MOXAM

Clinical safety rating: caution

Comprehensive clinical and safety monograph for MOXAM (MOXAM).

How it works

Moxifloxacin is a fluoroquinolone antibiotic that inhibits bacterial DNA gyrase (topoisomerase II) and topoisomerase IV, thereby interfering with DNA replication, transcription, repair, and recombination.

What the body does with it

Metabolism	Moxifloxacin is primarily metabolized via glucuronide conjugation (sulfation and N-methylation are minor pathways); CYP450 enzymes are not significantly involved.
Excretion	Renal: ~70% unchanged; biliary/fecal: ~20% as unchanged drug and metabolites; minor metabolism via glucuronidation.
Half-life	Terminal elimination half-life: 6-8 hours; prolonged in renal impairment (up to 20 hours with CrCl <30 mL/min).
Protein binding	~30% bound to albumin.
Volume of Distribution	0.25-0.4 L/kg, indicating distribution primarily in extracellular fluid.
Bioavailability	Oral: 80-90% (tablet) and 70-80% (suspension) due to moderate first-pass metabolism.
Onset of Action	Intravenous: Within 30 minutes; Oral: 1-2 hours.
Duration of Action	12-24 hours; clinical effect correlates with serum levels above MIC for 40-50% of dosing interval.

Classification & Brands

Action Class

Quinolones/ Fluroquinolones

Dosing & administration

400 mg orally every 24 hours for 7-14 days.

Dosage form	INJECTABLE
Renal impairment	For CrCl 30-49 mL/min: 400 mg every 24 hours. For CrCl 15-29 mL/min: 400 mg every 48 hours. For CrCl <15 mL/min or hemodialysis: 400 mg every 96 hours (after dialysis).
Liver impairment	No dose adjustment required for mild to moderate hepatic impairment (Child-Pugh A and B). Not recommended in severe hepatic impairment (Child-Pugh C).
Pediatric use	Not recommended for use in patients under 18 years of age due to lack of safety and efficacy data.
Geriatric use	No specific dose adjustment; use caution due to age-related renal impairment. Monitor renal function and adjust dose based on creatinine clearance.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for MOXAM (MOXAM).

Breastfeeding	MOXAM is excreted in human milk in low concentrations. M/P ratio not reported. Generally considered compatible with breastfeeding due to poor oral bioavailability and minimal exposure, but caution advised in infants with gastrointestinal disturbances or allergic history.
Teratogenic Risk	MOXAM (moxalactam) is a beta-lactam antibiotic classified as FDA Pregnancy Category B. Animal studies do not indicate fetal harm, but no adequate human studies exist. First trimester: no reported teratogenicity; second and third trimesters: considered safe when clinically indicated.

Warnings & precautions

■ FDA Black Box Warning

Fluoroquinolones, including moxifloxacin, are associated with an increased risk of tendinitis and tendon rupture in all ages. This risk is further increased in patients over 60 years of age, those taking corticosteroids, and patients with kidney, heart, or lung transplants.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to moxifloxacin or any fluoroquinolone","Previous tendon disorder related to fluoroquinolone use","Patients with known QT prolongation or ventricular arrhythmias including torsades de pointes","Patients with uncorrected hypokalemia or hypomagnesemia","Concurrent use with Class IA or Class III antiarrhythmic agents"]

Clinical Precautions

Precautions

["Tendon damage","Peripheral neuropathy","CNS effects (e.g., dizziness, confusion, seizures)","QT prolongation","Hypersensitivity reactions","Blood glucose disturbances","Photosensitivity","Clostridium difficile-associated diarrhea","Myasthenia gravis exacerbation"]

Clinical Tips & Counseling

Drug interactions

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MOXAM

Clinical safety rating: caution

Comprehensive clinical and safety monograph for MOXAM (MOXAM).

How it works

What the body does with it

Metabolism	Moxifloxacin is primarily metabolized via glucuronide conjugation (sulfation and N-methylation are minor pathways); CYP450 enzymes are not significantly involved.
Excretion	Renal: ~70% unchanged; biliary/fecal: ~20% as unchanged drug and metabolites; minor metabolism via glucuronidation.
Half-life	Terminal elimination half-life: 6-8 hours; prolonged in renal impairment (up to 20 hours with CrCl <30 mL/min).
Protein binding	~30% bound to albumin.
Volume of Distribution	0.25-0.4 L/kg, indicating distribution primarily in extracellular fluid.
Bioavailability	Oral: 80-90% (tablet) and 70-80% (suspension) due to moderate first-pass metabolism.
Onset of Action	Intravenous: Within 30 minutes; Oral: 1-2 hours.
Duration of Action	12-24 hours; clinical effect correlates with serum levels above MIC for 40-50% of dosing interval.

Classification & Brands

Action Class

Quinolones/ Fluroquinolones

Dosing & administration

400 mg orally every 24 hours for 7-14 days.

Dosage form	INJECTABLE
Renal impairment	For CrCl 30-49 mL/min: 400 mg every 24 hours. For CrCl 15-29 mL/min: 400 mg every 48 hours. For CrCl <15 mL/min or hemodialysis: 400 mg every 96 hours (after dialysis).
Liver impairment	No dose adjustment required for mild to moderate hepatic impairment (Child-Pugh A and B). Not recommended in severe hepatic impairment (Child-Pugh C).
Pediatric use	Not recommended for use in patients under 18 years of age due to lack of safety and efficacy data.
Geriatric use	No specific dose adjustment; use caution due to age-related renal impairment. Monitor renal function and adjust dose based on creatinine clearance.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for MOXAM (MOXAM).

Breastfeeding	MOXAM is excreted in human milk in low concentrations. M/P ratio not reported. Generally considered compatible with breastfeeding due to poor oral bioavailability and minimal exposure, but caution advised in infants with gastrointestinal disturbances or allergic history.
Teratogenic Risk	MOXAM (moxalactam) is a beta-lactam antibiotic classified as FDA Pregnancy Category B. Animal studies do not indicate fetal harm, but no adequate human studies exist. First trimester: no reported teratogenicity; second and third trimesters: considered safe when clinically indicated.