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Moxifloxacin (Ophthalmic)

Medically reviewed by Drugs.com. Last updated on Oct 2, 2020.

Pronunciation

(moxs i FLOKS a sin)

Index Terms

  • Moxifloxacin Hydrochloride

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Ophthalmic:

Moxeza: 0.5% (3 mL)

Vigamox: 0.5% (3 mL)

Generic: 0.5% (3 mL)

Brand Names: U.S.

  • Moxeza
  • Vigamox

Pharmacologic Category

  • Antibiotic, Fluoroquinolone
  • Antibiotic, Ophthalmic

Pharmacology

Moxifloxacin is a DNA gyrase inhibitor, and also inhibits topoisomerase IV. DNA gyrase (topoisomerase II) is an essential bacterial enzyme that maintains the superhelical structure of DNA. DNA gyrase is required for DNA replication and transcription, DNA repair, recombination, and transposition; inhibition is bactericidal.

Absorption

Minimal systemic absorption; resulting serum concentration was 0.02% of that achieved with oral formulation

Use: Labeled Indications

Bacterial conjunctivitis: Treatment of bacterial conjunctivitis caused by susceptible organisms: Acinetobacter lwoffii, Aerococcus viridams, Chlamydia trachomatis, Corynebacterium spp, Cutibacterium (formerly Propionibacterium) acnes, Enterococcus faecalis, Escherichia coli, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Micrococcus luteus, Staphylococcus arlettae, Staphylococcus aureus, Staphylococcus capitis, Staphylococcus epidermidis, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus saprophyticus, Staphylococcus warneri, Streptococcus mitis, Streptococcus parasanguinis, Streptococcus pneumoniae, Viridans group streptococci.

Off Label Uses

Surgical (ophthalmic) prophylaxis

Based on the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), the Surgical Infection Society (SIS), and the Society of Healthcare Epidemiology of America (SHEA) guidelines for antimicrobial prophylaxis in surgery, moxifloxacin (ophthalmic) is recommended for ophthalmic surgical prophylaxis.

Contraindications

Moxeza ophthalmic solution: There are no contraindications listed in manufacturer's labeling

Vigamox: Hypersensitivity to moxifloxacin, other quinolone antibiotics, or any component of the formulation

Dosing: Adult

Bacterial conjunctivitis: Ophthalmic:

Moxeza: Instill 1 drop into affected eye(s) 2 times daily for 7 days.

Vigamox: Instill 1 drop into affected eye(s) 3 times daily for 7 days.

Surgical prophylaxis (off-label use): Instill 1 drop into operative eye every 5 to 15 minutes for five doses within the hour prior to the start of the procedure (ASHP/IDSA/SIS/SHEA [Bratzler 2013]). Note: Prophylactic administration has ranged from preoperatively (including day of surgery only to 1 to 3 days preoperatively), intraoperatively, at end of procedure, and postoperatively. However, no specific recommendations beyond immediate preoperative use, including duration of prophylaxis, can be made due to insufficient evidence. A total duration (pre- and postoperatively) of up to 15 days has been reported (ASHP/IDSA/SIS/SHEA [Bratzler 2013]; Freitas 2007; Speaker 2009).

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Bacterial conjunctivitis: Ophthalmic:

Moxeza: Infants ≥4 months, Children, and Adolescents: Instill 1 drop into affected eye(s) 2 times daily for 7 days

Vigamox: Infants, Children, and Adolescents: Instill 1 drop into affected eye(s) 3 times daily for 7 days

Administration

For topical ophthalmic use only; not for injection. Avoid touching tip of applicator to eye or other surfaces.

Storage

Store at 2°C to 25°C (36°F to 77°F).

Drug Interactions

There are no known significant interactions.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

1% to 6%: Ophthalmic: Eye irritation (1% to 2%), conjunctivitis, decreased visual acuity, eye discomfort, eye pain, eye pruritus, lacrimation, ocular hyperemia, subconjunctival hemorrhage, xerophthalmia

Warnings/Precautions

Concerns related to adverse effects:

• Hypersensitivity reactions: Severe hypersensitivity reactions, including anaphylaxis, angioedema, and dermatologic reactions, have been reported with systemic use of moxifloxacin. Discontinue use if an allergic reaction occurs.

• Superinfection: Prolonged use may lead to overgrowth of nonsusceptible organisms, including fungi. If superinfection occurs, discontinue use and institute appropriate alternative therapy.

Dosage form specific issues:

• Ophthalmic solution: For topical ophthalmic use only. Not for subconjunctival injection or for direct introduction into the anterior chamber of the eye. Contact lenses should not be worn during therapy.

Pregnancy Considerations

When administered orally or IV, moxifloxacin crosses the placenta (Ozyüncü 2010a; Ozyüncü 2010b). The amount of moxifloxacin available systemically following topical application of the ophthalmic drops is limited and significantly less in comparison to oral or IV doses.

If ophthalmic agents are needed during pregnancy, the minimum effective dose should be used in combination with punctal occlusion for 3 to 5 minutes after application to decrease potential exposure to the fetus (Samples 1988).

Patient Education

What is this drug used for?

• It is used to treat eye infections.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Short-term pain

• Watery eyes

• Dry eyes

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Vision changes

• Eye pain

• Severe eye irritation

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine’s uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.