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moxifloxacin (Avelox, Vigamox)

Indications: - bacterial infections due to susceptible organisms - community-acquired pneumonia - sinusitis - acute exacerbation of chronic bronchitis - bacterial conjunctivitis (ophthalmic) [4] - complicated intra-abdominal infections [5] - pulmonary tuberculosis - plague [9] - abdominal abscess [8] - bacterial peritonitis - skin or soft tissue infection - eye infection - corneal ulcer [8] * on list on medications to avoid [10] - hepatoxicity & heart disease cited Contraindications: - NOT for use in urinary tract infections does not reach adequate concentrations in urine - widened QRS complex may increase risk of QT prolongation Dosage: - 400 mg QD - no dosage adjustment needed for elderly Tablets: 400 mg Injection: 400 mg in 250 mL of normal saline (yellow) Ophthalmic: (Vigamox) [4] Pharmacokinetics: - well absorbed from the gastrointestinal tract - absolute bioavailability ~90% with a high-fat meal - 30-50% bound to serum proteins - 5% metabolized via glucuronide & sulfate conjugation - CYP450 not involved in moxifloxacin metabolism - sulfate conjugate accounts for ~38% of the dose, & is eliminated primarily in the feces - glucuronide conjugate accounts for ~14% of dose, & is excreted exclusively in the urine Dosage adjustment in renal failure: - no dosage adjustment is necessary in patients with renal impairment, including patients on hemodialysis Antimicrobial activity: - Gram-positive (activity enhanced) Streptococcus pneumoniae - Anaerobes (activity enhanced) - Mycoplasma pneumoniae [8] - Chlamydophila pneumoniae - Haemophilus influenzae - Haemophilus parainfluenzae - Klebsiella - Klebsiella pneumoniae - Moraxella catarrhalis - Escherichia coli - Enterobacter [8] Adverse effects: - prolonged QT interval - acute liver injury (hepatotoxicity) [7] - heart disease ? [10] Drug interactions: - moxifloxacin does not inhibit CYP3A4, CYP2D6, CYP2C9, CYP2C19, or CYP1A2 Laboratory: - moxifloxacin in dried blood spot - moxifloxacin in serum/plasma Notes: Manufacturer: Bayer

Interactions

drug interactions drug adverse effects of fluoroquinolones

Specific

Moxifloxacin Ophthalmic

General

fluoroquinolone

Properties

INHIBITS: DNA gyrase

Database Correlations

PUBCHEM correlations

References

  1. Prescriber's Letter 7(2):7, Feb. 2000
  2. Norman, D, In: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  3. Prescriber's Letter 9(2):S1, Feb. 2002
  4. Prescriber's Letter 10(5):27 2003
  5. Malangoni MA et al, Randomized controlled trial of moxifloxacin compared with piperacillin-tazobactam and amoxicillin-clavulanate for the treatment of complicated intra-abdominal infections. Ann Surg 2006, 244:204 PMID: 16858182
  6. RxList: Avelox http://www.rxlist.com/avelox-drug.htm
  7. Paterson MJ et al Fluoroquinolone therapy and idiosyncrativ acute liver injury: a population-based study CMAJ August 13, 2012 PMID: 22891208 http://www.cmaj.ca/content/early/2012/08/13/cmaj.111823.full.pdf+html - Hayashi PH and Chalasani NP Liver injury in the elderly due to fluoroquinolones: Should these drugs be avoided? CMAJ August 13, 2012 PMID: 22891207 http://www.cmaj.ca/content/early/2012/08/13/cmaj.121270
  8. Deprecated Reference
  9. FDA News Release. May 8, 2015 FDA approves additional antibacterial treatment for plague http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm446283.htm
  10. Therapeutics Letter #108. Therapeutics Initiative Drugs to Avoid. http://www.ti.ubc.ca/2018/01/04/108-drugs-avoid/