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Moxifloxacin (Ophthalmic)



(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)

Brand Names: U.S.

  • Moxeza
  • Vigamox

Pharmacologic Category

  • Antibiotic, Fluoroquinolone
  • Antibiotic, Ophthalmic


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.


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, Corynebacterium spp, Enterococcus faecalis, Micrococcus luteus, Staphylococcus arlettae, S. aureus, S. capitis, S. epidermidis, S. haemolyticus, S. hominis, S. saprophyticus, S. warneri, Streptococcus viridans spp., S. pneumoniae, Escherichia coli, Haemophilus influenzae, H. parainfluenzae, Klebsiella pneumoniae, Propionibacterium acnes, Chlamydia trachomatis


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): Vigamox: 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:

Children ≥4 months and Adolescents (Moxeza): Refer to adult dosing.

Children ≥1 year and Adolescents (Vigamox): Refer to adult dosing.

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment unlikely due to low systemic absorption.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment unlikely due to low systemic absorption.


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


Store at 2°C to 25°C (36°F to 77°F).

Drug Interactions

There are no known significant interactions.

Adverse Reactions

1% to 6%: Conjunctivitis, dry eye, ocular discomfort, ocular hyperemia, ocular irritation (1% to 2%), ocular pain, ocular pruritus, subconjunctival hemorrhage, tearing, visual acuity decreased


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 Risk Factor


Pregnancy Considerations

Adverse events have been observed in some animal reproduction studies. When administered orally or IV, moxifloxacin crosses the placenta (Ozyüncü and Beksac 2010; Ozyüncü and Nemutlu, 2010). The amount of moxifloxacin available systemically following topical application of the ophthalmic drops is 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 punctual occlusion for 3 to 5 minutes after application to decrease potential exposure to the fetus (Samples 1988).

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience short-term pain or dry eyes. Have patient report immediately to prescriber vision changes, eye pain, or severe eye irritation (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.