MOXIFLOXACIN HYDROCHLORIDE IN SODIUM CHLORIDE 0.8% IN PLASTIC CONTAINER
Clinical safety rating
safeNo significant drug interactions Can cause hypernatremia and fluid overload.
Inhibits DNA gyrase (topoisomerase II) and topoisomerase IV, thereby interfering with bacterial DNA replication, transcription, repair, and recombination.
| Metabolism | Moxifloxacin undergoes sulfate conjugation (phase II metabolism) via sulfotransferases; it is not metabolized by cytochrome P450 enzymes. Approximately 20% is excreted unchanged in urine, and 25% as a glucuronide conjugate. |
| Excretion | Renal (~20% unchanged, plus ~35% as glucuronide and sulfate conjugates), biliary/fecal (~25% unchanged and conjugates, total ~50% via feces). |
| Half-life | 12-15 hours (terminal elimination half-life; allows once-daily dosing; may be prolonged in renal impairment). |
| Protein binding | ~50% bound, primarily to serum albumin. |
| Volume of Distribution | 2.5–3.5 L/kg (indicates extensive tissue penetration, including lung and sinuses). |
| Bioavailability | Oral: ~90% (bioequivalent to IV). |
| Onset of Action | IV: Therapeutic concentrations achieved within 30 minutes; oral: peak serum levels at 1-3 hours; clinical effect begins within hours. |
| Duration of Action | Approximately 24 hours (supports once-daily dosing; post-antibiotic effect against Gram-positive pathogens). |
| Molecular Weight | 437.89 |
400 mg intravenously once daily.
| Dosage form | SOLUTION |
| Renal impairment | No dose adjustment required for GFR ≥30 mL/min; insufficient data for GFR <30 mL/min, use with caution. |
| Liver impairment | No dose adjustment for Child-Pugh A or B; not recommended for Child-Pugh C due to lack of data. |
| Pediatric use | Not recommended for patients <18 years due to risk of musculoskeletal adverse effects. |
| Geriatric use | No specific dose adjustment; monitor for QT prolongation and tendon effects. |
| 1st trimester | Use only if benefit outweighs risk; animal studies show adverse effects but no adequate human studies. |
| 2nd trimester | Use only if clearly needed; limited human data, potential risk of arthropathy. |
| 3rd trimester | Use only if clearly needed; risk of fetal cardiac effects and neonatal infection. |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Placental transfer | Crosses placenta; fetal concentrations are approximately 50% of maternal levels. |
| Breastfeeding | Moxifloxacin is excreted in human milk at low concentrations. Monitor infant for gastrointestinal effects, rash, and potential joint damage. Use with caution. |
| Lactation Rating | L3 (Moderately Safe) |
| Teratogenic Risk | Moxifloxacin is contraindicated in pregnant women due to risk of fetal harm. Animal studies show arthropathy and cartilage damage in immature animals. Human data limited; avoid in all trimesters. |
| Fetal Monitoring | Monitor for maternal adverse effects: tendonitis, tendon rupture, peripheral neuropathy, QT prolongation. Fetal monitoring not standard due to contraindication. |
| Fertility Effects | Moxifloxacin may impair fertility in females, based on animal studies (prolonged estrous cycle). Human data insufficient. |
■ 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, in those taking corticosteroids, and in kidney, heart, or lung transplant recipients. Fluoroquinolones may exacerbate muscle weakness in patients with myasthenia gravis. Avoid use in patients with known myasthenia gravis.
| Common Effects | Eye discomfort Dry eye Burning sensation in eye |
| Serious Effects |
Hypersensitivity to moxifloxacin or any fluoroquinoloneHistory of tendon disorders with fluoroquinolonesProlonged QT interval or concurrent use with QT-prolonging drugs
| Precautions | Tendon injury (tendinitis, tendon rupture), Worsening of myasthenia gravis, Peripheral neuropathy, irreversible, Central nervous system effects (seizures, dizziness, confusion), QT prolongation (avoid in patients with known QTc prolongation, electrolyte abnormalities, or concomitant QT-prolonging drugs), Hypersensitivity/anaphylactic reactions, Clostridioides difficile-associated diarrhea, Photosensitivity/phototoxicity, Blood glucose disturbances (especially in diabetic patients on oral hypoglycemics or insulin), Avoid in patients with known aortic aneurysm or at risk for aortic aneurysm |
| Food/Dietary | Avoid concurrent intake of dairy products (milk, yogurt, cheese), antacids containing calcium, magnesium, or aluminum, and supplements with calcium, iron, or zinc. Separate dosing by at least 2 hours before or 6 hours after these products. Caffeine intake should be limited as moxifloxacin may increase its effects (nervousness, insomnia). No other significant food interactions. |
| Clinical Pearls | Moxifloxacin is a fourth-generation fluoroquinolone with enhanced activity against Gram-positive bacteria and anaerobes. It achieves high tissue penetration, including into the CSF. Avoid in patients with known QT prolongation or uncorrected hypokalemia due to risk of torsades de pointes. Use with caution in elderly patients and those with renal impairment; no dose adjustment needed for renal impairment but adjust for hepatic impairment (Child-Pugh C). Monitor for signs of tendinitis or tendon rupture, especially in patients over 60, those on corticosteroids, or with kidney, heart, or lung transplants. Administer intravenous infusion over 60 minutes to reduce risk of infusion-related reactions. |
| Patient Advice | Take this medication exactly as prescribed; do not skip doses or stop early even if you feel better. · Contact your doctor immediately if you experience tendon pain, swelling, or rupture (especially in the Achilles tendon), or if you have muscle weakness, joint pain, or difficulty moving. · Avoid excessive sunlight or UV light exposure; use sunscreen and protective clothing as this drug can cause photosensitivity. · This drug may cause dizziness or lightheadedness; do not drive or operate machinery until you know how it affects you. · Drink plenty of fluids to stay hydrated, unless instructed otherwise by your doctor. · Inform your doctor if you have a history of seizures, QT prolongation, heart rhythm problems, or if you are taking antiarrhythmics or other drugs that affect heart rhythm. · Do not take with dairy products, antacids, or supplements containing calcium, magnesium, aluminum, or iron; these can reduce drug absorption. Take moxifloxacin at least 2 hours before or 6 hours after these products. · Report any signs of allergic reaction: rash, hives, difficulty breathing, swelling of face, lips, or throat. |
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