MOXIFLOXACIN HYDROCHLORIDE IN SODIUM CHLORIDE 0.8% IN PLASTIC CONTAINER
Clinical safety rating: safe
No 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). |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Breastfeeding | Moxifloxacin is excreted in human milk; M/P ratio unknown. Potential for infant joint damage. Avoid breastfeeding or discontinue drug. |
| 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. |
■ 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 |
["Known hypersensitivity to moxifloxacin or any fluoroquinolone","Pregnancy (animal data showing fetal harm; avoid unless benefit outweighs risk)","Lactation (not recommended; may cause articular damage in nursing infants)","Patients under 18 years of age (except for specific approved indications like anthrax)","History of tendon disorders related to fluoroquinolone use","Uncorrected hypokalemia or hypomagnesemia (risk of QTc prolongation)","Concomitant use with Class IA or Class III antiarrhythmics (QT prolongation risk)"]
| 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"] |
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| 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. |