogurt
Bioavailability: 90%
Excretion: Feces (25%), urine (20% as unchanged drug)
Contraindications
• Hypersensitivity to moxifloxacin or any member of the quinolone class of antibacterials 
Adverse Reactions
Nausea, Diarrhea, Dizziness, Decreased amylase, Decreased basophils, eosinophils, hemoglobin, prothrombin time, red blood cells, neutrophils, Decreased serum glucose, Increased serum chloride, Increased serum ionized calcium, Immune hypersensitivity reaction, Prolonged QT interval
Major Drug Interactions
Disopyramide - Ibutilide - Indapamide - Pentamidine - Pimozide - Procainamide - Quinidine - Sotalol
Warnings
• Fluoroquinolones have been associated with disabling and potentially irreversible serious adverse reactions that have occurred together including: tendinitis and tendon rupture, peripheral neuropathy, and CNS effects
• Discontinue the drug immediately and avoid use of systemic fluoroquinolones in patients who experience any of these serious adverse reactions
• May exacerbate muscle weakness in patients with myasthenia gravis, fluoroquinolones should be avoided in patients with known history of myasthenia gravis
• Because fluoroquinolones have been associated with serious adverse reactions, reserve drug use in patients who have no alternative treatment options for the following indications: Acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis 
Recommendations for Patient
• Quinolone antibiotics (including moxifloxacin) may cause serious and possibly permanent tendon damage (such as tendonitis, tendon rupture), nerve problems in the arms and legs (peripheral neuropathy), and nervous system problems. 
• Get medical help right away if you have any of the following symptoms: pain/numbness/burning/tingling/weakness in your arms/hands/legs/feet, changes in how you sense touch/pain/temperature/vibration/body position, severe/lasting headache, vision changes, shaking (tremors), seizures, mental/mood changes (such as agitation, anxiety, confusion, hallucinations, depression, rare thoughts of suicide). 
• Tendon damage may occur during or after treatment with this medication. Stop exercising, rest, and get medical help right away if you develop joint/muscle/tendon pain or swelling. 
• Your risk for tendon problems is greater if you are over 60 years of age, if you are taking corticosteroids (such as prednisone), or if you have a kidney, heart, or lung transplant. 
Pregnancy Considerations
There are no available human data establishing a drug associated risk 
Advise pregnant women of potential risk to fetus 
Breastfeeding Considerations
No information is available on the use of moxifloxacin during breastfeeding. Use of moxifloxacin is acceptable in nursing mothers with monitoring of the infant for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash). However, it is preferable to use an alternate drug for which safety information is available. 

Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.

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