A-Z Drug Facts > Norfloxacin

Norfloxacin

Pronouncation: (nor-FLOX-uh-SIN)
Class: Fluoroquinolone

Trade Names:
Chibroxin
- Solution 3 mg/mL

Trade Names:
Noroxin
- Tablets 400 mg

Apo-Norflox (Canada)
Novo-Norfloxacin (Canada)

Pharmacology

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Interferes with microbial DNA synthesis.

Pharmacokinetics

Absorption

Norfloxacin is rapidly absorbed; 30% to 40% absorbed in fasting patients. Food and dairy products decrease absorption. Steady state is 2 days, C _max is 0.8 to 2.4 mcg/mL, and T _max is approximately 1 h after dosing.

Distribution

Protein binding is 10% to 15% and crosses the placenta.

Metabolism

Suggested as first-pass metabolism; however, further study is needed.

Elimination

Norfloxacin is eliminated in urine (26% to 32% as norfloxacin, 5% to 8% as active metabolites) and feces (30%).

Special Populations

Renal Function Impairment

Renal insufficiency increases half-life. Alteration of dose is necessary.

Indications and Usage

Oral treatment of urinary tract infections (UTIs) caused by susceptible organisms; treatment of STDs caused by Neisseria gonorrhoeae ; ocular solution for treatment of superficial ocular infections due to strains of susceptible organisms; prostatitis caused by  E. coli .

Contraindications

Hypersensitivity to fluoroquinolones, quinolones, or any component; tendonitis or tendon rupture associated with quinolone use.

Ophthalmic use

Epithelial herpes simplex keratitis; fungal disease of ocular structure; mycobacterial infections of eye; vaccinia; varicella.

Dosage and Administration

UTIs
Adults

PO 400 mg every 12 h for 3 to 21 days.

STDs
Adults

PO 800 mg as single dose.

Ocular Infections
Adults and Children Acute infection

Topical 1 to 2 gtt every 15 to 30 min

Moderate infection

Topical 1 to 2 gtt 4 to 6 times/day.

Prostatitis Caused By E. coli
Adults

PO 400 mg every 12 h for 28 days.

General Advice

• Tablets
• Give 1 h before or 2 h after meals with full glass of water.
• Do not administer antacids within 2 h of dose.

Storage/Stability

Store tablets and ophthalmic solution at controlled room temperature (59° to 86°F).

Drug Interactions

Antacids, iron salts, zinc salts, sucralfate, didanosine

May decrease oral absorption of norfloxacin.

Antineoplastic agents

Serum norfloxacin levels may be decreased.

Cyclosporine

Elevated serum cyclosporine levels.

Theophylline

Decreased clearance and increased plasma levels of theophylline may result in toxicity.

Laboratory Test Interactions

None well documented.

Adverse Reactions

CNS

Headache; dizziness; fatigue; drowsiness.

Dermatologic

Rash.

EENT

Conjunctival hyperemia, chemosis, photophobia, transient burning, itching, or stinging.

GI

Diarrhea; nausea; vomiting; abdominal pain/discomfort.

Genitourinary

Increased serum creatinine and BUN.

Hematologic

Eosinophilia; leukopenia; neutropenia.

Hepatic

Increased ALT, AST, LDH.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy not established (oral form).

Renal Function

Reduced clearance may occur in patients with renal impairment; adjust dose accordingly.

Superinfection

Use of antibiotics may result in bacterial or fungal overgrowth.

Photosensitivity

Moderate to severe reactions have occurred; avoid excessive sunlight and ultraviolet light.

Convulsions

CNS stimulation can occur; use drug with caution in patients with known or suspected CNS disorders.

Pseudomembranous colitis

Consider possibility in patients who develop diarrhea.

Overdosage

Symptoms

Nausea, headache, dizziness, crystalluria, vomiting, drowsiness, seizures.

Patient Information

• For ophthalmic use, demonstrate and observe return demonstration of correct technique for instillation of drops.
• Advise patient to take medication on empty stomach with full glass of water.
• Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
• Advise patient not to double dose if one dose is missed and to notify health care provider if > 1 dose is missed.
• Advise patient to notify health care provider of any nausea, rashes, diarrhea, shortness of breath, dizziness, unusual headache, or lethargy.
• Instruct patient to maintain increased fluid intake (if not contraindicated) while taking this medication.
• Advise patient to use caution when driving or performing tasks that require mental alertness until effects of medication are determined.
• Remind patient to complete full course of therapy, even if symptoms of urinary tract or eye infection have resolved.
• Instruct patient to stop treatment and inform health care provider if experiencing pain, inflammation, or rupture of tendon, and to rest or refrain from exercise until diagnosis of tendonitis or tendon rupture is excluded.

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