What is Moxifloxacin?
Moxifloxacin injection is used to treat bacterial infections in many different parts of the body.
Moxifloxacin belongs to the class of medicines known as quinolone antibiotics. It works by killing bacteria or preventing their growth. However, Moxifloxacin will not work for colds, flu, or other virus infections.
Moxifloxacin is to be given only by or under the direct supervision of your doctor.
Moxifloxacin Tablets and I.V. are indicated for the treatment of adults ( ≥ 18 years of age) with infections caused by susceptible strains of the designated microorganisms in the conditions listed below. Acute Bacterial Sinusitis caused by Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis.
Acute Bacterial Exacerbation of Chronic Bronchitis caused by Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, methicillin-susceptible Staphylococcus aureus, or Moraxella catarrhalis.
Community Acquired Pneumonia caused by Streptococcus pneumoniae (including multi-drug resistant strains*), Haemophilus influenzae, Moraxella catarrhalis, methicillin-susceptible Staphylococcus aureus, Klebsiella pneumoniae, Mycoplasma pneumoniae, or Chlamydia pneumoniae.
* MDRSP, Multi-drug resistant Streptococcus pneumoniae includes isolates previously known as PRSP (Penicillin-resistant S. pneumoniae), and are strains resistant to two or more of the following antibiotics: penicillin (MIC ≥ 2 μg/mL), 2nd generation cephalosporins (e.g., cefuroxime), macrolides, tetracyclines, and trimethoprim/sulfamethoxazole.
Uncomplicated Skin and Skin Structure Infections caused by methicillin-susceptible Staphylococcus aureus or Streptococcus pyogenes.
Complicated Intra-Abdominal Infections including polymicrobial infections such as abscess caused by Escherichia coli, Bacteroides fragilis, Streptococcus anginosus, Streptococcus constellatus, Enterococcus faecalis, Proteus mirabilis, Clostridium perfringens, Bacteroides thetaiotaomicron, or Peptostreptococcus species.
Complicated Skin and Skin Structure Infections caused by methicillin-susceptible Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, or Enterobacter cloacae.
Appropriate culture and susceptibility tests should be performed before treatment in order to isolate and identify organisms causing infection and to determine their susceptibility to Moxifloxacin. Therapy with Moxifloxacin may be initiated before results of these tests are known; once results become available, appropriate therapy should be continued.
To reduce the development of drug-resistant bacteria and maintain the effectiveness of Moxifloxacin and other antibacterial drugs, Moxifloxacin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
How should I use Moxifloxacin?
Use Moxifloxacin drops as directed by your doctor. Check the label on the medicine for exact dosing instructions.
- Moxifloxacin drops is only for the eye. Do not get it in your nose or mouth.
- To use Moxifloxacin drops in the eye, first, wash your hands. Tilt your head back. Using your index finger, pull the lower eyelid away from the eye to form a pouch. Drop the medicine into the pouch and gently close your eyes. Immediately use your finger to apply pressure to the inside corner of the eyelid for 1 to 2 minutes. Do not blink. Remove excess medicine around your eye with a clean, dry tissue, being careful not to touch your eye. Wash your hands to remove any medicine that may be on them.
- To prevent germs from contaminating your medicine, do not touch the applicator tip to any surface, including the eye. Keep the container tightly closed.
- Do not wear contact lenses while you are using Moxifloxacin drops. Take care of your contact lenses as directed by the manufacturer. Check with your doctor before you use them.
- To clear up your infection completely, use Moxifloxacin drops for the full course of treatment. Keep using it even if you feel better in a few days.
- If you miss a dose of Moxifloxacin drops, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.
Ask your health care provider any questions you may have about how to use Moxifloxacin drops.
Uses of Moxifloxacin in details
Moxifloxacin is used to treat bacterial infections of the respiratory tract, infections of female upper genital tract, abdominal infections and infections of skin and eye.
Each tablet contains Moxifloxacin HCl 436.8 mg equivalent to Moxifloxacin 400 mg. It also contains croscarmellose sodium, lactose monohydrate, magnesium stearate, microcrystalline cellulose, hypromellose, macrogol 4000, titanium dioxide (E171) and ferric oxide (E172) as inactive constituents.
Each 250 mL solution for infusion contain Moxifloxacin HCl 436.8 mg equivalent to Moxifloxacin 400 mg. It also contains sodium chloride, 1N hydrochloric acid, 2N sodium hydroxide and water for injection. The solution for infusion (250 mL) contains sodium 34 mmol.
DOSAGE AND ADMINISTRATION
The dose of Moxifloxacin is 400 mg (orally or as an intravenous infusion) once every 24 hours. The duration of therapy depends on the type of infection as described below.
For Complicated Intra-Abdominal Infections, therapy should usually be initiated with the intravenous formulation.
When switching from intravenous to oral dosage administration, no dosage adjustment is necessary. Patients whose therapy is started with Moxifloxacin I.V. may be switched to Moxifloxacin Tablets when clinically indicated at the discretion of the physician.
Oral doses of Moxifloxacin should be administered at least 4 hours before or 8 hours after antacids containing magnesium or aluminum, as well as sucralfate, metal cations such as iron, and multivitamin preparations with zinc, or VIDEX® (didanosine) chewable/buffered tablets or the pediatric powder for oral solution.
Impaired Renal Function
No dosage adjustment is required in renally impaired patients, including those on either hemodialysis or continuous ambulatory peritoneal dialysis.
Impaired Hepatic Function
No dosage adjustment is recommended for mild, moderate, or severe hepatic insufficiency (Child-Pugh Classes A, B, or C).
Moxifloxacin I.V. should be administered by INTRAVENOUS infusion only. It is not intended for intra-arterial, intramuscular, intrathecal, intraperitoneal, or subcutaneous administration.
Moxifloxacin I.V. should be administered by intravenous infusion over a period of 60 minutes by direct infusion or through a Y-type intravenous infusion set which may already be in place. CAUTION: RAPID OR BOLUS INTRAVENOUS INFUSION MUST BE AVOIDED.
Since only limited data are available on the compatibility of Moxifloxacin intravenous injection with other intravenous substances, additives or other medications should not be added to Moxifloxacin I.V. or infused simultaneously through the same intravenous line. If the same intravenous line or a Y-type line is used for sequential infusion of other drugs, or if the “piggyback” method of administration is used, the line should be flushed before and after infusion of Moxifloxacin I.V. with an infusion solution compatible with Moxifloxacin I.V. as well as with other drug(s) administered via this common line.
Preparation for administration of Moxifloxacin I.V. injection premix in flexible containers:
- Close flow control clamp of administration set.
- Remove cover from port at bottom of container.
- Insert piercing pin from an appropriate transfer set (e.g. one that does not require excessive force, such as ISO compatible administration set) into port with a gentle twisting motion until pin is firmly seated.
NOTE: Refer to complete directions that have been provided with the administration set.
Tablet: For the following substances, absence of a clinically relevant interaction with Moxifloxacin was proven: Atenolol, ranitidine, calcium supplements, theophylline, oral contraceptives, glibenclamide, itraconazole, digoxin, morphine, probenecid. No dose adjustment is necessary for these drugs.
Antacids, Minerals and Multivitamins: Concomitant ingestion of Moxifloxacin with antacids, minerals and multivitamins may result in impaired absorption of Moxifloxacin after oral administration due to formation of chelate complexes with the multivalent cations contained in these preparations. This may lead to plasma concentrations considerably lower than desired. Hence, antacids, antiretroviral drugs (eg, didanosine) and other preparations containing magnesium or aluminium, sucralfate and agents containing iron or zinc should be administered at least 4 hours before or 2 hours after ingestion of an oral Moxifloxacin dose.
Ranitidine: The concomitant administration with ranitidine did not change the absorption characteristics of Moxifloxacin. Absorption parameters (Cmax, tmax, AUC) were comparable, indicating absence of an influence of gastric pH on Moxifloxacin uptake from the gastrointestinal tract.
Calcium Supplements: When given with high dose calcium supplements, only a slightly reduced rate of absorption was observed, while extent of absorption remained unaffected. The effect of high-dose calcium supplements on the absorption of Moxifloxacin is considered as clinically not relevant.
Theophylline: In accordance with in vitro data, no influence of Moxifloxacin on theophylline pharmacokinetics (and vice versa) at steady state was detected in humans, indicating that Moxifloxacin does not interfere with the 1A2 subtypes of the CYP450 enzymes.
Warfarin: No interaction during concomitant treatment with warfarin on pharmacokinetics, prothrombin time and other coagulation parameters has been observed.
Changes in International Normalized Ratio (INR): Cases of increased anticoagulant activity have been reported in patients receiving anticoagulants concurrently with antibiotics, including Moxifloxacin. The infectious disease (and its accompanying inflammatory process), age and general status of the patient are risk factors. Although an interaction between Moxifloxacin and warfarin was not demonstrated in clinical trials, INR monitoring should be performed and, if necessary, the oral anticoagulant dosage should be adjusted as appropriate.
Oral Contraceptives:No interaction has occured following concomitant oral administration of Moxifloxacin with oral contraceptives.
Antidiabetics: No clinically relevant interaction was seen between glibenclamide and Moxifloxacin.
Itraconazole: Exposure (AUC) to itraconazole was only marginally altered under concomitant Moxifloxacin treatment. Pharmacokinetics of Moxifloxacin were not significantly altered by itraconazole. No dose adjustment is necessary for itraconazole when given with Moxifloxacin and vice versa.
Digoxin: The pharmacokinetics of digoxin are not significantly influenced by Moxifloxacin (and vice versa). After repeated dosing in healthy volunteers, Moxifloxacin increased Cmax of digoxin by approximately 30% at steady state without affecting AUC or trough levels.
Parenteral administration of morphine with Moxifloxacin did not reduce the oral bioavailability of Moxifloxacin and only slighlty decreased Cmax (17 %).
Atenolol: The pharmacokinetics of atenolol are not significantly altered by Moxifloxacin. Following single dose administration in healthy subjects, AUC was marginally increased (by approximately 4%) and peak concentrations were decreased by 10%.
Probenecid: No significant effect on apparent total body clearance and renal clearance of Moxifloxacin was found in a clinical study investigating the impact of probenecid on renal excretion.
Charcoal: Concomitant dosing of charcoal and oral Moxifloxacin 400 mg reduced the systemic availability of the drug by >80% by preventing absorption in vivo. The application of activated charcoal in the early absorption phase prevents further increase of systemic exposure in cases of overdose.
After IV drug administration, carbo medicinalis only slightly reduces systemic exposure (approximately 20%).
Food and Dairy Products: Absorption of Moxifloxacin was not altered by food intake (including dairy products). Moxifloxacin can be taken independent from food intake.
Infusion: No interaction during concomitant treatment with warfarin, itraconazole, theophylline, digoxin and oral contraceptives.
Moxifloxacin side effects
Clinical efficacy trials enrolled over 9,200 Moxifloxacin orally and intravenously treated patients, of whom over 8,600 patients received the 400 mg dose. Most adverse events reported in Moxifloxacin trials were described as mild to moderate in severity and required no treatment. Moxifloxacin was discontinued due to adverse reactions thought to be drug-related in 2.9% of orally treated patients and 6.3 % of sequentially (intravenous followed by oral) treated patients. The latter studies were conducted in community acquired pneumonia and complicated skin and skin structure infections and complicated intra-abdominal infections with, in general, a sicker patient population compared to the tablet studies.
Adverse reactions, judged by investigators to be at least possibly drug-related, occurring in greater than or equal to 2% of Moxifloxacin treated patients were: nausea (6%), diarrhea (5%), dizziness (2%).
Additional clinically relevant uncommon events, judged by investigators to be at least possibly drug-related, that occurred in greater than or equal to 0.1% and less than 2% of Moxifloxacin treated patients were:
BODY AS A WHOLE: abdominal pain, headache, asthenia, dehydration (secondary to diarrhea or reduced fluid intake), injection site reaction (including phlebitis), malaise, moniliasis, pain, allergic reaction
CARDIOVASCULAR: cardiac arrhythmia (not otherwise specified), tachycardia, palpitation, vasodilation, QT interval prolonged
DIGESTIVE: vomiting, abnormal liver function test (increased transaminases, increased bilirubin), dyspepsia, dry mouth, flatulence, oral moniliasis, constipation, GGTP increased, anorexia, stomatitis, glossitis
HEMIC AND LYMPHATIC: leukopenia, eosinophilia, prothrombin decrease (prothrombin time prolonged/International Normalized Ratio (INR) increased), thrombocythemia
METABOLIC AND NUTRITIONAL: lactic dehydrogenase increased, amylase increased
MUSCULOSKELETAL: arthralgia, myalgia
NERVOUS SYSTEM: insomnia, nervousness, vertigo, somnolence, anxiety, tremor
SKIN/APPENDAGES: rash (maculopapular, purpuric, pustular), pruritus, sweating, urticaria
SPECIAL SENSES: taste perversion
UROGENITAL: vaginal moniliasis, vaginitis
Additional clinically relevant rare events, judged by investigators to be at least possibly drug-related, that occurred in less than 0.1% of Moxifloxacin treated patients were:
abnormal dreams, abnormal vision (visual disturbances temporally associated with CNS symptoms), agitation, amblyopia, amnesia, anemia, aphasia, arthritis, asthma, atrial fibrillation, back pain, chest pain, confusion, convulsions of various clinical manifestations (including grand mal convulsions), depersonalization, depression (potentially culminating in self-endangering behavior), dysphagia, dyspnea, ECG abnormal, emotional lability, face edema, gastritis, gastrointestinal disorder, hallucinations, hyperglycemia, hyperlipidemia, hypertension, hypertonia, hyperuricemia, hypesthesia, hypotension, incoordination, jaundice (predominantly cholestatic), kidney function abnormal, lab test abnormal (not specified), leg pain, paraesthesia, parosmia, pelvic pain, peripheral edema, photosensitivity/phototoxicity reactions, pseudomembranous colitis, prothrombin increase (prothrombin time decreased/International Normalized Ratio (INR) decreased), sleep disorders, speech disorders, supraventricular tachycardia, syncope, taste loss, tendon disorder, thinking abnormal, thrombocytopenia, thromboplastin decrease, tinnitus, tongue discoloration, ventricular tachycardia
Post-Marketing Adverse Event Reports:
Additional adverse events have been reported from worldwide post-marketing experience with Moxifloxacin. Because these events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. These events, some of them life-threatening, include anaphylactic reaction, anaphylactic shock, angioedema (including laryngeal edema), hepatic failure, including fatal cases, hepatitis (predominantly cholestatic), photosensitivity/phototoxicity reaction (see
Hypersensitivity to other quinolones, Moxifloxacin or any of the excipients of Moxifloxacin.
Use in pregnancy: The safe use of Moxifloxacin in human pregnancy has not been established. Reversible joint injuries are described in children receiving some quinolones. However, this effect has not been reported as occurring on exposed foetuses. Animal studies have shown reproductive toxicity. The potential risk for humans is unknown.
Consequently, the use of Moxifloxacin during pregnancy is contraindicated.
Use in lactation: As with other quinolones, Moxifloxacin has been shown to cause lesions in the cartilage of the weight bearing joints of immature animals. Preclinical evidence indicates that small amounts of Moxifloxacin may be secreted in human milk. There is no data available in lactating or nursing women. Therefore, the use of Moxifloxacin in nursing mothers is contraindicated.
Use in children: Safety and efficacy of Moxifloxacin in children and adolescents have not been established.
Active ingredient matches for Moxifloxacin:
|Unit description / dosage (Manufacturer)||Price, USD|
|Tablet; Oral; Moxifloxacin Hydrochloride 400 mg|
|Solution; Ophthalmic; Moxifloxacin Hydrochloride 0.5%|
|Vigamox 0.5% Solution 3ml Bottle||$ 90.72|
|Vigamox 0.5% eye drops||$ 27.22|
|Avelox 400 mg tablet||$ 16.68|
|Avelox abc pack 400 mg tablet||$ 16.35|
|Avelox iv 400 mg/250 ml||$ 0.17|
|Tablets; Oral; Moxifloxacin Hydrochloride 400 mg|
|MOXIFLOXACIN 400MG TABLET 1 strip / 5 tablets each (Jan Aushadhi)||$ 1.46|
|Moxifloxacin injection, solution 400 mg/250mL (Fresenius Kabi USA, LLC (US))|
|Moxifloxacin tablet, film coated 400 mg/1 (Major Pharmaceuticals (US))|
List of Moxifloxacin substitutes (brand and generic names):
|Moxiflox (Egypt, Philippines)|
|Moxiflox NA Eye Drop (InnoGen Pharmaceuticals)||$ 1.39|
|Moxifloxacin - 1 A Pharma (Germany)|
|Moxifloxacin AbZ (Germany)|
|Moxifloxacin AL (Germany)|
|Moxifloxacin Apotex (Belgium)|
|Moxifloxacin Aurobindo (Germany)|
|Moxifloxacin Fresenius Kabi (Sweden)|
|Moxifloxacin Heumann (Germany)|
|Moxifloxacin HEXAL (Germany)|
|Moxifloxacin Kabi (Germany)|
|Moxifloxacin Krka (Denmark)|
|Moxifloxacin Noridem (Poland)|
|Moxifloxacin Rivopharm (Switzerland)|
|Moxifloxacin Sabaa (Egypt)|
|Moxifloxacin Sandoz (Switzerland)|
|Moxifloxacin Spirig HC (Switzerland)|
|Moxifloxacin STADA (Germany)|
|Moxifloxacin TAD (Germany)|
|Moxifloxacin Teva (Israel)|
|Moxifloxacin-1A Pharma (Germany)|
|Moxifloxacin-Actavis (Denmark, Germany, Switzerland)|
|Moxifloxacin-ratiopharm (Germany, Hungary)|
|Moxifloxacina Aurobindo (Portugal)|
|Moxifloxacina La Santé (Colombia, Costa Rica, Ecuador, Panama)|
|Moxifloxacina MK (Colombia)|
|Moxifloxacina Vesalius (Colombia)|
|Moxifloxacine Double-E Pharma (Netherlands)|
|Moxifloxacine EG (Belgium, France)|
|Moxifloxacine Fresenius Kabi (Netherlands)|
|Moxifloxacine Krka (France)|
|Moxifloxacine Mylan (Belgium)|
|Moxifloxacine PCH (Netherlands)|
|Moxifloxacine Sandoz (France, Netherlands)|
|Moxifloxacine Teva (Belgium, Netherlands)|
|Moxifloxacino Actavis (Spain)|
|Moxifloxacino Apotex (Spain)|
|Moxifloxacino Aurobindo (Spain)|
|Moxifloxacino Cinfa (Spain)|
- PubChem. "moxifloxacin". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
- DrugBank. "moxifloxacin". http://www.drugbank.ca/drugs/DB00218 (accessed September 17, 2018).
- Wikipedia. "moxifloxacin: Link to the compound information in Wikipedia.". https://en.wikipedia.org/wiki/Moxifl... (accessed September 17, 2018).
- MeSH. "Anti-Bacterial Agents". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
- European Chemicals Agency - ECHA. "1-Cyclopropyl-6-fluoro-1,4-dihydro-8-methoxy-7-[(4aS,7aS)-octahydro-6H-pyrrolo[3,4-b]pyridin-6-yl]-4-oxo-3-quinolinecarboxylic acid: The information provided here is aggregated from the "Notified classification and labelling" from ECHA's C&L Inventory. ". https://echa.europa.eu/information-o... (accessed September 17, 2018).
ReviewsThe results of a survey conducted on ndrugs.com for Moxifloxacin are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Moxifloxacin. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.
1 consumer reported price estimatesWas the price you paid to purchase the drug reasonable? Did you feel it was expensive?
The below mentioned numbers have been reported by ndrugs.com website users about whether the Moxifloxacin drug is expensive or inexpensive. There is a mixed opinion among users. The rating about the cost of the drug depends on factors like which brand drug the patient purchased, how effective it was for the price paid, the country or place the drug is marketed, and the economic condition of the patient. The users who feel the drug is expensive can look for an alternative brand drug or a generic drug to save the cost.
2 consumers reported time for resultsTo what extent do I have to use Moxifloxacin before I begin to see changes in my health conditions?
As part of the reports released by ndrugs.com website users, it takes 1 week and a few days before you notice an improvement in your health conditions.
Please note, it doesn't mean you will start to notice such health improvement in the same time frame as other users. There are many factors to consider, and we implore you to visit your doctor to know how long before you can see improvements in your health while taking Moxifloxacin. To get the time effectiveness of using Moxifloxacin drug by other patients, please click here.
8 consumers reported age
There are no reviews yet. Be the first to write one!
Information checked by Dr. Sachin Kumar, MD Pharmacology