Moxifloxacin HCl

A to Z Drug Facts

  Action Interferes with microbial DNA synthesis.

  Indications Treatment of acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, community-acquired pneumonia, and uncomplicated skin and skin structure infections caused by susceptible organisms.

  Contraindications Hypersensitivity to moxifloxacin or any member of the fluoroquinolone class; tendonitis or tendon rupture associated with quinolone use.

  Route/Dosage

Acute Bacterial Sinusitis

ADULTS: IV/PO 400 mg/day for 10 days.

Community-Acquired Pneumonia

ADULTS: IV/PO 400 mg/day for 7 to 14 days.

Acute Bacterial Exacerbation of Chronic Bronchitis

ADULTS: IV/PO 400 mg/day for 5 days.

Uncomplicated Skin and Skin Structure Infections

ADULTS: IV/PO 400 mg/day for 7 days.

  Interactions

Antacids Containing Aluminum, Calcium, or Magnesium; Drug Formulations Containing Divalent or Trivalent Cations (eg, Didanosine); Metal Cations (eg, Iron); Multivitamins Containing Iron or Zinc; Sucralfate: May decrease the absorption of moxifloxacin. Cisapride; Class IA Antiarrhythmic Agents (eg, Procainamide, Quinidine); Class III Antiarrhythmic Agents (eg, Amiodarone, Sotalol); Erythromycin; Pentamidine; Phenothiazines; Tricyclic Antidepressants; any Other Drug Known to Prolong the QTc Interval: Increased risk of torsades de pointes or other ventricular arrhythmias.

  Lab Test Interferences None well documented.

  Adverse Reactions CARDIOVASCULAR: Tachycardia. CNS: Dizziness; headache. EENT: Taste perversion. GI: Nausea; diarrhea; abdominal pain; vomiting; dyspepsia. HEMATOLOGIC: Increased neutrophils and WBCs; decreased hemoglobin, amylase, RBCs, neutrophils, eosinophils, basophils, and PT ratio. HEPATIC: Abnormal LFTs. METABOLIC: Decreased glucose, bilirubin, and amylase.

  Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. CHILDREN: Safety and efficacy not established. Convulsions and Toxic Psychosis: CNS stimulation, lowering of the seizure threshold, and psychotic reactions have been reported with similar agents. Use with caution in patients with seizures or other CNS disorders. Hypersensitivity Reactions: Acute anaphylactic reactions and serious dermatologic hypersensitivity reactions have been reported with similar agents. Pseudomembranous Colitis: Consider possibility in patients with diarrhea. Tendonitis: Inflammation and rupture of tendons have been associated with the use of fluoroquinolone antibiotics. Superinfection: Use of antibiotics may result in bacterial or fungal overgrowth. QT Interval: QT interval may be prolonged in some patients; avoid use in patients with known prolongation of QT interval or uncorrected hypokalemia.

  Administration/Storage

• Store at room temperature in tightly closed container.
• Administer ³ 4 hr before or 8 hr after ingesting antacids containing magnesium or aluminum, sucralfate, iron, iron products, or other metal cations, multivitamin preparations with zinc, and didanosine.

IV

• Store at room temperature; do not regrigerate.
• Premixed flexible containers are for single use only; discard any unused portion.
• Administer IV moxifloxacin by IV infusion only.
• Administer IV infusion over a 60-min period by direct infusion or through a Y-type IV infusion set that may be in place already.
• Do not administer additives or other medication to IV moxifloxacin or infuse simultaneously through same IV line.
• Flush line before and after infusion of moxifloxacin IV with an infusion solution compatible with moxifloxacin.

  Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Monitor patient during first dose, as many adverse reactions, including hypersensitivity, can occur at this time.
• Monitor patient for potential signs and symptoms of hypersensitivity, and institute supportive measures. Discontinue moxifloxacin and notify health care provider at the first appearance of rash or any other sign of hypersensitivity. Treatment for severe reactions includes the use of epinephrine, oxygen, IV steroids, and airway management, including intubation.
• Monitor for symptoms of superinfections (eg, vaginitis, stomatitis, diarrhea). Notify health care provider if symptoms occur.
• Monitor patient for convulsions, dizziness, confusion, tremors, hallucinations, depression, or suicidal thoughts; if occurring, discontinue medication and refer for appropriate treatment.
• Monitor for signs of arthropathy, pain, inflammation, or rupture of a tendon; if present, discontinue medication.
• Monitor for ECG changes.
• Notify health care provider if symptoms of pseudomembranous colitis occur (eg, loose or foul-smelling stools).

  Patient/Family Education

• Instruct patient that moxifloxacin may be taken with or without food and to drink fluids liberally.
• Instruct patient that absorption of moxifloxacin can be reduced by milk, aluminum-, and magnesium-containing antacids, iron and zinc salts, and sucralfate, and to take moxifloxacin ³ 4 hr before or 8 hr after ingesting any of these products.
• Instruct patient regarding the signs and symptoms of hypersensitivity; discontinue the medication at once and seek treatment immediately if occurring.
• Instruct patient to discontinue treatment at sign of tendon pain or inflammation. Tell patient not to exercise and to rest until tendinitis has been ruled out.
• Inform patient that moxifloxacin may produce prolongation of the QTc interval on an ECG.
• Instruct patient to inform health are privider of any personal or family history of QTc prolongation or proarrhythmic conditions such as recent hypokalemia, significant bradycardia, acute myocardial ischemia, or history of convulsions.
• Instruct patient to inform health care provider of any prescription or otc medications concurrently being taken.
• Inform patient of the additive effects of other drugs such as cisapride, erythromycin, antipsychotics, and tricyclic antidepressants to further QTc prolongation.
• Instruct patient to contact primary caregiver if experiencing palpitations or fainting spells while taking moxifloxacin.
• Instruct patient to inform health care provider of any diarrhea, foul-smelling stools, stomatitis, vaginitis, or black “furry” appearance of tongue.
• Inform patient that moxifloxacin may cause dizziness and lightheadedness and to not drive an automobile, operate dangerous machinery, or engage in activities that require mental alertness and coordination.
• Avoid excessive sunlight and artificial UV light. If sunburn-like reaction or skin eruption occur, contact health care provider.
• Instruct patient to notify health care provider if becoming or planning to become pregnant or planning to breastfeed.
• Instruct patient to complete full course of therapy, even if symptoms of infection have resolved.
• Advise patient to consult health care provider before taking any other medication, including otc medication.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts