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To reduce development of drug-resistant bacteria in the future, Moxifloxacin should be used only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.
Avoid using Moxifloxacin in patients with known history of myasthenia gravis because it may exacerbate muscle weakness.
Moxifloxacin may cause phototoxicity reaction. Immediately discontinue the drug and consult physician, if the symptoms of skin occur after an administration. Avoid exposure to sunlight during the drug therapy.
Use with caution in patients with known or suspected CNS disorder or patients with factors that predispose to seizures or lower the seizure threshold.
Use with caution in patients with mild, moderate or severe hepatic impairment or liver cirrhosis as it may increase the risk of QT prolongation.
Fulminant hepatitis potentially leading to liver failure (including fatalities) has been reported with use of Moxifloxacin.
Treatment with anti-infectives alters normal colon flora and may permit overgrowth of Clostridium difficile. C. difficile-associated diarrhea and colitis or pseudomembranous colitis have been reported in patients receiving antibacterial agents including Moxifloxacin which may range in severity from mild to life-threatening. Therefore it is important to consider this diagnosis in patients who develop diarrhea after administration of the drug. Mild cases of pseudomembranous colitis usually respond to discontinuation of the drug, while the moderate to severe cases may require management with fluids, electrolytes, protein supplement and treatment with other appropriate antibacterial agents.
Moxifloxacin is not recommended for the treatment of MRSA infections. Instead, treatment with an appropriate antibacterial agent should be started.
In vitro, Moxifloxacin may interfere the Mycobacterium spp. culture test by suppression of mycobacterial growth causing false negative results in specimens from patients currently taking Moxifloxacin.
Sensory or sensorimotor axonal polyneuropathy resulting in paresthesias, hypoesthesias, dysesthesias, and weakness have been reported in patients receiving fluoroquinolones including Moxifloxacin.
Monotherapy with Moxifloxacin should be avoided in patients with pelvic inflammatory disease, unless fluoroquinolone-resistant Neisseria gonorrhoeae can be excluded, because of the widespread and rising prevalence of fluoroquinolone-resistant N. gonorrhoeae infections. If fluoroquinolone-resistant N. gonorrhoeae cannot be excluded, the addition of an appropriate antibiotic which is active against N. gonorrhoeae (e.g., a cephalosporin) to empirical Moxifloxacin therapy should be considered.
Svoz: Continue to take Moxifloxacin until the full prescribed amount is finished, even if symptoms disappear after few days. Skipping dose or stopping the medication too early may result in a decrease of its effectiveness and cause the development of resistance in the future.
Patients under treatment with Moxifloxacin should be advised to inform their doctor prior to continuing treatment if symptoms of neuropathy such as pain, burning, tingling, numbness or weakness develop.
Psychiatric reactions such as depression or suicide attempts, in very rare cases, may occur even after the first administration of fluoroquinolones including Moxifloxacin. Moxifloxacin should be discontinued and appropriate measures instituted.
Use with caution in psychotic patients or in patients with a history of psychiatric disease.
Svoz Infusion: Fluoroquinolones including Moxifloxacin are associated with disabling and potentially irreversible serious adverse reactions that may occur together, including tendinitis and tendon rupture, peripheral neuropathy, and CNS effects. Discontinue Moxifloxacin immediately and avoid use of fluoroquinolones in patients with these serious adverse reactions.
Reserve use of Moxifloxacin for patients with no alternative treatment options for acute bacterial sinusitis or acute bacterial exacerbation of chronic bronchitis because of the risk of disabling and potentially serious adverse reactions (e.g., tendinitis and tendon rupture, peripheral neuropathy, CNS effects).
Prolonged use of Moxifloxacin may result in fungal or bacterial superinfection, including Clostridium difficile-associated diarrhea (CDAD) and pseudomembranous colitis.
Moxifloxacin should be discontinued immediately if symptoms of peripheral neuropathy (e.g. pain, burning, tingling, numbness and/or weakness) occur or if there are other alterations in sensations (e.g. light touch, pain, temperature, position sense, vibratory sensation). Symptoms may occur soon after initiation of Moxifloxacin and in some patients, may be irreversible. Avoid use in patients who have previously experienced peripheral neuropathy.
Psychotic reactions progressing to suicidal ideations/thoughts, hallucinations, paranoia, depression, self-injurious behavior (such as attempted or completed suicide), anxiety, agitation, nervousness and delirium have been reported with fluoroquinolones including Moxifloxacin. Psychotic reactions may occur after first dose. In the event that the patient develops these reactions, Moxifloxacin should be discontinued and appropriate measures instituted. Use with caution in psychotic patients or in patients with a history of psychiatric disease.
Fluoroquinolones including Moxifloxacin may prolong QT interval. Moxifloxacin should be avoided in patients with known prolongation of the QT interval, ventricular arrhythmias (including torsades de pointes), any ongoing proarrhythmic conditions (e.g. clinically important bradycardia and acute myocardial ischemia), uncorrected hypokalemia or hypomagnesemia. Moxifloxacin also should be avoided in patients receiving class IA (e.g. quinidine, procainamide) or class III (e.g. amiodarone, sotalol) antiarrhythmic agents, or other drugs that prolong the QT interval (e.g. cisapride, erythromycin, antipsychotics agents, tricyclic antidepressants).
Use Moxifloxacin with caution in diabetes. Alterations in blood glucose concentrations, including hyperglycemia and hypoglycemia, have been reported with fluoroquinolones, including Moxifloxacin. Blood glucose disturbances usually have occurred in elderly patients with diabetes mellitus receiving an oral antidiabetic agent (e.g., sulfonylurea agent) or insulin. Patients should be monitored closely for signs/symptoms of disordered glucose regulation. Blood glucose concentrations should be carefully monitored in diabetic patients receiving antidiabetic agents and Moxifloxacin concomitant.
Severe hypersensitivity reactions including anaphylaxis have occurred in patients receiving therapy with fluoroquinolones, including Moxifloxacin. Prompt discontinuation of the drug should occur if skin rash or other sign of hypersensitivity arise.
Use in the Elderly: Use with caution in elderly patients (usually older than 60 years), patients taking corticosteroid drugs, patients with kidney, heart or lung transplants, patients with rheumatoid arthritis or renal impairment as it may increase risks of tendonitis and tendon rupture.
