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moxifloxacin (Rx)Brand and Other Names:Avelox, Moxifloxacin Systemic

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 400mg/250mL

tablet

  • 400mg
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Acute Bacterial Sinusitis

400 mg PO/IV qDay for 5-10 days

Community-Acquired Pneumonia

400 mg PO/IV qDay for 7-14 days

Acute Exacerbation of Chronic Bronchitis

Indicated for acute exacerbations of chronic bronchitis caused by bacterial infections

400 mg PO/IV qDay for 5 days

Skin & Skin Structure Infections

Uncomplicated: 400 mg PO/IV qDay for 7 days

Complicated: 400 mg PO/IV qDay for 7-21 days

Intra-abdominal Infections

Complicated: 400 mg PO/IV qDay for 5-14 days

Pneumonic & Septicemic Plague

Indicated in adults for the treatment of plague, including pneumonic and septicemic plague, caused by susceptible isolates of Yersinia pestis; it is also indicated for prophylaxis of plague in adults

400 mg PO/IV qDay x10-14 days

Begin administration as soon as possible after suspected or confirmed exposure to Yersinia pestis

Dosing Considerations

Initial IV administration may be changed to PO administration at same dosage to complete therapy, depending on patient's clinical status

Susceptible organisms

  • Aeromonas hydrophila, Bacillus anthracis, Bacteroides fragilis, Bacteroides thetaiotaomicron, Campylobacter jejuni, Citrobacter diversus, Citrobacter freundii, Clostridium perfringens, Escherichia coli, Enterobacter spp, Haemophilus influenzae, Hafnia alvei, Klebsiella pneumoniae, Legionella pneumophila, Morganella morganii, Moraxella catarrhalis, Mycobacterium pneumoniae, Mycobacterium tuberculosis, Neisseria gonorrhoeae, Peptostreptococcus spp, Proteus mirabilis, Proteus vulgaris, Providencia spp, Pseudomonas aeruginosa, Salmonella typhi, Shigella spp, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus anginosus, Streptococcus constellatus, Streptococcus pneumoniae, Vibrio cholerae, Yersinia pestis
  • First-line therapy: C jejuni; no unanimity on others (eg, L pneumophila, M morganii)

<18 years: Safety and efficacy not established

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Interactions

Interaction Checker

moxifloxacin and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Nausea (7%)

            Diarrhea (6%)

            Dizziness (3%)

            Decreased amylase (2%)

            Decreased basophils, eosinophils, hemoglobin, prothrombin time, red blood cells, neutrophils (2%)

            Decreased serum glucose (2%)

            Increased serum chloride (2%)

            Increased serum ionized calcium (2%)

            Immune hypersensitivity reaction (0.1-2%)

            Prolonged QT interval (0.1-2%)

            <1%

            Acute renal failure

            Agranulocytosis

            Anaphylactoid reaction

            Aplastic anemia

            Extrinsic allergic alveolitis

            Hemolytic anemia

            Hepatic failure

            Hepatic necrosis

            Hepatitis

            Pancytopenia

            Seizure

            Serum sickness due to drug

            Stevens-Johnson syndrome

            Tendon rupture, tendinitis

            Thrombocytopenia

            Torsades de pointes

            Toxic epidermal necrolysis

            Postmarketing Reports

            Blood and lymphatic disorders: Agranulocytosis, pancytopenia

            Cardiovascular disorders: Ventricular tachyarrhythmias (including in very rare cases cardiac arrest and torsade de pointes)

            Ear and labyrinth disorders: Hearing impairment, including deafness (reversible in most cases)

            Eye disorders: Vision loss (especially in the course of CNS reactions, transient in majority of cases)

            Hepatobiliary disorders: Hepatitis, hepatic failure, jaundice, acute hepatic necrosis

            Immune system disorders: Anaphylactic reactions including shock, angioedema (including laryngeal edema)

            Musculoskeletal/connective tissue disorders: Tendon rupture

            Nervous system disorders: Exacerbation of myasthenia gravis symptoms, altered coordination, abnormal gait, muscle weakness, peripheral neuropathy, polyneuropathy

            Psychiatric disorders: Psychotic reaction (very rarely culminating in self-injurious behavior, such as suicidal ideation/thoughts or suicide attempts)

            Renal and urinary disorders: Renal dysfunction, interstitial nephritis

            Respiratory disorders: Allergic pneumonitis

            Skin and tissue disorders: Photosensitivity/phototoxicity reaction, Stevens-Johnson syndrome, Toxic epidermal necrolysis

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            Warnings

            Black Box Warnings

            Fluoroquinolones are associated with increased risk of tendinitis and tendon rupture; this risk is further increased in older patients (usually >60 years); in kidney, heart, and lung transplant recipients; and with use of concomitant steroid therapy

            May exacerbate muscle weakness in patients with myasthenia gravis; fluoroquinolones should be avoided in patients with known history of myasthenia gravis

            Contraindications

            Hyersensitivity to drug or component

            Cautions

            In prolonged therapy, perform periodic evaluations of organ system function (eg, renal, hepatic, hematopoietic); superinfections may occur with prolonged or repeated antibiotic therapy

            Phototoxicity reactions may occur; avoid excessive sunlight

            Use caution in cardiovascular disease especially significant bradycardia or acute myocardial ischemia

            Peripheral neuropathy: Sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias, and weakness reported; peripheral neuropathy may occur rapidly after initiating and may potentially become permanent

            Serious, sometimes fatal hypogycemia reported including in patients without a history of hypoglycemia (common with gatifloxacin, which is no longer marketed); monitor glucose levels closely in patients with diabetes; if hypoglycemic reaction occurs, discontinue therapy and initiate appropriate therapy immediately

            Fulminant hepatitis, potentially leading to liver failure reported; discontinue treatment if hepatitis symptoms occur

            Risk of tendinitis or tendon rupture

            Avoid use in presence of drugs or conditions that prolong QT interval, uncorrected hypomagnesemia or hypokalemia

            Hallucinations, convulsions, and increased intracranial pressure (including pseudotumor cerebri) and toxic psychosis reported

            Acute onset of retinal detachment increased 4.5-fold with oral fluoroquinolones in a single case-controlled study - JAMA 2012;307(13):1414-1419; another study disputes these findings (relative risk, 1.29) - JAMA 2013;310(20):2184-2190

            Use caution in patients with a history of diabetes, hepatic impairment, renal impairment, or rheumatoid arthrtitis

            As with all fluoroquinolones, disturbances in blood glucose, including both hypoglycemia and hyperglycemia have been reported in diabetic patients; monitor blood glucose

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Unknown if excreted in milk; discontinue drug, or do not nurse

            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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            Pharmacology

            Mechanism of Action

            Inhibits A subunits of DNA gyrase, resulting in inhibition of bacterial DNA replication and transcription

            Absorption

            Well absorbed; absorption is not affected by high-fat meal or yogurt

            Bioavailability: 90%

            Distribution

            Protein bound: 50%

            Vd: 1.7-2.7 L/kg; tissue concentrations often exceed plasma concentrations in respiratory tissues, alveolar macrophages, and sinus tissues

            Metabolism

            Metabolized in liver via glucuronide (14%) and sulfate (38%) conjugation

            Elimination

            Half-life: PO, 12 hr; IV, 15 hr

            Excretion: Feces (25%), urine (20% as unchanged drug)

            Sulfate conjugate metabolites are excreted in feces, glucuronide conjugate metabolites in urine

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            Administration

            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

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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