Moxifloxacin Overdose

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What happens if I overdose Moxifloxacin?

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local, or emergency room immediately.

Proper storage of Moxifloxacinloxacin drops:

Store Moxifloxacinloxacin drops between 36 and 77 degrees F (2 and 25 degrees C) in a tightly closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Moxifloxacinloxacin drops out of the reach of children and away from pets.

Overdose of Moxifloxacin in details

infoWhen a dose is taken in higher dose than the recommended doses, it is called Overdose. Overdose always needs a clinical supervision. Any medicine or drug when consumed in Overdose produces untoward side effects on one or various organs in the body. A medicine is excreted in the kidney or metabolized in the liver most of the times. This process goes without any hurdles when taken in normal dose, but when taken in an overdose, the body is not able to metabolize it or send it out properly which causes the effects of anoverdose.
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Single oral overdoses up to 2.8 g were not associated with any serious adverse events. In the event of acute overdose, the stomach should be emptied and adequate hydration maintained. ECG monitoring is recommended due to the possibility of QT interval prolongation. The patient should be carefully observed and given supportive treatment. The administration of activated charcoal as soon as possible after oral overdose may prevent excessive increase of systemic Moxifloxacinloxacin exposure. About 3% and 9% of the dose of Moxifloxacinloxacin, as well as about 2% and 4.5% of its glucuronide metabolite are removed by continuous ambulatory peritoneal dialysis and hemodialysis, respectively.

Single oral Moxifloxacinloxacin doses of 2000, 500, and 1500 mg/kg were lethal to rats, mice, and cynomolgus monkeys, respectively. The minimum lethal intravenous dose in mice and rats was 100 mg/kg. Toxic signs after administration of a single high dose of Moxifloxacinloxacin to these animals included CNS and gastrointestinal effects such as decreased activity, somnolence, tremor, convulsions, vomiting and diarrhea.

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 Moxifloxacinloxacin 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 Moxifloxacinloxacin 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:

  1. Close flow control clamp of administration set.
  2. Remove cover from port at bottom of container.
  3. 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.

What should I avoid while taking Moxifloxacin?

Do not take Moxifloxacin with dairy products such as milk or yogurt, or with calcium-fortified juice. You may eat or drink these products as part of a regular meal, but do not use them alone when taking Moxifloxacin. They could make the medication less effective.

You may be taking certain other medicines that should not be taken at the same time as Moxifloxacin. Avoid taking the following medicines within 8 hours before or 4 hours after you take Moxifloxacin. These other medicines can make Moxifloxacinloxacin much less effective when taken at the same time:

  • antacids that contain magnesium or aluminum (such as Maalox, Mylanta, or Rolaids), or the ulcer medicine sucralfate (Carafate);

  • didanosine (Videx) powder or chewable tablets; or

  • vitamin or mineral supplements that contain aluminum, iron, magnesium, or zinc.

Moxifloxacin may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Avoid exposure to sunlight or tanning beds. Moxifloxacin can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Call your doctor if you have severe burning, redness, itching, rash, or swelling after being in the sun.

Moxifloxacin warnings

infoWarnings are a mix of Precautions. Contraindications and interactions and serious harmful effects associated with the medicine intake. A diabetic or Hypertensive patient need to be warned about few drug interactions. A known hypersensitivity patient needs to be careful about the reactions or anaphylactic shock. A pregnant woman or a breastfeeding woman should be warned of certain medications. A Hepatitis [liver disease] patient or a cardiac patient should avoid few drugs.
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You should not use this medication if you are allergic to Moxifloxacinloxacin or similar antibiotics such as ciprofloxacin (Cipro), levofloxacin (Levaquin), ofloxacin (Floxin), norfloxacin (Noroxin), lomefloxacin (Maxaquin), and others.

Before taking Moxifloxacinloxacin, tell your doctor if you have kidney or liver disease, myasthenia gravis, joint problems, diabetes, a history of seizures, low levels of potassium in your blood (hypokalemia), or a personal or family history of "Long QT syndrome."

Avoid taking antacids, vitamin or mineral supplements, sucralfate (Carafate), or didanosine (Videx) powder or chewable tablets within 8 hours before or 4 hours after you take Moxifloxacinloxacin. These other medicines can make Moxifloxacinloxacin much less effective when taken at the same time.

Taking Moxifloxacinloxacin can make your skin more sensitive to sunlight. Avoid exposure to sunlight, sun lamps, or tanning beds.

Moxifloxacinloxacin may cause swelling or tearing of a tendon (the fiber that connects bones to muscles in the body), especially in the Achilles’ tendon of the heel. These effects may be more likely to occur if you are over 60, if you take an oral steroid medication, or if you have had a kidney, heart, or lung transplant. Stop taking Moxifloxacinloxacin and call your doctor at once if you have sudden pain, swelling, tenderness, stiffness, or movement problems in any of your joints. Rest the joint until you receive medical care or instructions. Do not share this medication with another person (especially a child), even if they have the same symptoms you do.

FDA pregnancy category C: It is not known whether Moxifloxacinloxacin is harmful to an unborn baby. Do not use Moxifloxacinloxacin without telling your doctor if you are pregnant. Tell your doctor if you become pregnant during treatment. Moxifloxacinloxacin passes into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

Moxifloxacinloxacin can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What should I discuss with my healthcare provider before taking Moxifloxacin?

Some medical conditions may interact with Moxifloxacinloxacin tablets. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines, foods, or other substances
  • if you have a stomach infection, liver problems, brain or nervous system problems, increased pressure in the brain, Alzheimer disease, or brain blood vessel problems
  • if you have a history of severe or persistent diarrhea, diabetes or high blood sugar, low blood sugar, seizures, skin sensitivity to the sun, low blood potassium levels, irregular heartbeat (eg, QT prolongation) or other heart problems (eg, fast or slow heartbeat, angina, heart failure), or heart attack, or if you have a family member with a history of irregular heartbeat (QT prolongation)
  • if you have a history of joint or tendon problems; rheumatoid arthritis; kidney problems or decreased kidney function; or a heart, kidney, or lung transplant
  • if you participate in strenuous physical work or exercise
  • if you take any medicine that may increase the risk of a certain type of irregular heartbeat (prolonged QT interval). Check with your doctor or pharmacist if you are unsure if any of your medicines may increase the risk of this type of irregular heartbeat

Some MEDICINES MAY INTERACT with Moxifloxacinloxacin tablets. Tell your health care provider if you are taking any other medicines, especially any of the following:

  • Corticosteroids (eg, prednisone) because the risk of tendon problems may be increased
  • Antiarrhythmics (eg, amiodarone, dofetilide, dronedarone, procainamide, quinidine, sotalol), cisapride, diuretics (eg, furosemide, hydrochlorothiazide), erythromycin, medicines to help mental or mood problems, or tricyclic antidepressants (eg, amitriptyline) because the risk of severe and possibly fatal irregular heartbeat may be increased
  • Insulin or oral diabetes medicines (eg, glyburide) because the risk of high or low blood sugar may be increased
  • Warfarin because the risk of bleeding may be increased by Moxifloxacinloxacin tablets
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen, ketorolac) because they may increase the risk of Moxifloxacinloxacin tablets's side effects

This may not be a complete list of all interactions that may occur. Ask your health care provider if Moxifloxacinloxacin tablets may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

Moxifloxacin precautions

infoCertain people who are very sick or very old or who are sensitive show an exacerbation of side effect of the drug which can turn dangerous at times. So, it is very important to remember the precautions while taking the medicine. Pregnancy and Breastfeeding are also special categories wherein extra care or precaution is needed when taking a drug. Few patients may have a hypersensitivity reaction to few medications, and that can be life-threatening rarely. Penicillin hypersensitivity is one example. Diarrhea, rashes are few other symptoms which need a watch. A patient with other co-existing diseases like liver disease, heart disease, kidney disease should take special precautions.
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Tendinopathy and Tendon Rupture

Fluoroquinolones, including Moxifloxacinloxacin hydrochloride, are associated with an increased risk of tendinitis and tendon rupture in all ages. This adverse reaction most frequently involves the Achilles tendon, and rupture of the Achilles tendon may require surgical repair. Tendinitis and tendon rupture in the rotator cuff (the shoulder), the hand, the biceps, the thumb, and other tendon sites have also been reported. The risk of developing fluoroquinolone-associated tendinitis and tendon rupture is further increased in older patients usually over 60 years of age, in patients taking corticosteroid drugs, and in patients with kidney, heart or lung transplants. Factors, in addition to age and corticosteroid use, that may independently increase the risk of tendon rupture include strenuous physical activity, renal failure, and previous tendon disorders such as rheumatoid arthritis. Tendinitis and tendon rupture have also occurred in patients taking fluoroquinolones who do not have the above risk factors. Tendon rupture can occur during or after completion of therapy; cases occurring up to several months after completion of therapy have been reported. Moxifloxacinloxacin hydrochloride tablets should be discontinued if the patient experiences pain, swelling, inflammation or rupture of a tendon. Patients should be advised to rest at the first sign of tendinitis or tendon rupture, and to contact their healthcare provider regarding changing to a non-quinolone antimicrobial drug.

Exacerbation of Myasthenia Gravis

Fluoroquinolones, including Moxifloxacinloxacin hydrochloride, have neuromuscular blocking activity and may exacerbate muscle weakness in persons with myasthenia gravis. Postmarketing serious adverse reactions, including deaths and requirement for ventilatory support, have been associated with fluoroquinolone use in persons with myasthenia gravis. Avoid Moxifloxacinloxacin hydrochloride in patients with known history of myasthenia gravis.

QT Prolongation

Moxifloxacinloxacin hydrochloride has been shown to prolong the QT interval of the electrocardiogram in some patients. Following oral dosing with 400 mg of Moxifloxacinloxacin hydrochloride the mean (± SD) change in QTc from the pre-dose value at the time of maximum drug concentration was 6 msec (± 26) (n = 787). Following a course of daily intravenous dosing (400 mg; 1 hour infusion each day) the mean change in QTc from the Day 1 pre-dose value was 10 msec (±22) on Day 1 (n=667) and 7 msec (± 24) on Day 3 (n = 667).

Avoid Moxifloxacinloxacin hydrochloride tablets in patients with the following risk factors due to the lack of clinical experience with the drug in these patient populations:

  • Known prolongation of the QT interval
  • Ventricular arrhythmias including torsade de pointes because QT prolongation may lead to an increased risk for these conditions
  • Ongoing proarrhythmic conditions, such as clinically significant bradycardia and acute myocardial ischemia,
  • Uncorrected hypokalemia or hypomagnesemia
  • Class IA (for example, quinidine, procainamide) or Class III (for example, amiodarone, sotalol) antiarrhythmic agents
  • Other drugs that prolong the QT interval such as cisapride, erythromycin, antipsychotics, and tricyclic antidepressants

Elderly patients using intravenous Moxifloxacinloxacin hydrochloride may be more susceptible to drug-associated QT prolongation.

In patients with mild, moderate, or severe liver cirrhosis, metabolic disturbances associated with hepatic insufficiency may lead to QT prolongation. Monitor ECG in patients with liver cirrhosis treated with Moxifloxacinloxacin hydrochloride.

The magnitude of QT prolongation may increase with increasing concentrations of the drug or increasing rates of infusion of the intravenous formulation. Therefore the recommended dose or infusion rate should not be exceeded.

In premarketing clinical trials, the rate of cardiovascular adverse reactions was similar in 798 Moxifloxacinloxacin hydrochloride and 702 comparator treated patients who received concomitant therapy with drugs known to prolong the QTc interval. No excess in cardiovascular morbidity or mortality attributable to QTc prolongation occurred with Moxifloxacinloxacin hydrochloride treatment in over 15,500 patients in controlled clinical studies, including 759 patients who were hypokalemic at the start of treatment, and there was no increase in mortality in over 18,000 Moxifloxacinloxacin hydrochloride tablet treated patients in a postmarketing observational study in which ECGs were not performed.

Hypersensitivity Reactions

Serious anaphylactic reactions, some following the first dose, have been reported in patients receiving quinolone therapy, including Moxifloxacinloxacin hydrochloride. Some reactions were accompanied by cardiovascular collapse, loss of consciousness, tingling, pharyngeal or facial edema, dyspnea, urticaria, and itching. Discontinue Moxifloxacinloxacin hydrochloride tablets at the first appearance of a skin rash or any other sign of hypersensitivity.

Other Serious and Sometimes Fatal Reactions

Other serious and sometimes fatal reactions, some due to hypersensitivity, and some due to uncertain etiology, have been reported in patients receiving therapy with fluoroquinolones, including Moxifloxacinloxacin hydrochloride. These reactions may be severe and generally occur following the administration of multiple doses. Clinical manifestations may include one or more of the following:

  • Fever, rash, or severe dermatologic reactions (for example, toxic epidermal necrolysis, Stevens- Johnson syndrome)
  • Vasculitis; arthralgia; myalgia; serum sickness
  • Allergic pneumonitis
  • Interstitial nephritis; acute renal insufficiency or failure
  • Hepatitis; jaundice; acute hepatic necrosis or failure
  • Anemia, including hemolytic and aplastic; thrombocytopenia, including thrombotic thrombocytopenic purpura; leukopenia; agranulocytosis; pancytopenia; and/or other hematologic abnormalities

Discontinue Moxifloxacinloxacin hydrochloride tablets immediately at the first appearance of a skin rash, jaundice, or any other sign of hypersensitivity and institute supportive measures.

Central Nervous System Effects

Fluoroquinolones, including Moxifloxacinloxacin hydrochloride, may cause central nervous system (CNS) reactions, including: nervousness, agitation, insomnia, anxiety, nightmares or paranoia.

Convulsions and increased intracranial pressure (including pseudotumor cerebri) have been reported in patients receiving fluoroquinolones, including Moxifloxacinloxacin hydrochloride. Moxifloxacinloxacin hydrochloride tablets may also cause central nervous system (CNS) reactions including: dizziness, confusion, tremors, hallucinations, depression, and, suicidal thoughts or acts. These adverse reactions may occur following the first dose. If these reactions occur in patients receiving Moxifloxacinloxacin hydrochloride tablets, the drug should be discontinued and appropriate measures instituted. As with all fluoroquinolones, use Moxifloxacinloxacin hydrochloride tablets when the benefits of treatment exceed the risks in patients with known or suspected CNS disorders (for example, severe cerebral arteriosclerosis, epilepsy) or in the presence of other risk factors that may predispose to seizures or lower the seizure threshold.

Clostridium Difficile-Associated Diarrhea

Clostridium difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including Moxifloxacinloxacin hydrochloride, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.

C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibacterial use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.

If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated.

Peripheral Neuropathy

Cases of sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias and weakness have been reported in patients receiving fluoroquinolones including Moxifloxacinloxacin hydrochloride. Symptoms may occur soon after initiation of Moxifloxacinloxacin hydrochloride tablets and may be irreversible. Moxifloxacinloxacin hydrochloride tablets should be discontinued immediately if the patient experiences symptoms of peripheral neuropathy including pain, burning, tingling, numbness, and/or weakness or other alterations of sensation including light touch, pain, temperature, position sense, and vibratory sensation.

Arthropathic Effects in Animals

In immature dogs, oral administration of Moxifloxacinloxacin hydrochloride tablets caused lameness. Histopathological examination of the weight-bearing joints of these dogs revealed permanent lesions of the cartilage. Related quinolone- class drugs also produce erosions of cartilage of weight-bearing joints and other signs of arthropathy in immature animals of various species.

Blood Glucose Disturbances

​As with all fluoroquinolones, disturbances in blood glucose, including both hypoglycemia and hyperglycemia have been reported with Moxifloxacinloxacin hydrochloride. In Moxifloxacinloxacin hydrochloride-treated patients, dysglycemia occurred predominantly in elderly diabetic patients receiving concomitant treatment with an oral hypoglycemic agent (for example, sulfonylurea) or with insulin. In diabetic patients, careful monitoring of blood glucose is recommended. If a hypoglycemic reaction occurs, Moxifloxacinloxacin hydrochloride tablets should be discontinued and appropriate therapy should be initiated immediately.

Photosensitivity/Phototoxicity

Moderate to severe photosensitivity/phototoxicity reactions, the latter of which may manifest as exaggerated sunburn reactions (for example, burning, erythema, exudation, vesicles, blistering, edema) involving areas exposed to light (typically the face, "V" area of the neck, extensor surfaces of the forearms, dorsa of the hands), can be associated with the use of fluoroquinolones, including Moxifloxacinloxacin hydrochloride, after sun or UV light exposure. Therefore, excessive exposure to these sources of light should be avoided. Moxifloxacinloxacin hydrochloride tablets should be discontinued if phototoxicity occurs.

Development of Drug Resistant Bacteria

Prescribing Moxifloxacinloxacin hydrochloride tablets in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.

What happens if I miss a dose of Moxifloxacin?

infoWhen you miss a dose, you should take it as soon as you remember, but you should take care that it should be well spaced from the next dose. You should not take an extra dose at the time of the second dose as it will become a double dose. The double dose can give unwanted side effects, so be careful. In chronic conditions or when you have a serious health issue, if you miss a dose, you should inform your health care provider and ask his suggestion.

Apply the missed dose as soon as you remember. However, if it is almost time for the next regularly scheduled dose, skip the missed dose and apply the next one as directed. Do not use a double dose of this medication.



References

  1. DrugBank. "moxifloxacin". http://www.drugbank.ca/drugs/DB00218 (accessed September 18, 2017).
  2. MeSH. "Anti-Bacterial Agents". https://www.ncbi.nlm.nih.gov/mesh/680009... (accessed September 18, 2017).

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