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norfloxacin (Rx)Brand and Other Names:Noroxin, Norfloxacin Systemic

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 400mg
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Prostatitis

Caused by susceptible strains E.coli

400 mg PO q12hr for 28-42 days

UTI (Cystitis)

Uncomplicated, caused by E. coli, K. pneumoniae or P. mirabilis: 400 mg PO q12hr for 3 days

Uncomplicated, caused by other susceptible organisms: 400 mg PO q12hr for 7-10 days

Complicated: 400 mg PO q12hr for 10-21 days

STD

800 mg PO single dose

Uncomplicated urethral and cervical gonorrhea caused by Neisseria gonorrhoeae

Travelers Diarrhea

400 mg PO q12hr for 3 days

Renal Impairment

CrCl <30 mL/min: Give qDay

Other Indications & Uses

Treatment of infection caused by suscep strains of designated organisms based on culture and suscep if possible

Campylobacter jejuni, Citrobacter spp., Enterobacter spp., Enterococcus faecalis, E. coli, Klebsiella pneumoniae, Legionella pneumophila, Proteus mirabilis, Providencia spp, Pseudomonas aeruginosa, Salmonella spp, Serratia spp., Shigella spp, MSSA, Staphylococcus saprophyticus

<18 years: Safety and efficacy not established

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Interactions

Interaction Checker

norfloxacin 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 (4%)

            Dizziness (3%)

            Headache (3%)

            Stomach cramps (3%)

            Weakness (1%)

            <1%

            Abdominal pain

            Anorexia

            Anxiety

            Arthralgia

            Arthritis

            Ataxia

            Back pain

            Bitter taste

            Cholestatic jaundice

            Confusion

            Constipation

            Depression

            Diarrhea

            Diplopia

            Dysgeusia

            Dyspepsia

            Dyspnea

            Erythema

            Exacerbation of myasthenia gravis

            Fever

            Flatulence

            GI bleeding

            Heartburn

            Postmarketing Reports

            Hypersensitivity reactions: Anaphylactoid reactions, angioedema, dyspnea, vasculitis, urticaria, arthritis, arthralgia, and myalgia

            Skin: Toxic epidermal necrolysis, Stevens-Johnson syndrome and erythema multiforme, exfoliative dermatitis, photosensitivity/phototoxicity reactions, leukocytoclastic vasculitis, drug rash with eosinophilia and systemic symptoms (DRESS syndrome)

            Gastrointestinal: Pseudomembranous colitis, hepatitis, jaundice (including cholestatic jaundice and elevated liver function tests), pancreatitis (rare), stomatitis

            Hepatic: Hepatic failure, including fatal cases

            Cardiovascular: On rare occasions, prolonged QTc interval and ventricular arrhythmia including torsades de pointes

            Renal: Interstitial nephritis, renal failure

            Nervous system/psychiatric: Peripheral neuropathy, Guillain-Barré syndrome, ataxia, paresthesia, hypoesthesia, psychic disturbances (including psychotic reactions and confusion)

            Musculoskeletal: Tendinitis, tendon rupture; exacerbation of myasthenia gravis, elevated creatine kinase (CK), muscle spasms

            Hematologic: Neutropenia, leukopenia, agranulocytosis, hemolytic anemia (sometimes associated with glucose-6-phosphate dehydrogenase deficiency), thrombocytopenia

            Special senses: Hearing loss, tinnitus, diplopia, dysgeusia

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            Warnings

            Black Box Warnings

            Fluoroquinolones are associated with an increased risk of tendinitis and tendon rupture; this risk is further increased in older patients, usually those older than 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; avoid fluoroquinolones with known history of myasthenia gravis

            Contraindications

            Documented hypersensitivity

            All drugs or conditions that prolong QT interval

            Cautions

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

            Convulsions, increased intracranial pressure (including pseudotumor cerebri), and toxic psychosis reported with fluoroquinolones

            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

            Not drug of first choice in pediatrics due to increased incidence of adverse events compared to controls, including arthropathy; no data exist for dose for pediatric patients with renal impairment (ie, CrCl <50 mL/min)

            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

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            Pregnancy & Lactation

            Pregnancy Category: C; crosses placenta

            Lactation: Small amounts excreted in breast 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 bacterial DNA gyrase, which in turn inhibits DNA replication and transcription, DNA repair, recombination and transposicion, causing bacterial cell death

            Absorption

            Absorption: rapid, up to 40%

            Peak Plasma Time: 1-2 hr

            Distribution

            Protein Bound: 15%

            Metabolism

            Hepatic

            Enzymes inhibited: CYP1A2

            Elimination

            Half-Life: 3-4.5 hr

            Excretion: Feces 39%; urine 26-36%

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • Compare formulary status to other drugs in the same class.
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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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