Medical term:
Avelox
moxifloxacin hydrochloride
Pharmacologic class: Fluoroquinolone
Therapeutic class: Anti-infective
Pregnancy risk category C
FDA Box Warning
• Fluoroquinolones for systemic use are associated with an increased risk of tendinitis and tendon rupture in all ages. This risk is further increased in patients usually over age 60, with concomitant use of corticosteroids, and in kidney, heart, and lung transplant recipients.
• Fluoroquinolones, including Avelox, may exacerbate muscle weakness in patients with myasthenia gravis. Avoid Avelox in patients with known history of myasthenia gravis.
Action
Selectively inhibits DNA synthesis by disrupting DNA replication and transcription and suppressing protein synthesis, causing bacterial cell death
Availability
Injection (premixed): 400 mg/250-ml bag
Ophthalmic solution: 5% (3 ml in 4-ml bottle)
Tablets: 400 mg
Indications and dosages
➣ Acute bacterial sinusitis
Adults: 400 mg P.O. or I.V. q 24 hours for 10 days
➣ Acute bacterial exacerbation of chronic bronchitis
Adults: 400 mg P.O. or I.V. q 24 hours for 5 days
➣ Community-acquired pneumonia
Adults: 400 mg P.O. or I.V. q 24 hours for 7 to 14 days
➣ Uncomplicated skin and skin-structure infections
Adults: 400 mg P.O. or I.V. q 24 hours for 7 days
➣ Bacterial conjunctivitis
Adults: Instill one drop of Vigamox ophthalmic solution into affected eye t.i.d. for 7 days or one drop of Moxeza ophthalmic solution into affected eye b.i.d. for 7 days.
Contraindications
• Hypersensitivity to drug, its components, or other fluoroquinolones
Precautions
Use cautiously in:
• known or suspected CNS disorders that may predispose to seizures or lower seizure threshold, peripheral neuropathy, diarrhea, renal impairment, cirrhosis, bradycardia, acute myocardial ischemia, dialysis
• prolonged QTc interval, hypokalemia, and drugs that prolong QT interval
• history of myasthenia gravis (avoid use)
• elderly patients
• pregnant or breastfeeding patients (safety not established except in post-exposure inhalation anthrax)
• children younger than age 18 (except in post-exposure inhalation anthrax)
• children younger than age 4 months (Moxeza ophthalmic use) or age 1 (Vigamox ophthalmic use).
Administration
• Give premixed I.V. dose over 60 minutes. Avoid bolus or rapid infusion.
• Don't mix with other drugs in same I.V. line.
• Know that although milk or yogurt may impair absorption of P.O. moxifloxacin, drug may be given with other calcium products.
Adverse reactions
CNS: dizziness, drowsiness, headache, confusion, light-headedness, insomnia, agitation, hallucinations, acute psychoses, tremor, seizures
CV: hypertension, vasodilation, tachycardia, prolonged QT interval, arrhythmias
EENT: conjunctivitis; decreased visual acuity; keratitis; eye dryness, discomfort, pain, pruritus, and hyperemia; subconjunctival hemorrhage; tearing; otitis media; pharyngitis; rhinitis (all with ophthalmic solution)
GI: nausea, diarrhea, abdominal pain, pseudomembranous colitis
GU: vaginitis
Hematologic: eosinophilia, thrombocytopenia, leukopenia
Musculoskeletal: joint pain, tendinitis, tendon rupture
Respiratory: increased cough (with ophthalmic solution)
Skin: rash, photosensitivity, phototoxicity, Stevens-Johnson syndrome
Other: altered taste (with ophthalmic solution), phlebitis at I.V. site, superinfection, fever, exacerbation of myasthenia gravis, hypersensitivity reactions including anaphylaxis
Interactions
Drug-drug. Amiodarone, bepridil, disopyramide, erythromycin, pentamidine, phenothiazines, pimozide, procainamide, quinidine, sotalol, tricyclic antidepressants: increased risk of serious adverse cardiovascular reactions
Antacids, bismuth subsalicylate, iron salts, sucralfate, zinc salts: decreased moxifloxacin absorption
Nonsteroidal anti-inflammatory drugs: increased risks of CNS stimulation and seizures
Theophylline: increased theophylline blood level and possible toxicity
Warfarin and its derivatives: enhanced anticoagulant effect
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, lactate dehydrogenase, platelets: increased levels
Drug-food. Concurrent tube feedings, milk, yogurt: impaired absorption of P.O. moxifloxacin
Drug-herbs. Dong quai, St. John's wort: phototoxicity
Fennel: decreased moxifloxacin absorption
Drug-behaviors. Sun exposure: phototoxicity
Patient monitoring
☞ Watch for hypersensitivity reaction (such as anaphylaxis) and other allergic reactions, which may occur after initial dose. Discontinue drug at first sign of rash, jaundice, or other signs or symptoms of hypersensitivity.
• Monitor cardiovascular and neurologic status closely.
☞ Stay alert for tendinitis and Achilles tendon rupture. Discontinue drug if tendon pain or inflammation occurs.
• Monitor CBC and liver function tests.
• Assess GI status. Report signs or symptoms of pseudomembranous colitis. Be aware that if pseudomembranous colitis is suspected or confirmed, ongoing antibiotic use not directed against Clostridium difficile may need to be discontinued.
• Watch closely for superinfection.
• Discontinue drug if peripheral neuropathy or phototoxicity occurs.
• Closely monitor prothrombin time, International Normalized Ratio, or other suitable anticoagulation tests if drug is given concomitantly with warfarin or its derivatives.
Patient teaching
• Advise patient to take tablets once a day with or without food, 4 hours before or 8 hours after antacids, multivitamins, sucralfate, or preparations containing aluminum, magnesium, iron, or zinc.
☞ Tell patient drug may cause serious allergic reactions even several days after therapy begins. Advise him to stop taking drug and report these reactions immediately.
☞ Urge patient to stop taking drug and promptly report tendon pain, diarrhea with blood or pus, and signs and symptoms of superinfection.
• Teach patient how to use eye drops. Caution him to avoid touching applicator tip to eye, finger, or other object.
• Instruct patient being treated for bacterial conjunctivitis not to wear contact lenses.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.
moxifloxacin
(mox-i-flox-a-sin) ,Avelox
(trade name)Classification
Therapeutic: anti infectivesPharmacologic: fluoroquinolones
Indications
- Respiratory tract infections, including acute sinusitis, acute exacerbations of chronic bronchitis, and community-acquired pneumonia (CAP),
- Uncomplicated and complicated skin and skin structure infections,
- Intra-abdominal infections.
Action
Therapeutic effects
- Staphylococcus aureus,
- Streptococcus pyogenes,
- Streptococcus pneumoniae (including multi-drug resistant strains).
- Escherichia coli,
- Klebsiella pneumoniae,
- Haemophilus influenzae,
- Haemophilus parainfluenzae,
- Moraxella catarrhalis.
- Chlamydophylia pneumoniae,
- Mycoplasma pneumoniae.
Pharmacokinetics
Time/action profile (blood levels)
| ROUTE | ONSET | PEAK | DURATION |
| PO | within 1 hr | 1–3 hr | 24 hr |
| IV | rapid | end of infusion | 24 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- elevated intracranial pressure (including pseudotumor cerebri) (life-threatening)
- seizures (life-threatening)
- agitation
- anxiety
- confusion
- depression
- dizziness
- hallucinations
- headache
- insomnia
- nightmares
- paranoia
- tremor
Cardiovascular
- torsade de pointes (life-threatening)
- QT interval prolongation
Gastrointestinal
- pseudomembranous colitis (life-threatening)
- diarrhea (most frequent)
- nausea (most frequent)
- abdominal pain
- dyspepsia
- ↑ liver enzymes
- vomiting
Dermatologic
- stevens-johnson syndrome (life-threatening)
- photosensitivity
Musculoskeletal
- tendinitis
- tendon rupture
Neurologic
- peripheral neuropathy
Miscellaneous
- hypersensitivity reactions including anaphylaxis (life-threatening)
Interactions
Drug-Drug interaction
Concurrent use ofamiodarone, disopyramide, erythromycin, procainamide, dofetilide, quinidine, some antipsychotics, sotalol, or tricyclic antidepressants ↑ risk of torsade de pointes in susceptible individuals (avoid concurrent use). May ↑ risk of bleeding with warfarin.Iron supplements and aluminum-, calcium-, or magnesium-containing antacids, bismuth subsalicylate, sucralfate, multivitamins with zinc, or didanosine (chewable/buffered tablets of pediatric suspension) ↓ absorption (take at least 2 hr before or 4 hr).Serum levels of fluoroquinolones may be ↓ by antineoplastics.Cimetidine may interfere with elimination of fluoroquinolones.May ↑ risk of nephrotoxicity from cyclosporine.Concurrent corticosteroid therapy may ↑ risk of tendon rupture.Route/Dosage
Availability
Nursing implications
Nursing assessment
- Assess for infection (vital signs, appearance of sputum, WBC) at beginning of and during therapy.
- Obtain specimens for culture and sensitivity prior to initiating therapy. First dose may be given before receiving results.
- Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue drug and notify physician or other health care professional immediately if these problems occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of an anaphylactic reaction.
- Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
- Assess for rash periodically during therapy. May cause Stevens-Johnson syndrome. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis and/or eosinophilia.
- Assess for signs and symptoms of peripheral neuropathy (pain, burning, tingling, numbness, and/or weakness or other alterations of sensation including light touch, pain, temperature, position sense, and vibratory sensation) periodically during therapy. Symptoms may be irreversible; discontinue moxifloxacin if symptoms occur.
- Lab Test Considerations: Monitor for ↑ serum AST, ALT, LDH, bilirubin, and alkaline phosphatase.
- May cause hyperglycemia, hyperlipidemia, and altered prothrombin time.
- May also cause ↑ or ↓ glucose.
Potential Nursing Diagnoses
Risk for infection (Patient/Family Teaching)Implementation
- Oral: May be administered without regard to meals. Products or foods containing calcium, magnesium, aluminum, iron, or zinc should not be ingested for 4 hr before and 8 hr after administration.
Intravenous Administration
- Intermittent Infusion: Diluent: Premixed bags are diluted in sodium chloride 0.8% and should not be further diluted. Use transfer set whose piercing pin does not require excessive force; insert with a gentle twisting motion until pin is firmly seated. Concentration: 1.6 mg/mL.
- Rate: Administer over 60 min. Avoid rapid or bolus infusion.
- Intermittent Infusion: Diluent: Premixed bags are diluted in sodium chloride 0.8% and should not be further diluted. Use transfer set whose piercing pin does not require excessive force; insert with a gentle twisting motion until pin is firmly seated. Concentration: 1.6 mg/mL.
- Rate: Administer over 60 min. Avoid rapid or bolus infusion.
- Y-Site Compatibility: alemtuzumab, amifostine, anidulafungin, argatroban, bivalirudin, bleomycin, bumetanide, busulfan, calcium acetate, caclium chloride, calcium gluconate, carboplatin, carmustine, caspofungin, ceftaroline, chlorpromazine, cisatracurium, cisplatin, cyclophosphamide, cyclosporine, cytarabine, dacarbacine, dactinomycin, daptomycin, daunorubicin, dexmedetonidine, dexrazoxane, digoxin, diltiazem, diphenhydramine, dobutamine, doripenem, ertapenem, mycophenolate, docetaxel, dolasetron, dopamine, doripenem, doxacurium, doxorubicin, doxorubicin liposome, droperidol, enalaprilat, epinephrine, epirubicin, ertapenem, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fludarabine, gallium nitrate, gemcitabine, glycopyrrolate, granisetron, haloperidol, heparin, hetastarch, hydralazine, hydrocortisone sodium succinate, idarubicin, insulin, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, lidocaine, magnesium sulfate, mannitol, mechlorethamine, melphalan, mesna, methotrexate, methyldopate, methylprednisolone, metoclopramide, metoprolol, minrinone, mitomycin, mitoxantrone, mivacuroum, mycophenolate, naloxone, nesiritide, nicardipine, nitroglycerin, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pemetrexed, phentolamine, phenylephrine, potassium acetate, potassium chloride, potassium phosphates, procainamide, prochlorperazine, promethazine, propranolol, ranitidine, rocuronium, sodium acetate, sodium bicarbonate, sodium phosphate, streptozocin, succinylcholine, tacrolimus, teniposide, theophylline, thiotepa, tigecycline, tirofiban, topotecan, vasopressin, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, zoledronic acid
- Y-Site Incompatibility: allopurinol, aminophylline, amphotericin B lipid complex, dantrolene, fluorouracil, fosphenytoin, furosemide, nitroprusside, pantoprazole, phenytoin, vancomycin, voriconazole
Patient/Family Teaching
- Instruct patient to take medication as directed at evenly spaced times and to finish drug completely, even if feeling better. Take missed doses as soon as possible, unless almost time for next dose. Do not double doses. Advise patient that sharing of this medication may be dangerous.
- Encourage patient to maintain a fluid intake of at least 1500–2000 mL/day to prevent crystalluria.
- Advise patient that antacids or medications containing calcium, magnesium, aluminum, iron, or zinc will decrease absorption and should not be taken within 4 hr before or 8 hr after taking this medication.
- May cause dizziness and drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
- Advise patient to notify health care professional of any personal or family history of QTc prolongation or proarrhythmic conditions such as recent hypokalemia, significant bradycardia, or recent myocardial ischemia or if fainting spells or palpitations occur. Patients with this history should not receive moxifloxacin.
- Caution patient to use sunscreen and protective clothing to prevent phototoxicity reactions during and for 5 days after therapy. Notify health care professional if a sunburn-like reaction or skin eruption occurs.
- Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
- Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools).
- Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
- Instruct patient to notify health care professional immediately if rash, jaundice, sign of hypersensitivity, or tendon (shoulder, hand, Achilles, and other) pain, swelling, or inflammation occurs. If tendon symptoms occur, avoid exercise and use of the affected area. Increased risk in >65 yr old, kidney, heart and lung transplant recipients, and patients taking corticosteroids concurrently. Therapy should be discontinued.
Evaluation/Desired Outcomes
- Resolution of the signs and symptoms of bacterial infection. Time for complete resolution depends on organism and site of infection.
Avelox
(ä′və-lŏks′)Avelox
A brand name for MOXIFLOXACIN.Latest Searches:
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