Moxifloxacin
Moxifloxacin: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Use in the elderly
- 14. Drug interactions
- 15. Analogs
- 16. Terms and conditions of storage
- 17. Terms of dispensing from pharmacies
- 18. Reviews
- 19. Price in pharmacies
Latin name: Moxifloxacine
ATX code: J01MA14
Active ingredient: moxifloxacin (moxifloxacin)
Manufacturer: Vertex AO (Russia), Hetero Labs Limited (India), PFC "Alium", LLC (Russia), Virend International, LLC (Russia), Promomed Rus, LLC (Russia)
Description and photo updated: 22.11.2018
Prices in pharmacies: from 340 rubles.
Buy
Moxifloxacin is an antibacterial agent with a broad spectrum of bactericidal action.
Release form and composition
Moxifloxacin dosage forms:
- film-coated tablets: biconvex; depending on the manufacturer: capsule-shaped, chamfered, from pale orange to pink, engraved with "80" on one side and "I" on the other; or round yellow; all tablets in a cross section - a core from pale yellow to yellow (5, 7 or 10 pieces in a blister, in a cardboard box 1, 2 or 3 blisters; 5, 7, 10 or 15 pieces in a contour cell packaging, in a cardboard box 1–6 packages; 10 pcs. in a polyethylene can, in a cardboard box 1 can);
- solution for infusion: clear, from pale yellow to green-yellow liquid (50 ml in vials made of colorless glass, in a cardboard box 5 bottles; 250 ml in polyethylene bottles, in a cardboard box 1 bottle in a hermetically sealed bag or without him; for hospitals - 1–96 bottles without packs in hermetically sealed bags or without them in a cardboard box).
1 tablet contains:
- active substance: moxifloxacin hydrochloride - 436.4 mg (corresponds to the content of moxifloxacin - 400 mg);
- additional components: povidone K29 / 32 or K-30 (Kollidon 30), microcrystalline cellulose, magnesium stearate, croscarmellose sodium; depending on the manufacturer, additionally - lactose monohydrate, talc and colloidal silicon dioxide;
- film casing (depending on the manufacturer): opadry II orange 85F23452 [polyvinyl alcohol, titanium dioxide, macrogol, talc, sunset yellow dye with aluminum varnish (E110), iron dye red oxide (E172)] or pink opadry 02F540000 [hypromellose 2910, titanium dioxide (E171), macrogol, iron dye red oxide (E172), iron dye yellow oxide (E172)] or dry mixture for a film coating [hypromellose, yellow iron oxide (iron oxide), hyprolose (hydroxypropyl cellulose), titanium dioxide, talc].
1 ml of solution for infusion contains:
- active substance: moxifloxacin hydrochloride - 1.744 mg (in terms of moxifloxacin base - 1.6 mg);
- additional components: sodium chloride, water for injection; sodium hydroxide solution or hydrochloric acid solution, or (depending on the manufacturer) ethylenediaminetetraacetic acid disodium salt (sodium hydroxide solution or hydrochloric acid solution - used if necessary to adjust the pH value in the technological process).
Pharmacological properties
Pharmacodynamics
Moxifloxacin is an antimicrobial drug of the fluoroquinolone group that has a bactericidal effect, the mechanism of which is due to the inhibition of bacterial enzymes topoisomerase II (DNA gyrase) and topoisomerase IV, which are necessary for the replication, transcription and repair of deoxyribonucleic acid (DNA), with the subsequent disruption of its synthesis, leading to the death of its synthesis, leading cells.
The minimum bactericidal concentration of a substance is generally comparable to its minimum inhibitory concentration (MIC). Antibacterial activity is not impaired by the mechanisms leading to the emergence of resistance to macrolides, aminoglycosides, cephalosporins, penicillins and tetracyclines. No cross-resistance was observed between these antibiotic groups and moxifloxacin; cases of plasmid resistance were also not observed. Resistance to the active substance develops slowly through multiple mutations. Against the background of multiple exposures of the drug to microorganisms at concentrations below the MIC, only a slight increase in this indicator was revealed. Cross-resistance to quinolones has been found, however, some gram-positive and anaerobic microorganisms,showing resistance to other quinolones, demonstrating sensitivity to moxifloxacin.
In vitro studies have shown activity against a wide range of anaerobes, gram-negative and gram-positive microorganisms, atypical and acid-resistant bacteria, including such as Legionella spp., Chlamydia spp., Mycoplasma spp., As well as bacteria resistant to the action of P-lactam and macrolide antibiotics.
In the course of two studies conducted on volunteers, after oral administration of the active substance, the following changes in the intestinal microflora were noted: a decrease in the level of Bacteroides vulgatus, Bacillus spp., Escherichia coli, Klebsiella spp., Enterococcus spp., As well as the anaerobes Peptostreptococcus spp., Eub … and Bifidobacterium spp. The number of these microorganisms returned to normal within two weeks. Clostridium difficile toxins were not detected.
Below are the microorganisms included in the spectrum of antibacterial activity of moxifloxacin.
Strains of the following microorganisms are sensitive to the action of the drug:
- gram-negative aerobes: Haemophilus influenzae and Moraxella catarrhalis (including strains synthesizing and not synthesizing beta-lactamases) *, Haemophilus parainfluenzae *, Proteus vulgaris, Acinetobacter baumannii, Bordetella pertussis;
- gram-positive aerobes: Gardnerella vaginalis, Streptococcus pneumoniae * [including strains with multiple antibiotic resistance and strains showing resistance to penicillin, as well as strains showing resistance to two or more antibiotics, such as penicillin (MIC more than 2 μg / ml), tetracyclines, II generation cephalosporins (for example, cefuroxime), trimethoprim-sulfamethoxazole, macrolides], Streptococcus milleri (Streptococcus constellatus *, Streptococcus anginosus *, Streptococcus intermedius *), Streptococcus pyogenes (group A) *, virptococcus pyogenes (group A) *, virptococcus pyogenes (group A) *,, Streptococcus viridans, Streptococcus salivarius, Streptococcus mutans, Streptococcus constellatus, Streptococcus thermophilus, Streptococcus sanguinis), Staphylococcus aureus (methicillin-sensitive strains) *, Streptococcus dysgalactiae,Streptococcus agalactiae, coagulase-negative staphylococci (Staphylococcus saprophyticus, Staphylococcus epidermidis, Staphylococcus hominis, Staphylococcus cohnii, Staphylococcus simulans, Staphylococcus haemolyticus susceptible)
- anaerobes: Porphyromonas spp., Fusobacterium spp., Propionibacterium spp., Prevotella spp.;
- atypical bacteria: Chlamydia trachomatis *, Chlamydia pneumoniae *, Coxiella burnetii, Mycoplasma hominis, Mycoplasma pneumoniae *, Mycoplasma genitalium, Legionella pneumophila *.
Strains of the following microorganisms are moderately sensitive to the action of moxifloxacin:
- gram-negative aerobes: Enterobacter spp. (Enterobacter sakazakii, Enterobacter intermedius, Enterobacter aerogenes), Citrobacter freundii **, Klebsiella pneumoniae *, Escherichia coli *, Klebsiella oxytoca, Pantoea agglomerans, Enterobacter clotacae *, Stenotrophomonas maltophilia cephalicia *, Stenotrophomonas maltophilia cepmonella * Providencia spp. (Providencia stuartii, Providencia rettgeri), Neisseria gonorrhoeae *;
- gram-positive aerobes: Enterococcus faecium *, Enterococcus avium *, Enterococcus faecalis (only strains sensitive to gentamicin and vancomycin) *;
- anaerobes: Clostridium spp. *, Peptostreptococcus spp. *, Bacteroides spp. (Bacteroides vulgaris *, Bacteroides fragilis *, Bacteroides thetaiotaomicron *, Bacteroides distasonis *, Bacteroides uniformis *, Bacteroides ovatus *).
The following microorganisms are resistant to the drug: coagulase-negative Staphylococcus spp. (strains resistant to methicillin Staphylococcus cohnii, Staphylococcus haemolyticus, Staphylococcus epidermidis, Staphylococcus saprophyticus, Staphylococcus hominis, Staphylococcus simulans), Staphylococcus aerosus aureus
* The sensitivity of microorganisms to moxifloxacin is confirmed by clinical data.
** Use is not recommended for the treatment of methicillin-resistant S. aureus (MRSA) strains. If MRSA infections are confirmed or suspected, appropriate antibacterial drugs are required for treatment.
The distribution of acquired drug resistance for some strains may be dissimilar over time and vary by geographic region. It is recommended to have local data on resistance during the testing of the susceptibility of the strain, this is especially important in the treatment of severe infections.
Pharmacokinetics
When taken orally, moxifloxacin is rapidly and highly absorbed. The absolute bioavailability of the product reaches approximately 91%. After taking once a day at a dose of 400 mg, its maximum concentration (Cmax) in the blood is 3.1 mg / l and is observed for 0.5-4 hours, the maximum value of the stable concentration (Css max) and its minimum value (Css min) is equal to 3.2 mg / l and 0.6 mg / l, respectively.
In the case of a single oral administration in the dose range of 50–1200 mg, as well as course use for 10 days at a daily dose of 600 mg, the pharmacokinetics of the active substance is linear. The equilibrium state is reached within 3 days. The agent can be used regardless of the diet, since the insignificant decrease in the Cmax value observed with food intake and the increase in the period of its achievement have no clinical significance - the duration of absorption does not change.
After a single infusion of moxifloxacin at a dose of 400 mg, lasting 1 hour, its Cmax is noted at the end of the procedure and is approximately 4.1 mg / l, which corresponds to an increase in this indicator by 26% when compared with those after oral administration. The exposure of the active substance is determined by the area under the concentration-time curve (AUC) and slightly exceeds the exposure for oral administration. The absolute bioavailability is approximately 91%.
After multiple intravenous (iv) infusions at a dose of 400 mg once a day for 1 hour, Css max and Css min of substances in plasma are in the range from 4.1 to 5.9 mg / l and from 0.43 to 0.84 mg / l, respectively. At the end of the one hour infusion, the average stable concentration is 4.4 mg / L.
Moxifloxacin is rapidly distributed in tissues and organs both orally and intravenously. The connection with blood plasma proteins (mostly with albumin) is approximately 45%, the volume of distribution is 2 l / kg. The substance reaches high concentrations in the lung tissue (including epithelial fluid and alveolar macrophages), in nasal polyps, the mucous membrane of the nasal sinuses, in the foci of inflammation (in the contents of the blisters with skin lesions), exceeding those in the plasma. In a free, protein-free form, moxifloxacin is found in saliva and in the interstitial fluid at concentrations exceeding plasma concentrations. In addition, high levels of the agent are determined in the peritoneal fluid, tissues of the abdominal organs and female genital organs.
The active substance undergoes phase II biotransformation and is excreted by the kidneys and through the intestines both unchanged and in the form of inactive sulfo compounds (M1) and glucuronides (M2). The microsomal system of cytochrome P450 is not involved in biotransformation. Plasma concentrations of metabolites M1 and M2, regardless of the route of administration, are lower compared to the plasma concentration of the parent compound. According to the results of preclinical studies, these metabolites do not have a negative effect on the body, in terms of tolerance and safety.
The half-life (T 1/2) is approximately 12 hours. After using the substance at a dose of 400 mg, the average total clearance can vary from 179 to 246 ml / min, and the renal clearance - from 24 to 53 ml / min, which confirms the partial tubular reabsorption of moxifloxacin. With a single injection of 400 mg of the substance, 22% of the dose is excreted unchanged by the kidneys, approximately 26% through the intestines.
There were no clinically significant differences in the pharmacokinetic parameters of moxifloxacin in patients of different sex and age, as well as different ethnic groups.
Indications for use
According to the instructions, Moxifloxacin is recommended for the treatment of infectious and inflammatory diseases caused by microorganisms that are sensitive to it:
- community-acquired pneumonia (including pneumonia caused by strains of microorganisms with multiple antibiotic resistance *);
- complicated infectious lesions of soft tissues (for solution), skin and subcutaneous tissues (including an infected diabetic foot);
- complicated intra-abdominal infections, including polymicrobial infections (including abscesses in the abdominal cavity).
Additionally for tablets:
- chronic bronchitis in the acute phase;
- acute sinusitis;
- uncomplicated infections of subcutaneous structures and skin;
- uncomplicated diseases of the pelvic organs of an inflammatory nature (including endometritis and salpingitis).
* Streptococcus pneumoniae with multiple resistance to antibacterial agents include strains showing resistance to penicillin, as well as strains resistant to two or more antibiotics belonging to the following groups: penicillins (MIC ≥2 μg / ml), macrolides, II generation cephalosporins (cefuroxime), tetracyclines, trimethoprim / sulfamethoxazole.
Contraindications
Absolute:
- a history of tendon pathologies resulting from therapy with quinolone antibiotics;
- cardiac pathologies: clinically significant heart failure with reduced left ventricular ejection fraction, clinically significant bradycardia, congenital / acquired documented prolongation of the QT interval, acute myocardial ischemia; electrolyte disturbances, mainly uncorrected hypokalemia; history of rhythm disturbances occurring with clinical symptoms (due to observed changes in electrophysiological parameters of the heart in the form of prolongation of the QT interval after drug administration during preclinical and clinical studies);
- combined use with drugs that prolong the QT interval;
- cirrhosis of the liver (for tablets, depending on the manufacturer);
- dysfunction of the liver of class C according to the Child-Pugh classification, with the level of transaminases exceeding five times the upper limit of normal (UHN);
- lactase deficiency, lactose intolerance, glucose-galactose malabsorption (for tablets containing lactose);
- pregnancy and lactation;
- age up to 18 years;
- hypersensitivity to any of the constituents of the drug or other quinolones.
Relative (use Moxifloxacin with extreme caution):
- diseases of the central nervous system (CNS), predisposing to the appearance of seizures and lowering the threshold of seizure activity;
- potentially proarrhythmic conditions such as acute myocardial ischemia and cardiac arrest, especially in women and the elderly;
- cirrhosis of the liver (depending on the manufacturer) due to the possible risk of developing prolongation of the QT interval;
- myasthenia gravis (Myasthenia Gravis), due to a possible exacerbation of this disease;
- history of psychosis and / or psychiatric illness;
- combination with drugs that reduce potassium levels;
- deficiency of glucose-6-phosphate dehydrogenase (due to the fact that patients with this disorder are prone to hemolytic reactions when treated with quinolones).
Instructions for the use of Moxifloxacin: method and dosage
In the treatment of infections caused by microorganisms sensitive to Moxifloxacin, it is recommended to use it once a day, 400 mg (1 tablet or 250 ml of solution for infusion), the dose should not be exceeded. The course of therapy will be determined taking into account the location and severity of the infection, and the clinical effect.
At the initial stages of treatment, an infusion solution can be used, and then, if indicated, it is possible to transfer the patient to oral administration of film-coated tablets.
The tablets are taken orally, swallowing whole, without chewing and drinking plenty of water. Food intake does not affect the effect of moxifloxacin.
The infusion solution is infused undiluted or in combination with the following compatible IV solutions for at least 60 minutes.
Recommended total duration of therapy (IV infusion followed by oral administration):
- community-acquired pneumonia: 7-14 days;
- complicated infections of the skin and subcutaneous structures: 7–21 days;
- complicated intra-abdominal infections: 5-14 days.
Recommended duration of treatment with the drug in the form of tablets:
- uncomplicated infections of subcutaneous structures and skin, acute sinusitis: 7 days;
- period of exacerbation of chronic bronchitis: 5-10 days;
- uncomplicated diseases of the pelvic organs, of an inflammatory nature: 14 days.
According to clinical studies, the duration of therapy with tablets or infusion solution can be up to 21 days.
Solutions for infusion compatible with Moxifloxacin solution (in case of combined use, they are introduced through a T-shaped adapter): Ringer's solution, xylitol solution 20%, sodium chloride solution 1M, dextrose solutions 5, 10 or 40%, sodium chloride solution 0.9%, solution Ringer's lactate, water for injection.
A mixture of the drug with the above solutions at room temperature remains stable for 24 hours. When Moxifloxacin solution is prescribed in combination with other drugs, each must be administered separately. It is necessary to store the vials with the solution in the production packaging. Only a transparent solution free from inclusions can be used for infusion. At temperatures below 12/15 ° C (depending on the manufacturer), a precipitate may occur, which dissolves at a temperature of 12/15 to 25 ° C.
Side effects
- hematopoietic system: infrequently - neutropenia, thrombocytosis, leukopenia, thrombocytopenia, anemia, increased international normalized ratio (INR) / prolonged prothrombin time; rarely - changes in the content of thromboplastin; extremely rare - an increase in prothrombin concentration / decrease in INR;
- infectious and parasitic lesions: often - fungal superinfections;
- metabolism: infrequently - hyperlipidemia; rarely - hyperuricemia, hyperglycemia; extremely rare - hypoglycemia;
- immune system: infrequently - rash, itching, urticaria, allergic reactions, eosinophilia; rarely - anaphylactic / anaphylactoid reactions, angioedema, including laryngeal edema (including a life-threatening nature); extremely rare - anaphylactic / anaphylactoid shock (including life-threatening);
- cardiovascular system: often - prolongation of the QT interval against the background of concomitant hypokalemia; infrequently - palpitations, vasodilation, tachycardia, prolongation of the QT interval; rarely - increase / decrease in blood pressure (BP), syncope, ventricular tachyarrhythmias; extremely rarely - pirouette ventricular tachycardia (Torsade de pointes), nonspecific arrhythmias, cardiac arrest (in most cases in persons with conditions predisposing to arrhythmias, such as acute myocardial ischemia, clinically significant bradycardia);
- organ of hearing and labyrinthine disorders: rarely - tinnitus, hearing impairment / loss (usually reversible);
- organ of vision (mainly with disorders of the central nervous system): infrequently - visual impairment; extremely rare - transient loss of vision;
- mental disorders: infrequently - psychomotor hyperreactivity / agitation, anxiety; rarely - depression (in isolated cases, accompanied by a desire for self-harm - suicidal thoughts / attempts), emotional lability, hallucinations; extremely rarely - depersonalization, psychotic reactions (with the possible appearance of suicidal thoughts / attempts);
- kidneys and urinary tract: infrequently - dehydration due to diarrhea or decreased fluid intake; rarely - functional impairment of the kidneys, renal failure due to dehydration (which can cause damage to the kidneys, especially in elderly patients with pre-existing impaired renal function);
- musculoskeletal and connective tissue: infrequently - myalgia, arthralgia; rarely - muscle weakness, increased muscle tone, convulsions, tendonitis; extremely rare - gait disturbance as a result of damage to the musculoskeletal system, arthritis, tendon ruptures, aggravation of myasthenia gravis symptoms;
- liver and biliary tract: often - increased activity of hepatic transaminases; infrequently - impaired liver function (including an increase in the activity of lactate dehydrogenase), an increase in the activity of alkaline phosphatase in the blood, an increase in the concentration of bilirubin, an increase in the activity of gamma-glutamyltransferase; rarely - jaundice, hepatitis (mainly cholestatic); extremely rarely - fulminant hepatitis, with the possible further occurrence of life-threatening liver failure (including fatal);
- gastrointestinal tract: often - abdominal pain, vomiting, diarrhea, nausea; infrequently - increased amylase activity, decreased appetite and food intake, flatulence, dyspepsia, constipation, gastroenteritis (except for erosive); rarely - stomatitis, dysphagia, pseudomembranous colitis (in extremely rare cases, associated with life-threatening complications);
- respiratory system, organs of the chest and mediastinum: infrequently - shortness of breath (including asthmatic condition);
- skin and soft tissues: extremely rare - bullous skin reactions, including Stevens-Johnson syndrome and Lyell's syndrome (toxic epidermal necrolysis), potentially life-threatening;
- injuries at the injection site and general disorders: often - local reactions; infrequently - sweating, pain for no apparent reason, general malaise, phlebitis / thrombophlebitis at the injection site; rarely - edema.
In the group of patients who received stepwise therapy (intravenous administration followed by oral administration), there was a higher incidence of the following disorders: often - increased activity of gamma-glutamyltransferase; infrequently - hypotension, ventricular tachyarrhythmias, edema, convulsions with various clinical manifestations (including grand mal seizures), pseudomembranous colitis (in isolated cases associated with life-threatening complications), renal failure (as a result of dehydration), impaired renal function, hallucinations.
Overdose
There are limited reports of moxifloxacin overdose. Against the background of using the drug once in a dose of up to 1200 mg or for 10 days at 600 mg per day, the appearance of any undesirable reactions was not observed.
If an overdose is suspected, symptomatic and supportive treatment is performed, depending on the clinical picture, as well as ECG monitoring. In case of an overdose of tablets, it is recommended to take activated charcoal immediately after taking them to prevent excessive systemic exposure.
special instructions
Against the background of the use of Moxifloxacin, cases of fulminant hepatitis have been recorded, which increases the threat of liver failure. With the development of symptoms of the latter, it is necessary to urgently seek advice from the attending physician before continuing treatment.
If during the course there are signs of damage to the mucous membranes or skin, you also need to immediately consult a specialist because of the threat of the possible development of bullous skin lesions.
During the period of antibiotic treatment, there is a likelihood of a complication such as pseudomembranous colitis, this should be taken into account in the development of severe diarrhea. Patients in this case require appropriate therapy. Taking medications that inhibit intestinal peristalsis is contraindicated.
When using moxifloxacin, especially in the elderly, receiving glucocorticosteroids, tendinitis and tendon rupture are possible. There is information about the appearance of these complications for several months after stopping treatment. When observing the first symptoms of inflammation or pain at the site of injury, the use of the drug must be canceled and the affected limb must be relieved.
During the period of therapy, it is recommended to avoid exposure to ultraviolet radiation and direct sunlight, since photosensitivity reactions were noted against the background of the use of quinolones.
In the presence of complicated inflammatory diseases of the pelvic organs (for example, associated with pelvic or tubo-ovarian abscesses), patients are not recommended to take the drug in the form of tablets.
The property of moxifloxacin to inhibit the growth of mycobacteria can lead to false negative results of bacteriological tests in patients with tuberculosis during treatment.
Since the development of sensorimotor or sensory polyneuropathy may develop during therapy with quinolones, patients should immediately consult a doctor and discontinue the drug if symptoms of this complication appear, including tingling, burning, pain, weakness and / or numbness or other sensory disturbances.
During the use of Moxifloxacin, there was a change in blood glucose levels, including hypo- and hyperglycemia. Dysglycemia occurred mainly in elderly people with diabetes mellitus taking oral hypoglycemic agents (including sulfonylurea derivatives) or insulin. Patients with diabetes mellitus during the period of therapy need to control the concentration of glucose in the blood.
Patients who are shown a diet with a low salt content (in the presence of heart failure, nephrotic syndrome, renal failure) should take into account that the solution for infusion contains sodium chloride: in a daily dose of the drug - 34 mmol.
Influence on the ability to drive vehicles and complex mechanisms
The use of Moxifloxacin can negatively affect the speed of psychomotor reactions and the ability to concentrate, impairing the skills of transport management and complex, potentially dangerous mechanisms.
Application during pregnancy and lactation
During pregnancy, moxifloxacin therapy is contraindicated due to the lack of clinical data confirming its safety during this period. Cases of reversible joint damage have been reported in children taking some quinolones, but there are no reports of this pathology in the fetus when used by the mother during pregnancy. In the course of animal studies, the reproductive toxicity of the drug was identified, but the possible risk to humans has not been established.
Since a small amount of moxifloxacin passes into breast milk, and there are no data on its use in women who are breastfeeding, its use is contraindicated during lactation.
Pediatric use
The use of Moxifloxacin is contraindicated in children and adolescents under 18 years of age, since its pharmacokinetics have not been studied in patients of this age group.
With impaired renal function
In the presence of impaired renal function (including severe renal failure with CC ≤ 30 ml / min / 1.73 m²), as well as in patients on continuous hemodialysis and receiving long-term outpatient peritoneal dialysis, correction of the dosage regimen of moxifloxacin is not required.
For violations of liver function
Moxifloxacin is contraindicated for use in patients with impaired liver function class C according to the Child-Pugh classification, as well as with transaminase concentrations exceeding five times the ULN, due to the limited data of clinical studies. In the presence of liver cirrhosis, the drug is contraindicated or special care is required (depending on the manufacturer).
In patients with functional disorders of the liver of class A and B according to the Child-Pugh scale, there is no need to change the dosage regimen of moxifloxacin.
Use in the elderly
Elderly patients do not need to adjust the dosage regimen.
Drug interactions
- tricyclic antidepressants; hydroquinidine, quinidine, disopyramide (class IA antiarrhythmics); ibutilide, dofetilide, sotalol, amiodarone (class III antiarrhythmics); halofantrine (antimalarial drugs), pentamidine, erythromycin (when administered intravenously), sparfloxacin (antimicrobial agents); sultopride, haloperidol, sertindole, pimozide, phenothiazine (antipsychotics); mizolastine, astemizole, terfenadine (antihistamines); diphemanil, bepridil, vincamine (with intravenous administration), cisapride and other drugs affecting the prolongation of the QT interval: their combined use with moxifloxacin is contraindicated due to the aggravation of the risk of ventricular arrhythmia (including ventricular tachycardia of the torsade de pointes type);
- preparations containing iron, zinc, magnesium and aluminum; antacids; antiretroviral drugs (didanosine); sucralfate: a significant decrease in the concentration of moxifloxacin is possible due to the formation of chelate complexes with multivalent cations included in their composition; the interval between taking these funds and moxifloxacin should be at least 4 hours;
- activated carbon: due to inhibition of the absorption of the antibiotic, its systemic bioavailability decreases by more than 80% (with oral administration of 400 mg);
- digoxin: there is no significant change in pharmacokinetic parameters;
- warfarin: there is no change in prothrombin time and other parameters of blood coagulation; at the same time, it is possible to increase the activity of anticoagulant drugs, risk factors include the presence of infectious diseases, the general condition and age of the patient; it is required to monitor INR and, if necessary, change the dosage of indirect anticoagulants;
- cyclosporine, calcium supplements, atenolol, theophylline, ranitidine, oral contraceptives, itraconazole, glibenclamide, morphine, digoxin, probenecid - no clinically significant interaction of these drugs with moxifloxacin was detected (dose change is not required);
- sodium bicarbonate solution 4.2 and 8.4%; sodium chloride solution 10 and 20% - these solutions are incompatible with the moxifloxacin infusion solution (it is forbidden to enter at the same time).
Analogs
Moxifloxacin analogues are: Vigamox, Alvelon-MF, Megaflox, Avelox, Moxigram, Maxiflox, Aquamox, Moxistar, Moxiflo, Moxispenser, Moximak, Moxifloxacin Sandoz, Moxifloxacin-KGP, Moxifloxin, MoksifloxinDA, Plevilox, Rotomox, Moxifur, Moxifloxacin-TL, Ultramox, Simoflox, Heinemox.
Terms and conditions of storage
Store out of the reach of children, protected from light and moisture, at a temperature not exceeding 25 ° C. The solution must not be frozen.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews of Moxifloxacin
Reviews of Moxifloxacin from both patients and doctors are predominantly positive. This antibiotic has proven itself in the treatment of infectious diseases, especially urinary tract lesions, demonstrating a persistent therapeutic effect.
The disadvantage of the drug, according to reviews, is a significant number of undesirable effects, such as dizziness, nausea, diarrhea, chest and abdominal pain, palpitations, tachycardia, insomnia, anxiety. In some cases, due to adverse reactions, patients had to discontinue therapy.
Price for Moxifloxacin in pharmacies
There is no reliable price data for Moxifloxacin as it is not currently available in pharmacies. The cost of its analogue, Moxifloxacin Canon, can be 500 rubles per pack containing 5 tablets of 400 mg each. Replacement of medicines should be agreed with the attending physician.
Moxifloxacin: prices in online pharmacies
|
Drug name Price Pharmacy |
|
Moxifloxacin 400 mg film-coated tablets 5 pcs. 340 RUB Buy |
|
Moxifloxacin 400 mg film-coated tablets 5 pcs. 383 r Buy |
|
Moxifloxacin Canon 400 mg film-coated tablets 5 pcs. 385 r Buy |
|
Moxifloxacin tablets p.o. 400mg 5 pcs. 480 RUB Buy |
Maria Kulkes Medical journalist About the author
Education: First Moscow State Medical University named after I. M. Sechenov, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
