According to the manufacturer, moxifloxacin should be avoided in patients taking drugs that can result in prolongation of the QT interval. 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. Stopping this medication too. IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. Quinolones have been associated with a risk of QT prolongation. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Discard the solution if it changes color, turns cloudy, or if it contains particles. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Prescription medication. There was no evidence of genotoxicity in vivo in a micronucleus test or a dominant lethal test in mice. NSAIDs in combination with very high doses of quinolones have been shown to provoke convulsions in preclinical studies and postmarketing. 4 CONTRAINDICATIONS VIGAMOX is contraindicated in patients with a history of hypersensitivity to moxifloxacin, to other quinolones, or to any NSAIDs in combination with very high doses of quinolones have been shown to provoke convulsions in preclinical studies and postmarketing. Consult your doctor before breast-feeding. Post-marketing surveillance has identified very rare cases of ventricular arrhythmias including torsade de pointes (TdP), usually in patients with severe underlying proarrhythmic conditions. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. 400 mg IV once; antibiotics should be discontinued within 24 hours. Toremifene: (Major) Avoid coadministration of moxifloxacin with toremifene if possible due to the risk of additive QT prolongation. Moxifloxacin has been reported to cause QT prolongation, however, no cardiovascular morbidity or deaths have been reported. Macimorelin: (Major) Avoid concurrent administration of macimorelin with drugs that prolong the QT interval, such as moxifloxacin. Thioridazine: (Contraindicated) Thioridazine is associated with a well-established risk of QT prolongation and torsades de pointes (TdP). document.write(new Date().getFullYear()) PDR, LLC. Do not dispense discolored product- Store at controlled room temperature (between 68 and 77 degrees F)Avelox:- Avoid excessive humidity- Protect from moisture- Store at controlled room temperature (between 68 and 77 degrees F)Avelox ABC Pack:- Avoid excessive humidity- Protect from moisture- Store at controlled room temperature (between 68 and 77 degrees F)Avelox I.V. Whenever clinical judgment dictates, the patient should be examined with the aid of magnification, such as slit-lamp biomicroscopy, and, where appropriate, fluorescein staining. If coadministration cannot be avoided, monitor ECG during treatment. 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. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. If other quinolones are used, ECG and/or Holter monitoring during therapy is recommended. 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. Data sources include IBM Watson Micromedex (updated 5 June 2023), Cerner Multum (updated 25 June 2023), ASHP (updated 11 June 2023) and others. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. Moxifloxacin has also been associated with prolongation of the QT interval. Lefamulin: (Major) Avoid coadministration of lefamulin with moxifloxacin as concurrent use may increase the risk of QT prolongation. 4 mg/kg/dose IV every 12 hours in combination with chloramphenicol for 10 to 14 days. Vigamox should be used only when prescribed during pregnancy. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. commonly, these are "preferred" (on formulary) brand drugs. It is not yet clear if bismuth subsalicylate (Pepto-Bismol) can interfere with fluoroquinolone bioavailability. Although data are limited, the manufacturer of efavirenz recommends an alternative antiretroviral be considered for patients receiving medications with a known risk for TdP. Also watch for symptoms of low blood sugar such as sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet. Aluminum Hydroxide; Magnesium Hydroxide; Simethicone: (Major) Administer oral moxifloxacin at least 4 hours before or 8 hours after magnesium hydroxide. In gram-negative bacteria, the primary target is the DNA gyrase A subunit, while the primary target in gram-positive bacteria is generally topoisomerase IV. Vorinostat therapy is associated with a risk of QT prolongation. If you log out, you will be required to enter your username and password the next time you visit. NSAIDs in combination with very high doses of quinolones have been shown to provoke convulsions in preclinical studies and postmarketing. Inform your doctor if they persist for a longer duration. Moxifloxacin has been associated with prolongation of the QT interval. Insulin Detemir: (Moderate) Monitor blood glucose during concomitant insulin and quinolone use. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. 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. The likelihood of QT prolongation may increase with increasing concentrations of moxifloxacin. Due to the risk for serious and potentially permanent side effects associated with fluoroquinolone antibiotics, moxifloxacin should only be used in cases where alternative treatment options cannot be used. Although extremely rare, torsade de pointes (TdP) has been reported during postmarketing surveillance of moxifloxacin; these reports generally involved patients with concurrent medical conditions or concomitant medications that may have been contributory. Patients should be advised not to wear contact lenses if they have signs or symptoms of bacterial conjunctivitis. 400 mg IV every 24 hours. This medicine belongs to a group of medicines called fluoroquinolone antibiotics. Oral administration of moxifloxacin to pregnant rats during late gestation through lactation did not produce adverse maternal, fetal or neonatal effects at clinically relevant doses [see Data]. Consult your pharmacist or local waste disposal company. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child. See additional information. NSAIDs in combination with very high doses of quinolones have been shown to provoke convulsions in preclinical studies and postmarketing. 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. Iron Salts: (Major) Administer oral moxifloxacin at least 4 hours before or 8 hours after oral products that contain iron. Aluminum Hydroxide: (Major) Administer oral moxifloxacin at least 4 hours before or 8 hours after products that contain aluminum hydroxide. It is not intended to be a substitute for the exercise of professional judgment. 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. The likelihood of QT prolongation may increase with increasing concentrations of moxifloxacin, therefore the recommended dose or infusion rate should not be exceeded. 4 mg/kg/dose PO every 12 hours in combination with chloramphenicol for 10 to 14 days. Please confirm that you would like to log out of Medscape. The NOAEL for developmental toxicity was 6.5 mg/kg/day (246 times the human AUC at the recommended human ophthalmic dose). Certain antibiotics (i.e., tetracyclines and quinolones) may chelate with the magnesium in sodium picosulfate; magnesium oxide; anhydrous citric acid solution. Adagrasib: (Major) Concomitant use of adagrasib and moxifloxacin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Calcium Carbonate; Magnesium Hydroxide; Simethicone: (Major) Administer oral moxifloxacin at least 4 hours before or 8 hours after oral products that contain calcium. Fluocinolone; Hydroquinone; Tretinoin: (Major) Avoid the concomitant use of tretinoin with other drugs known to cause photosensitivity, such as moxifloxacin. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. UseVigamoxexactly as prescribed by your doctor. According to the manufacturer, moxifloxacin should be avoided in patients taking drugs that can result in prolongation of the QT interval. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Disturbances of blood glucose, including hyperglycemia and hypoglycemia, have been reported in patients treated concomitantly with quinolones and an antidiabetic agent. Do not store in the bathroom. Moxifloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. commonly, these are "non-preferred" brand drugs or specialty Moxifloxacin has also been associated with prolongation of the QT interval. . Use dual therapy with 2 distinct classes of antimicrobials for initial treatment of naturally occurring plague in pregnant patients, patients with severe disease, and patients infected after intentional release of Y. pestis. Treat for 7 to 10 days for naturally acquired infection. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. This medication falls into category C. There are no well-controlled studies have been done in humans. Drospirenone; Ethinyl Estradiol: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. Due to inconsistencies between the drug labels on DailyMed and the pill images provided by RxImage, we no longer . Avoid systemic quinolones, such as moxifloxacin, in patients with a history of myasthenia gravis. Because of this risk for serious and potentially permanent side effects, quinolones should only be used for the treatment of acute bacterial exacerbation of chronic bronchitis or acute bacterial sinusitis in cases where alternative treatment options cannot be used. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. All information on this site is provided "as-is" for informational purposes only and is not a substitute for medical advice or treatment. (Moderate) Monitor blood glucose during concomitant dipeptidyl peptidase-4 inhibitors and quinolone use. moxifloxacin have been associated with hypersensitivity reactions, even In vitro studies indicate that moxifloxacin does not inhibit CYP3A4, CYP2D6, CYP2C9, CYP2C19, or CYP1A2, indicating that moxifloxacin is unlikely to alter the pharmacokinetics of drugs metabolized by these cytochrome P450 isozymes. One drop is instilled into the affected eyes(s) 3 times daily for 7 days. 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. Propafenone: (Major) Concomitant use of propafenone and moxifloxacin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). [42303]No dosage adjustment needed. These reports generally involved patients with concurrent medical conditions or concomitant medications that may have been contributory. Prolongation of the QT interval has also been reported with administration of moxifloxacin. Dapagliflozin; Metformin: (Moderate) Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including metformin, are coadministered. Quinolones have been associated with a risk of QT prolongation. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Fluconazole: (Major) Concomitant use of fluconazole and moxifloxacin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Insulin, Inhaled: (Moderate) Monitor blood glucose during concomitant insulin and quinolone use. It provides increased penetration into ocular tissues and fluids with improved activity against Streptococci and Staphylococci species and moderate to excellent activity against clinically relevant, gram . 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. Vigamox Ophthalmic Solution: View Uses, Side Effects, Price and - 1mg Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. This is not a complete list ofVigamoxside effects. Ribociclib; Letrozole: (Major) Avoid coadministration of ribociclib with moxifloxacin due to an increased risk for QT prolongation and torsade de pointes (TdP). difficile-associated diarrhea / Delayed / Incidence not knownpancytopenia / Delayed / Incidence not knownaplastic anemia / Delayed / Incidence not knownagranulocytosis / Delayed / Incidence not knownthrombotic thrombocytopenic purpura (TTP) / Delayed / Incidence not knownhemolytic anemia / Delayed / Incidence not knowncoma / Early / Incidence not knownincreased intracranial pressure / Early / Incidence not knownseizures / Delayed / Incidence not knownsuicidal ideation / Delayed / Incidence not knownmyasthenia gravis / Delayed / Incidence not knowntendon rupture / Delayed / Incidence not knownanaphylactoid reactions / Rapid / Incidence not knownlaryngeal edema / Rapid / Incidence not knowntoxic epidermal necrolysis / Delayed / Incidence not knownanaphylactic shock / Rapid / Incidence not knownStevens-Johnson syndrome / Delayed / Incidence not knownangioedema / Rapid / Incidence not knownventricular tachycardia / Early / Incidence not knownaortic dissection / Delayed / Incidence not knowntorsade de pointes / Rapid / Incidence not knownkeratitis / Delayed / Incidence not knownocular hemorrhage / Delayed / Incidence not knownvisual impairment / Early / Incidence not knowntoxic anterior segment syndrome / Early / Incidence not knownserum sickness / Delayed / Incidence not knownvasculitis / Delayed / Incidence not knowninterstitial nephritis / Delayed / Incidence not knownhearing loss / Delayed / Incidence not known, constipation / Delayed / 2.0-2.0elevated hepatic enzymes / Delayed / 0.1-1.0candidiasis / Delayed / 0-1.0anemia / Delayed / 1.0-1.0hypokalemia / Delayed / 1.0-1.0dehydration / Delayed / 0.1-0.9gastritis / Delayed / 0.1-0.9erythema / Early / 0.1-0.9edema / Delayed / 0.1-0.9leukopenia / Delayed / 0.1-0.9thrombocytosis / Delayed / 0.1-0.9thrombocytopenia / Delayed / 0.1-0.9neutropenia / Delayed / 0.1-0.9eosinophilia / Delayed / 0.1-0.9hyperglycemia / Delayed / 0.1-0.9hyperuricemia / Delayed / 0.1-0.9hyperlipidemia / Delayed / 0.1-0.9hyperamylasemia / Delayed / 0.1-0.9depression / Delayed / 0.1-0.9confusion / Early / 0.1-0.9hallucinations / Early / 0.1-0.9hypotension / Rapid / 0.1-0.9hypertension / Early / 0.1-0.9angina / Early / 0.1-0.9QT prolongation / Rapid / 0.1-0.9chest pain (unspecified) / Early / 0.1-0.9palpitations / Early / 0.1-0.9sinus tachycardia / Rapid / 0.1-0.9blurred vision / Early / 0.1-0.9phlebitis / Rapid / 0.1-0.9dysuria / Early / 0.1-0.9dyspnea / Early / 0.1-0.9wheezing / Rapid / 0.1-0.9hepatitis / Delayed / Incidence not knownjaundice / Delayed / Incidence not knownpseudomembranous colitis / Delayed / Incidence not knownsuperinfection / Delayed / Incidence not knownhypoglycemia / Early / Incidence not knownpsychosis / Early / Incidence not knownpseudotumor cerebri / Delayed / Incidence not knowndelirium / Early / Incidence not knownneurotoxicity / Early / Incidence not knownmemory impairment / Delayed / Incidence not knownperipheral neuropathy / Delayed / Incidence not knowntendinitis / Delayed / Incidence not knownpneumonitis / Delayed / Incidence not knownconjunctivitis / Delayed / Incidence not knownhyperemia / Delayed / Incidence not known, nausea / Early / 7.0-7.0diarrhea / Early / 6.0-6.0fever / Early / 1.0-4.0rhinitis / Early / 1.0-4.0infection / Delayed / 0.1-4.0pharyngitis / Delayed / 1.0-4.0rash / Early / 0.1-4.0headache / Early / 4.0-4.0cough / Delayed / 1.0-4.0dizziness / Early / 3.0-3.0abdominal pain / Early / 2.0-2.0vomiting / Early / 2.0-2.0insomnia / Early / 2.0-2.0dyspepsia / Early / 1.0-1.0gastroesophageal reflux / Delayed / 0.1-0.9dysgeusia / Early / 0.1-0.9flatulence / Early / 0.1-0.9anorexia / Delayed / 0.1-0.9xerostomia / Early / 0.1-0.9malaise / Early / 0.1-0.9fatigue / Early / 0.1-0.9chills / Rapid / 0.1-0.9pruritus / Rapid / 0.1-0.9night sweats / Early / 0.1-0.9hyperhidrosis / Delayed / 0.1-0.9urticaria / Rapid / 0.1-0.9leukocytosis / Delayed / 0.1-0.9tinnitus / Delayed / 0.1-0.9drowsiness / Early / 0.1-0.9vertigo / Early / 0.1-0.9anxiety / Delayed / 0.1-0.9agitation / Early / 0.1-0.9lethargy / Early / 0.1-0.9syncope / Early / 0.1-0.9paresthesias / Delayed / 0.1-0.9restlessness / Early / 0.1-0.9hypoesthesia / Delayed / 0.1-0.9tremor / Early / 0.1-0.9arthralgia / Delayed / 0.1-0.9asthenia / Delayed / 0.1-0.9back pain / Delayed / 0.1-0.9musculoskeletal pain / Early / 0.1-0.9nightmares / Early / Incidence not knownparanoia / Early / Incidence not knowndysesthesia / Delayed / Incidence not knownweakness / Early / Incidence not knownarthropathy / Delayed / Incidence not knownphotosensitivity / Delayed / Incidence not knownxerophthalmia / Early / Incidence not knownocular pruritus / Rapid / Incidence not knownocular pain / Early / Incidence not knownocular irritation / Rapid / Incidence not knownlacrimation / Early / Incidence not known. Moxifloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. The likelihood of QT prolongation may increase with increasing concentrations of moxifloxacin; therefore, the recommended dose or infusion rate should not be exceeded. Although data are limited, the manufacturer of efavirenz recommends an alternative antiretroviral be considered for patients receiving medications with a known risk for TdP. Phenothiazines have also been associated with a risk of QT prolongation and/or TdP. Moxifloxacin has also been associated with prolongation of the QT interval. Monotherapy can be considered for mild-to-moderate disease in patients with naturally occurring plague. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Additionally, post-marketing surveillance has identified very rare cases of ventricular arrhythmias including TdP, usually in patients with severe underlying proarrhythmic conditions. Copyright(c) 2023 First Databank, Inc. Higher doses of moxifloxacin may be needed when used with rifampin, however, data assessing the efficacy and safety of these higher doses are not available. The likelihood of QT prolongation may increase with increasing concentrations of moxifloxacin, therefore the recommended dose or infusion rate should not be exceeded. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Phenothiazines, such as prochlorperazine, have been reported to prolong the QT interval. Although extremely rare, torsade de pointes (TdP) has been reported during postmarketing surveillance of moxifloxacin; these reports generally involved patients with concurrent medical conditions or concomitant medications that may have been contributory. Moxifloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Pre- & post-op sterilization Instill 1 drop in affected eye 5 times daily pre-op & tds post-op. 4 mg/kg/dose (Max: 200 mg/dose) IV every 12 hours for 10 to 14 days as an alternative therapy. Supratherapeutic doses of rilpivirine (75 to 300 mg/day) have caused QT prolongation. If an allergic reaction to moxifloxacin occurs, discontinue use of the drug. Consider pseudomembranous colitis in patients presenting with diarrhea after antibacterial use. Moxifloxacin was not mutagenic in the CHO/HGPRT mammalian cell gene mutation assay. 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. Moxifloxacin (Ophthalmic Route) Proper Use - Mayo Clinic Moxifloxacin should be discontinued if an allergic reaction or any other sign of hypersensitivity appears. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Data sources include IBM Watson Micromedex (updated 5 June 2023), Cerner Multum (updated 25 June 2023), ASHP (updated 11 June 2023) and others. Complicated infections include peritonitis and appendicitis complicated by rupture, and intraabdominal abscess. Use dual therapy with 2 distinct classes of antimicrobials for initial treatment of naturally occurring plague in pregnant patients and patients infected after intentional release of Y. pestis. Instill one drop in the affected eye 3 times a day for 7 days. In healthy volunteers, calcium supplements had no significant effect on the AUC of moxifloxacin, however, the mean Cmax was slightly reduced and the time to Cmax was prolonged compared to moxifloxacin given alone. This survey is being conducted by the WebMD marketing sciences department. Listeria monocytogenesStaphylococcus saprophyticusStreptococcus agalactiaeStreptococcus mitisStreptococcus pyogenesStreptococcus Group C, G, and F, Acinetobacter baumanniiAcinetobacter calcoaceticusCitrobacter freundiiCitrobacter koseriEnterobacter aerogenesEnterobacter cloacaeEscherichia coliKlebsiella oxytocaKlebsiella pneumoniaeMoraxella catarrhalisMorganella morganiiNeisseria gonorrhoeaeProteus mirabilisProteus vulgarisPseudomonas stutzeri, Clostridium perfringensFusobacterium speciesPrevotella speciesPropionibacterium acnes, Chlamydia pneumoniaeLegionella pneumophilaMycobacterium aviumMycobacterium marinumMycoplasma pneumoniae. Estradiol; Norethindrone: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. Neither drug is approved for intraocular administration. If these drugs are administered together, obtain an electrocardiogram and electrolyte concentrations before and periodically during treatment. Do not double the dose to catch up. For systemic infection in which meningitis cannot be excluded, IV treatment should continue for at least 2 to 3 weeks or until clinical criteria for improvement are met. The likelihood of QT prolongation may increase with increasing concentrations of moxifloxacin, therefore the recommended dose or infusion rate should not be exceeded. Keep all medical and lab appointments. Use dual therapy with 2 distinct classes of antimicrobials for initial treatment in patients infected after intentional release of Y. pestis.
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