Moxifloxacin

Moxifloxacin is also sometimes used to treat tuberculosis (TB) ,certain sexually transmitted diseases, and endocarditis (infection of the heart lining and valves) when other medications cannot be used. Moxifloxacin also may be used to treat or prevent anthrax (a serious infection that may be spread on purpose as part of a bioterror attack) in people who may have been exposed to anthrax germs in the air if other medications are not available for this purpose. Moxifloxacin is also sometimes used to treat salmonella (an infection that causes severe diarrhea) and shigella (an infection that causes severe diarrhea) in patients who have human immunodeficiency virus (HIV) infection.Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

IV Preparation

No further dilution of infusion solution is necessary

IV Administration

Infuse over 1 hour

Do not admix with other drugs or infuse through same tubing simultaneously

Use caution when driving, operating machinery, or performing other hazardous activities. Moxifloxacin ophthalmic may cause blurred vision. If you experience blurred vision, avoid these activities.

If you wear contact lenses, remove them before applying moxifloxacin ophthalmic. Ask your doctor if contact lenses can be reinserted after application of the medication.

Do not use other eye drops or medications during treatment with moxifloxacin ophthalmic unless otherwise directed by your doctor.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven)
• antidepressants
• antipsychotics
• corticosteroids
• nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, Naprosyn, others)
• diuretics ('water pills')
• erythromycin (E.E.S., E-Mycin, Erythrocin, others)
• medications for irregular heartbeat including amiodarone (Cordarone), disopyramide (Norpace), procainamide (Procanbid), quinidine, and sotalol (Betapace, Betapace AF, Sorine)

This is not a complete list of moxifloxacin drug interactions. Ask your doctor or pharmacist for more information.

Moxifloxacin may cause swelling or tearing of a tendon, especially if you are over 60, if you take steroid medication, or if you have had a kidney, heart, or lung transplant.

Take moxifloxacin only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

moxifloxacin comes with a Medication Guide. Read and follow the instructions carefully. Ask your doctor if you have any questions.

Swallow the tablet whole with a glass of water. Do not split, crush or chew it. moxifloxacin may be taken with or without food.

Take moxifloxacin at the same time each day.

Drink plenty of fluids with moxifloxacin to help prevent some unwanted effects.

If you are taking aluminum or magnesium-containing antacids, iron supplements, multivitamins, didanosine (Videx®), sucralfate (Carafate®), or zinc, do not take them at the same time that you take moxifloxacin. It is best to take these medicines at least 4 hours before or 8 hours after taking moxifloxacin. These medicines may keep moxifloxacin from working properly.

Keep using moxifloxacin for the full treatment time, even if you feel better after the first few doses. Your infection may not clear up if you stop using the medicine too soon.

Dosing

The dose of moxifloxacin will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of moxifloxacin. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (tablets):
  • For infections:
    • Adults—400 milligrams (mg) once every 24 hours.
    • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of moxifloxacin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

It is very important that your doctor check your progress while you are taking moxifloxacin. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it.

If you have low potassium levels in the blood, moxifloxacin may increase your risk of having a fast, slow or irregular heartbeat, loss of consciousness, or fainting spells. If these symptoms occur, tell your doctor right away.

moxifloxacin may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and require immediate medical attention. Call your doctor right away if you have itching, hives, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth after you take moxifloxacin.

Moxifloxacin may cause diarrhea, and in some cases it can be severe. It may occur 2 months or more after you stop taking moxifloxacin. Do not take any medicine to treat diarrhea without checking first with your doctor. Diarrhea medicines may make the diarrhea worse or make it last longer. If you have any questions about this or if mild diarrhea continues or gets worse, check with your doctor.

Tell your doctor right away if you start having numbness, tingling, or burning pain in your hands, arms, legs, or feet. These may be symptoms of a condition called peripheral neuropathy.

Moxifloxacin may rarely cause inflammation (tendinitis) or tearing of a tendon (the cord that attaches muscles to bones). This can occur while you are taking the medicine or after you finish taking it. The risk of having tendon problems may be increased if you are over 60 years of age, are using steroid medicines (eg, dexamethasone, prednisolone, prednisone, or Medrol®), have severe kidney problems, have a history of tendon problems (eg, rheumatoid arthritis), or if you have received an organ transplant (eg, heart, kidney, or lung). Check with your doctor right away if you have sudden pain or swelling in a tendon after exercise (eg, ankle, back of the knee or leg, shoulder, elbow, or wrist), bruise more easily after an injury, or are unable to bear weight or move the affected area. Refrain from exercise until your doctor says otherwise.

Tell your doctor right away if you have any of the following symptoms while using moxifloxacin: convulsions, feeling anxious, confused, or depressed, seeing, hearing, or feeling things that are not there, severe headache, trouble sleeping, or unusual thoughts or behaviors.

Moxifloxacin may cause some people to become dizzy, lightheaded, drowsy, or less alert than they are normally. Make sure you know how you react to moxifloxacin before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert. If these reactions are especially bothersome, check with your doctor.

Some people who take moxifloxacin may become more sensitive to sunlight than normal. Exposure to sunlight, even for brief periods of time, may cause severe sunburn, or skin rash, redness, itching, or discoloration. When you begin using moxifloxacin:

• Stay out of direct sunlight, especially between the hours of 10 AM and 3 PM, if possible.
• Wear protective clothing, including a hat and sunglasses.
• Apply a sun block product that has a sun protection factor (SPF) of at least 15. Some people may require a product with a higher SPF number, especially if they have a fair complexion. If you have any questions about this, check with your doctor.
• Do not use a sunlamp or tanning bed or booth.

If you have a severe reaction from the sun, check with your doctor.

For diabetic patients: moxifloxacin may affect blood sugar levels. If you notice a change in the results of your blood or urine sugar tests or if you have any questions, check with your doctor.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

400 mg orally or IV every 24 hours for 5 to 14 days

Use: For the treatment of complicated intraabdominal infections including polymicrobial infections (such as abscess) due to susceptible isolates of E coli, Bacteroides fragilis, S anginosus, S constellatus, Enterococcus faecalis, Proteus mirabilis, Clostridium perfringens, B thetaiotaomicron, or Peptostreptococcus species

US CDC recommendations: 400 mg orally or IV every 24 hours

Duration of Therapy:
Postexposure prophylaxis for B anthracis infection: 60 days

Systemic anthrax:
-With possible/confirmed meningitis: At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
-When meningitis has been excluded: At least 2 weeks or until patient is clinically stable (whichever is longer)
-Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial regimen of 60 days from onset of illness.

Cutaneous anthrax without systemic involvement:
-Bioterrorism-related cases: 60 days
-Naturally acquired cases: 7 to 10 days

Comments:
-Ciprofloxacin is preferred for pregnant women.
-Recommended as an alternative oral drug for postexposure prophylaxis and as an alternative IV drug for the treatment of systemic anthrax
-Recommended as a preferred oral drug for the treatment of cutaneous anthrax without systemic involvement
-Recommended for all strains (regardless of penicillin susceptibility or if susceptibility is unknown) when used for postexposure prophylaxis, systemic anthrax when meningitis has been excluded, or cutaneous anthrax without systemic involvement
-Recommended for use with a protein synthesis inhibitor when used for systemic anthrax; the addition of a bactericidal beta-lactam is recommended with possible/confirmed meningitis.
-Systemic anthrax includes anthrax meningitis; inhalation, injection, and gastrointestinal anthrax; and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-Current guidelines should be consulted for additional information.

American Society of Health-System Pharmacists (ASHP), IDSA, Surgical Infection Society (SIS), and Society for Healthcare Epidemiology of America (SHEA) recommendations:
-Preoperative dose: 400 mg orally or IV once, starting within 120 minutes before surgical incision

Comments:
-Recommended as part of an alternative regimen for surgical prophylaxis for hysterectomy (vaginal or abdominal); coadministration with other agents is recommended.
-A single prophylactic dose is usually sufficient; if prophylaxis is continued postoperatively, duration should be less than 24 hours.
-Before use, local susceptibility should be reviewed due to increasing resistance of E coli to fluoroquinolones.
-Current guidelines should be consulted for additional information.

American Academy of Pediatrics recommendations:
Up to 4 weeks of age:
-Gestational age 32 to 37 weeks: 5 mg/kg IV every 24 hours
-Term neonate: 10 mg/kg IV every 24 hours

3 months to 11 years:
-For 3 months to less than 2 years: 6 mg/kg IV every 12 hours
-For 2 to 5 years: 5 mg/kg IV every 12 hours
-For 6 to 11 years: 4 mg/kg IV every 12 hours
Maximum dose: 200 mg/dose

12 years or older:
Less than 45 kg: 4 mg/kg IV every 12 hours
-Maximum dose: 200 mg/dose
At least 45 kg: 400 mg IV once a day

Duration of Therapy: At least 2 to 3 weeks, continuing until patient is clinically stable
-Patients will require prophylaxis with a different agent to complete an antimicrobial regimen of up to 60 days from onset of illness.

Comments:
-Dosing for neonates provided only as guidance during emergency biological weapon event (based on available text or pharmacokinetic data extrapolated from older children).
-Recommended as an alternative IV drug for the treatment of systemic/severe anthrax (anthrax meningitis or disseminated infection and meningitis cannot be excluded)
-Recommended for use with a protein synthesis inhibitor plus (a bactericidal beta-lactam [all applicable patients] or a bactericidal glycopeptide [patients 3 months or older])
-Systemic/severe anthrax includes anthrax meningitis; inhalation anthrax; or injection, gastrointestinal, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-Current guidelines should be consulted for additional information.

American Academy of Pediatrics recommendations:
Up to 4 weeks of age:
-Gestational age 32 to 37 weeks: 5 mg/kg IV every 24 hours
-Term neonate: 10 mg/kg IV every 24 hours

3 months to 11 years:
-For 3 months to less than 2 years: 6 mg/kg IV every 12 hours
-For 2 to 5 years: 5 mg/kg IV every 12 hours
-For 6 to 11 years: 4 mg/kg IV every 12 hours
Maximum dose: 200 mg/dose

12 years or older:
Less than 45 kg: 4 mg/kg IV every 12 hours
-Maximum dose: 200 mg/dose
At least 45 kg: 400 mg IV once a day

Duration of Therapy: At least 2 to 3 weeks, continuing until patient is clinically stable
-Patients will require prophylaxis with a different agent to complete an antimicrobial regimen of up to 60 days from onset of illness.

Comments:
-Dosing for neonates provided only as guidance during emergency biological weapon event (based on available text or pharmacokinetic data extrapolated from older children).
-Recommended as an alternative IV drug for the treatment of systemic/severe anthrax (anthrax meningitis or disseminated infection and meningitis cannot be excluded)
-Recommended for use with a protein synthesis inhibitor plus (a bactericidal beta-lactam [all applicable patients] or a bactericidal glycopeptide [patients 3 months or older])
-Systemic/severe anthrax includes anthrax meningitis; inhalation anthrax; or injection, gastrointestinal, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-Current guidelines should be consulted for additional information.