Moxifloxacin has also been associated with prolongation of the QT interval. Sulindac: (Moderate) Use quinolones and nonsteroidal anti-inflammatory drugs (NSAIDs) concomitantly with caution due to potential increased risk of CNS stimulation and convulsive seizures. NSAIDs in combination with very high doses of quinolones have been shown to provoke convulsions in preclinical studies and postmarketing. Lefamulin: (Major) Avoid coadministration of lefamulin with moxifloxacin as concurrent use may increase the risk of QT prolongation. but their clinical significance in ophthalmic infections is unknown. [61094] [65619], 10 mg/kg/dose (Max: 400 mg/dose) PO once daily or 5 days/week. Drugs with a possible risk for QT prolongation and torsade de pointes (TdP) that should be used cautiously and with close monitoring with eliglustat include moxifloxacin. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. Only a few patients had a history of hypersensitivity reactions. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. The use of any information on this site is solely at your own risk. Prolongation of the QT interval has also been reported with moxifloxacin. Although data are limited, the manufacturer of efavirenz recommends an alternative antiretroviral be considered for patients receiving medications with a known risk for TdP. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. Toremifene: (Major) Avoid coadministration of moxifloxacin with toremifene if possible due to the risk of additive QT prolongation. Each mL of Vigamox solution contains 5.45 mg moxifloxacin hydrochloride, equivalent to 5 mg moxifloxacin base. Patients should be advised not to wear contact lenses if they have signs or symptoms of bacterial conjunctivitis. As with other anti-infectives, prolonged use may result in overgrowth of non-susceptible organisms, including fungi. The concomitant use of dronedarone with other drugs that prolong the QTc may induce TdP and is contraindicated. Moxifloxacin hydrochloride ophthalmic solution 0.5% (Vigamox . The mean steady-state Cmax (2.7 ng/mL) and AUC0- (41.9 nghr/mL) values were 1600 and 1100 times lower than the mean Cmax and AUC reported after therapeutic 400 mg doses of moxifloxacin. Please note that microbiologic eradication does not always correlate with clinical outcome in anti-infective trials. Disturbances of blood glucose, including hyperglycemia and hypoglycemia, have been reported in patients treated concomitantly with quinolones and an antidiabetic agent. Moxifloxacin has also been associated with prolongation of the QT interval. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. Paliperidone: (Major) Concurrent use of paliperidone and moxifloxacin should be avoided if possible due to an increased risk for QT prolongation and torsade de pointes (TdP). Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Midostaurin: (Major) The concomitant use of midostaurin and moxifloxacin may lead to additive QT interval prolongation. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Azithromycin: (Major) Concomitant use of azithromycin with moxifloxacin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Due to inconsistencies between the drug labels on DailyMed and the pill images provided by RxImage, we no longer . Crizotinib: (Major) Avoid coadministration of crizotinib with moxifloxacin due to the risk of QT prolongation. At the maternal toxic doses of 30 mg/kg/day, increased abortion, vomiting, and diarrhea were observed. These reports generally involved patients with concurrent medical conditions or concomitant medications that may have been contributory. The above information is provided for general Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. For more information on this medication choose from the list of selections below. Use dual therapy with 2 distinct classes of antimicrobials for initial treatment in patients infected after intentional release of Y. pestis. Oral administration of moxifloxacin to pregnant rats and monkeys and intravenously to pregnant rabbits during the period of organogenesis did not produce adverse maternal or fetal effects at clinically relevant doses. Quinolones have also been associated with a risk of QT prolongation and TdP. Artemether; lumefantrine is also associated with prolongation of the QT interval. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. moxifloxacin hydrochloride - Drug Summary - PDR.Net Maternal death occurred during gestation at 500 mg/kg/day. If you use too much this medication, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away. Donepezil: (Major) Case reports indicate that QT prolongation and torsade de pointes (TdP) can occur during donepezil therapy. Moxifloxacin belongs to a class of drugs called quinolone antibiotics. Pimavanserin: (Major) Pimavanserin may cause QT prolongation and should generally be avoided in patients receiving other medications known to prolong the QT interval, such as moxifloxacin. PMID: 16257311 DOI: 10.1016/j.survophthal.2005.05.004 Abstract Five independent, multicentered, double-masked, parallel, controlled studies were conducted to determine the safety of moxifloxacin ophthalmic solution 0.5% (VIGAMOX) in pediatric and nonpediatric patients with bacterial conjunctivitis. Monotherapy can be considered for mild-to-moderate disease in patients with naturally occurring plague. NSAIDs in combination with very high doses of quinolones have been shown to provoke convulsions in preclinical studies and postmarketing. The chemical structure is presented below: Moxifloxacin hydrochloride is a slightly yellow to yellow crystalline powder. Supratherapeutic doses of rilpivirine (75 to 300 mg/day) have caused QT prolongation. Does Vigamox Drops interact with other drugs you are taking? Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Fluvoxamine: (Major) There may be an increased risk for QT prolongation and torsade de pointes (TdP) during concurrent use of fluvoxamine and moxifloxacin. Etonogestrel; Ethinyl Estradiol: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. These reports generally involved patients with concurrent medical conditions or concomitant medications that may have been contributory. Glyburide: (Moderate) Monitor blood glucose during concomitant sulfonylurea and quinolone use. Diclofenac: (Moderate) Use quinolones and nonsteroidal anti-inflammatory drugs (NSAIDs) concomitantly with caution due to potential increased risk of CNS stimulation and convulsive seizures. [61094] Daily dosing is defined as 5- or 7 days/week. Although extremely rare, torsade de pointes has been reported during postmarketing surveillance of moxifloxacin. No dosage adjustment is required in patients with mild or moderate hepatic insufficiency (Child-Pugh Classes A and B). Quinolones have been associated with a risk of QT prolongation. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available. May also contain hydrochloric acid/sodium hydroxide to adjust pH to approximately 6.8. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. These reports generally involved patients with concurrent medical conditions or concomitant medications that may have been contributory. The likelihood of QT prolongation may increase with increasing concentrations of moxifloxacin, therefore the recommended dose or infusion rate should not be exceeded. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. Please note that microbiologic eradication does not always correlate with clinical outcome in anti-infective trials. The NOAEL for developmental toxicity was 6.5 mg/kg/day (246 times the human AUC at the recommended human ophthalmic dose). Moxifloxacin has also been associated with prolongation of the QT interval. The federal Omnibus Budget Reconciliation Act (OBRA) regulates medication use in residents of long-term care facilities (LTCFs); limit antibiotic use to confirmed or suspected bacterial infections. Polyethylene Glycol; Electrolytes; Ascorbic Acid: (Major) Administer quinolones at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. Hypoglycemia, sometimes resulting in coma, can occur. [65900] Moxifloxacin ophthalmic solutions are for topical use and not intended for subconjunctival injection, intracameral administration, or direct administration into the anterior chamber of the eye as this will cause damage to the corneal endothelium. It may cause eye discomfort, dry eyes and burning sensation in the eyes immediately following application. Maprotiline: (Major) Concurrent use of maprotiline and moxifloxacin should be avoided due to an increased risk for QT prolongation and torsade de pointes (TdP). Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Patients should be told to discontinue use immediately NSAIDs in combination with very high doses of quinolones have been shown to provoke convulsions in preclinical studies and postmarketing. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Copyright(c) 2023 First Databank, Inc. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. Slight increases in the duration of pregnancy, reduced pup birth weight, and decreased prenatal and neonatal survival were observed at 500 mg/kg/day (estimated 277 times the human AUC at the recommended human ophthalmic dose). Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. The likelihood of QT prolongation may increase with increasing concentrations of moxifloxacin, therefore the recommended dose or infusion rate should not be exceeded. Do not wear contact lenses if you still have signs or symptoms of bacterial conjunctivitis. The likelihood of QT prolongation may increase with increasing concentrations of moxifloxacin, therefore the recommended dose or infusion rate should not be exceeded. Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. Hypoglycemia, sometimes resulting in coma, can occur. Additionally, post-marketing surveillance has identified very rare cases of ventricular arrhythmias including TdP, usually in patients with severe underlying proarrhythmic conditions. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Solifenacin: (Major) Concurrent use of moxifloxacin and solifenacin should be avoided due to an increased risk for QT prolongation and torsade de pointes (TdP). These reports generally involved patients with concurrent medical conditions or concomitant medications that may have been contributory. Patients with diabetes may also be at an increased risk of developing detachment of the retina. The likelihood of QT prolongation may increase with increasing concentrations of moxifloxacin, therefore the recommended dose or infusion rate should not be exceeded. The delayed-release didanosine capsules do not contain a buffering agent and would not be expected to interact with moxifloxacin. Resistance to moxifloxacin occurs in vitro at a general frequency of between 1.8 x 10-9 to less than 1 x 10-11 for gram-positive bacteria. This survey is being conducted by the WebMD marketing sciences department. Moxifloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. If any of these effects last or get worse, tell your doctor. Pregnant cynomolgus monkeys were administered moxifloxacin at doses of 10, 30 or 100 mg/kg/day by intragastric intubation between Gestation Days 20 and 50, targeting the period of organogenesis. Quinolones have been associated with a risk of QT prolongation and torsade de pointes (TdP). Last reviewed on RxList: 6/6/2023 Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Use dual therapy with 2 distinct classes of antimicrobials for initial treatment in patients with severe disease and patients infected after intentional release of Y. pestis. Consult your doctor before breast-feeding. Lapatinib has been associated with concentration-dependent QT prolongation; ventricular arrhythmias and torsade de pointes (TdP) have been reported in postmarketing experience with lapatinib. The following in vitro data are also available, but their clinical significance in ophthalmic infections is unknown. Monotherapy can be considered for mild-to-moderate disease in patients with naturally occurring plague. Aerobic Gram-Positive Microorganisms Listeria monocytogenes Staphylococcus saprophyticus Streptococcus agalactiae Streptococcus mitis Streptococcus pyogenes Streptococcus Group C, G, and F, Aerobic Gram-Negative Microorganisms Acinetobacter baumannii Acinetobacter calcoaceticus Citrobacter freundii Citrobacter koseri Enterobacter aerogenes Enterobacter cloacae Escherichia coli Klebsiella oxytoca Klebsiella pneumoniae Moraxella catarrhalis Morganella morganii Neisseria gonorrhoeae Proteus mirabilis Proteus vulgaris Pseudomonas stutzeri, Anaerobic Microorganisms Clostridium perfringens Fusobacterium species Use of these drugs together may increase the risk of developing torsade de pointes-type ventricular tachycardia. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. In patients receiving systemically administered quinolones, including moxifloxacin, serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported, some following the first dose. You may report side effects to Health Canada at 1-866-234-2345. Although there are no studies examining the effects of ranolazine in patients receiving other QT prolonging drugs, coadministration of such drugs may result in additive QT prolongation. These reports generally involved patients with concurrent medical conditions or concomitant medications that may have been contributory. The likelihood of QT prolongation may increase with increasing concentrations of moxifloxacin; therefore, the recommended dose or infusion rate should not be exceeded. Granisetron: (Major) Concurrent use of granisetron and moxifloxacin should be avoided due to an increased risk for QT prolongation and torsade de pointes (TdP). One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. Elagolix; Estradiol; Norethindrone acetate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. Systemic quinolones have been associated with disabling and potentially irreversible serious neurotoxicity, including central nervous system effects, peripheral neuropathy, or psychiatric event. Moxifloxacin should be used cautiously in patients with cardiac arrhythmias or other cardiac disease that predisposes to cardiac arrhythmias. Phototoxicity reactions have been observed in patients who were exposed to direct sunlight or tanning booths while receiving some quinolones. Due to metabolic disturbances associated with hepatic insufficiency, which may cause QT prolongation, use moxifloxacin with caution in these patients. Tendon rupture typically involves the Achilles tendon; however, ruptures of the hand, shoulder, biceps, thumb, and other tendons have also been reported. Examples of compounds that may interfere with quinolone bioavailability include multivitamins that contain iron. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. Empagliflozin; Linagliptin; Metformin: (Moderate) Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including metformin, are coadministered. Atenolol; Chlorthalidone: (Moderate) In a crossover study in healthy volunteers (n=24), the mean atenolol AUC following a single 50 mg PO atenolol dose with placebo was similar to that observed when atenolol was given with a single 400 mg PO moxifloxacin dose. Use dual therapy with 2 distinct classes of antimicrobials for initial treatment in patients with severe disease and patients infected after intentional release of Y. pestis. The likelihood of QT prolongation may increase with increasing concentrations of moxifloxacin, therefore the recommended dose or infusion rate should not be exceeded. These reports generally involved patients with concurrent medical conditions or concomitant medications that may have been contributory. Instill one drop in the affected eye 3 times a day for 7 days. Additionally, post-marketing surveillance has identified very rare cases of ventricular arrhythmias including TdP, usually in patients with severe underlying proarrhythmic conditions. The dose of Vigamox: Instill one drop in the affected eye 3 times a day for 7 days. [28423], TuberculosisDirectly observed therapy (DOT) is recommended for all children as well as adolescents and adults living with HIV. These reports generally involved patients with concurrent medical conditions or concomitant medications that may have been contributory. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. (Moderate) Monitor blood glucose during concomitant thiazolidinedione and quinolone use. Monitor ECGs more frequently for QT prolongation if coadministration is necessary. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances. Additionally, post-marketing surveillance has identified very rare cases of ventricular arrhythmias including TdP, usually in patients with severe underlying proarrhythmic conditions. Perphenazine: (Minor) Concurrent use of perphenazine and moxifloxacin should be avoided due to an increased risk for QT prolongation and torsade de pointes (TdP). Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. dry eyes or watery eyes; eye pain or discomfort; blurred vision; or mild itching, redness, or other irritation. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Class IA antiarrhythmics are associated with QT prolongation and torsades de pointes (TdP). Most reactions were reported between 12 and 53 weeks after start of treatment with complete resolution at the end of the study. One drop is instilled into the affected eyes(s) 3 times daily for 7 days. (Moderate) Monitor blood glucose during concomitant SGLT2 inhibitor and quinolone use. Moxifloxacin is a fluoroquinolone (flor-o-KWIN-o-lone) antibiotic that fights bacteria in the body. If chloramphenicol is not available or not desired due to potential toxicity in young children, a nonfluoroquinolone first-line or alternative antimicrobial for treatment of septicemic plague can be substituted. Iloperidone has also been associated with QT prolongation; however, TdP has not been reported. 400 mg PO every 24 hours until 48 hours after the last perceived exposure as first-line therapy in most patients and as an alternative therapy in pregnant patients. Hypoglycemia, sometimes resulting in coma, can occur. 400 mg IV every 24 hours for 7 to 21 days. Prolongation of the QT interval has been reported with administration of moxifloxacin. Sodium Ferric Gluconate Complex; ferric pyrophosphate citrate: (Major) Administer oral moxifloxacin at least 4 hours before or 8 hours after oral products that contain iron. 400 mg PO every 24 hours for 7 to 14 days as an alternative; treat for at least 14 days if concurrent bacteremia in persons with a CD4 count more than 200 cells/mm3. Moxifloxacin exhibits in vitro minimal inhibitory concentrations (MICs) of 2 microgram/mL or less (systemic susceptible breakpoint) against most (greater than or equal to 90%) strains of the following ocular pathogens. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Systemic levels of moxifloxacin following topical ocular administration are low [see Clinical Pharmacology (12.3)], and it is not known whether measurable levels of moxifloxacin would be present in maternal milk following topical ocular administration. Moxifloxacin ophthalmic solution is used to treat bacterial conjunctivitis (pink eye; infection of the membrane that covers the outside of the eyeballs and the inside of the eyelids). Mefloquine: (Major) Concurrent use of mefloquine and moxifloxacin should be avoided due to an increased risk for QT prolongation and torsade de pointes (TdP). Distributed by: Other reasons for tendon ruptures include physical activity or exercise, kidney failure, or tendon problems in the past. Triclabendazole: (Major) Concomitant use of triclabendazole and moxifloxacin increases the risk of QT/QTc prolongation and torsade de pointes (TdP).
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