moxifloxacin hydrochloride

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.

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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.

Route	Onset	Peak	Duration
P.O.	Within 1 hr	1-3 hr	24 hr
I.V.	Rapid	End of infusion	24 hr
Ophthalmic	Unknown	Unknown	Unknown

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.