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moxifloxacin hydrochloride

   Also found in: Wikipedia 0.02 sec.
moxifloxacin hydrochloride,
the hydrochloride salt of moxifloxacin, administered orally in the treatment of bacterial exacerbation of chronic bronchitis, acute sinusitis, community-acquired pneumonia, and skin and skin structure infections caused by susceptible organisms.

moxifloxacin hydrochloride

Avelox, Vigamox

Pharmacologic class: Fluoroquinolone

Therapeutic class: Anti-infective

Pregnancy risk category C

Action

Selectively inhibits DNA synthesis by disrupting DNA replication and transcription and suppressing protein synthesis, causing bacterial cell death

Availability

Injection (premixed): 400 mg/250-ml bag

Ophthalmic solution: 5% (3 ml in 6-ml bottle)

Tablets: 400 mg

Indications and dosages

Acute bacterial sinusitis

Adults: 400 mg P.O. or I.V. q 24 hours for 10 days

Acute bacterial exacerbation of chronic bronchitis

Adults: 400 mg P.O. or I.V. q 24 hours for 5 days

Community-acquired pneumonia

Adults: 400 mg P.O. or I.V. q 24 hours for 7 to 14 days

Uncomplicated skin and skin-structure infections

Adults: 400 mg P.O. or I.V. q 24 hours for 7 days

Bacterial conjunctivitis

Adults: Instill one drop of ophthalmic solution into affected eye t.i.d. for 7 days.

Contraindications

• Hypersensitivity to drug, its components, or other fluoroquinolones

Precautions

Use cautiously in:
• underlying CNS diseases or disorders, renal impairment, cirrhosis, bradycardia, acute myocardial ischemia, prolonged QTc interval, uncorrected hypokalemia, dialysis
• elderly patients
• pregnant or breastfeeding patients (safety not established except in post-exposure inhalation anthrax)
• children younger than age 18 (except in postexposure inhalation anthrax)
• children younger than age 1 (ophthalmic use).

Administration

• Give premixed I.V. dose over 60 minutes. Avoid bolus or rapid infusion.
• Don't mix with other drugs in same I.V. line.
• Know that although milk or yogurt may impair absorption of P.O. moxifloxacin, drug may be given with other calcium products.

RouteOnsetPeakDuration
P.O.Within 1 hr1-3 hr24 hr
I.V.RapidEnd of infusion24 hr
OphthalmicUnknownUnknownUnknown

Adverse reactions

CNS: dizziness, drowsiness, headache, confusion, light-headedness, insomnia, agitation, hallucinations, acute psychoses, tremor, seizures

CV: hypertension, vasodilation, tachycardia, prolonged QT interval, arrhythmias

EENT: conjunctivitis; decreased visual acuity; keratitis; eye dryness, discomfort, pain, pruritus, and hyperemia; subconjunctival hemorrhage; tearing; otitis media; pharyngitis; rhinitis (all with ophthalmic solution)

GI: nausea, diarrhea, abdominal pain, pseudomembranous colitis

GU: vaginitis

Hematologic: eosinophilia, thrombocytopenia, leukopenia

Musculoskeletal: joint pain, tendinitis, tendon rupture

Respiratory: increased cough (with ophthalmic solution)

Skin: rash, photosensitivity, phototoxicity, Stevens-Johnson syndrome

Other: altered taste, fever (with ophthalmic solution), phlebitis at I.V. site, superinfection, hypersensitivity reactions including anaphylaxis

Interactions

Drug-drug. Amiodarone, bepridil, disopyramide, erythromycin, pentamidine, phenothiazines, pimozide, procainamide, quinidine, sotalol, tricyclic antidepressants: increased risk of serious adverse cardiovascular reactions

Antacids, bismuth subsalicylate, iron salts, sucralfate, zinc salts: decreased moxifloxacin absorption

Theophylline: increased theophylline blood level and possible toxicity

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, lactate dehydrogenase, platelets: increased levels

Drug-food. Concurrent tube feedings, milk, yogurt: impaired absorption of P.O. moxifloxacin

Drug-herbs. Dong quai, St. John's wort: phototoxicity

Fennel: decreased moxifloxacin absorption

Drug-behaviors. Sun exposure: phototoxicity

Patient monitoring

Watch for hypersensitivity reaction (such as anaphylaxis) and other allergic reactions, which may occur after initial dose.
• Monitor cardiovascular and neurologic status closely.
• Stay alert for tendinitis and Achilles tendon rupture.
• Monitor CBC and liver function tests.
• Assess GI status. Report signs or symptoms of pseudomembranous colitis.
• Watch closely for superinfection.

Patient teaching

• Advise patient to take tablets once a day with or without food, 4 hours before or 8 hours after antacids, multivitamins, sucralfate, or preparations containing aluminum, magnesium, iron, or zinc.
Tell patient drug may cause serious allergic reactions even several days after therapy begins. Advise him to stop taking drug and report these reactions immediately.
Urge patient to promptly report tendon pain, diarrhea with blood or pus, and signs and symptoms of superinfection.
• Teach patient how to use eye drops. Caution him to avoid touching applicator tip to eye, finger, or other object.
• Instruct patient being treated for bacterial conjunctivitis not to wear contact lenses.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.



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