Fluoroquinolone (Oral route, injection route, intravenous route)

Brand Names:

Avelox
Avelox I.V.
Ciloxan
Cipro
Cipro IV
Factive
Floxin
Levaquin
Maxaquin
Noroxin
Ocuflox
Quixin
Tequin
Tequin Teq-Paqs
Zagam
Ciprofloxacin
Cipro Iv Minibags
Trovan

Dosage Forms:

Tablet
Solution
Powder for Suspension
Injectable

Uses of This Medicine:

Fluoroquinolones are used to treat bacterial infections in many different parts of the body. They work by killing bacteria or preventing their growth. However, these medicines will not work for colds, flu, or other virus infections. Fluoroquinolones may also be used for other problems as determined by your doctor.

Enoxacin (Penetrex(R)) was withdrawn from the market by Aventis Pharmaceuticals effective August 2001 .

Gatifloxacin (Tequin(R)) tablets and injection were voluntarily discontinued by Bristol-Myers Squibb effective June 2, 2006 .

Sparfloxacin (Zagam(R)) is no longer available in the United States effective August 28, 2007.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, fluoroquinolones are used in certain patients with the following medical conditions:

Chancroid
Pulmonary exacerbations (airway infections) in cystic fibrosis

Before Using This Medicine:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children

Use is not recommended for infants or children younger than 18 years of age since fluoroquinolones have been shown to cause bone development problems in young animals. However, your doctor may choose to use one of these medicines if other medicines cannot be used.

Older adults

These medicines have been tested and, in effective doses, have not been shown to cause different side effects or problems in older people than they do in younger adults.

Pregnancy

Studies have not been done in humans. However, use is not recommended during pregnancy since fluoroquinolones have been reported to cause bone development problems in young animals. Before taking a fluoroquinolone, make sure your doctor knows if you are pregnant or if you may become pregnant.

Breast-feeding

Some of the fluoroquinolones are known to pass into human breast milk. Since fluoroquinolones have been reported to cause bone development problems in young animals, breast-feeding is not recommended during treatment with these medicines. Be sure you have discussed the risks and benefits of the medicine with your doctor.

Other medicines

Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.

Acecainide
Acetophenazine
Amiodarone
Amitriptyline
Amoxapine
Astemizole
Bepridil
Bretylium
Chlorpromazine
Cisapride
Clomipramine
Desipramine
Disopyramide
Dofetilide
Dothiepin
Doxepin
Erythromycin
Ethopropazine
Fluphenazine
Haloperidol
Ibutilide
Imipramine
Lofepramine
Mesoridazine
Methotrimeprazine
Moricizine
Nortriptyline
Opipramol
Pentamidine
Perphenazine
Pimozide
Pipotiazine
Pirmenol
Prajmaline
Probucol
Procainamide
Prochlorperazine
Promazine
Promethazine
Propiomazine
Protriptyline
Quinidine
Ranolazine
Recainam
Sotalol
Terfenadine
Thiethylperazine
Thioridazine
Tizanidine
Trifluoperazine
Triflupromazine
Trimeprazine
Trimipramine
Ziprasidone

Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acarbose
Acecainide
Acetohexamide
Acetophenazine
Ajmaline
Alfuzosin
Alosetron
Amiodarone
Amisulpride
Amitriptyline
Amoxapine
Arsenic Trioxide
Astemizole
Azimilide
Bendamustine
Benfluorex
Bretylium
Chloral Hydrate
Chloroquine
Chlorpromazine
Chlorpropamide
Clarithromycin
Clomipramine
Desipramine
Dibenzepin
Disopyramide
Dofetilide
Dolasetron
Dothiepin
Doxepin
Droperidol
Encainide
Erythromycin
Ethopropazine
Flecainide
Fluconazole
Fluoxetine
Fluphenazine
Foscarnet
Gliclazide
Glimepiride
Glipizide
Gliquidone
Glyburide
Guar Gum
Halofantrine
Haloperidol
Hydroquinidine
Ibutilide
Imipramine
Insulin
Insulin Aspart, Recombinant
Insulin Glulisine
Insulin Lispro, Recombinant
Isradipine
Levomethadyl
Lidocaine
Lidoflazine
Lofepramine
Mefloquine
Metformin
Methadone
Methotrimeprazine
Mexiletine
Miglitol
Moricizine
Mycophenolate Mofetil
Nilotinib
Nortriptyline
Octreotide
Opipramol
Paliperidone
Pentamidine
Perphenazine
Pipotiazine
Pirmenol
Prajmaline
Prednisone
Probucol
Procainamide
Prochlorperazine
Promazine
Promethazine
Propafenone
Propiomazine
Protriptyline
Quetiapine
Quinidine
Recainam
Risperidone
Sematilide
Sertindole
Sotalol
Spiramycin
Sucralfate
Sulfamethizole
Sultopride
Tedisamil
Tetrabenazine
Theophylline
Thiethylperazine
Tizanidine
Tocainide
Tolazamide
Tolbutamide
Trifluoperazine
Triflupromazine
Trimeprazine
Trimethoprim
Trimipramine
Troglitazone
Vasopressin
Warfarin
Ziprasidone
Zolmitriptan
Zotepine

Other interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other medical problems

The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:

Brain or spinal cord disease, including hardening of the arteries in the brain or epilepsy or other seizures Fluoroquinolones may cause nervous system side effects.

Diabetes mellitus (sugar diabetes) Levofloxacin may cause changes in blood sugar, which could lead to problems in controlling blood sugar.

Diarrhea May be a sign of colon problems and taking fluoroquinolones could make this problem worse. Your doctor will want to check you before you begin taking your medicine.

Glucose-6-phosphate dehydrogenase activity defect (problem with an enzyme that your body makes) If you have this condition and you take a fluoroquinolone, you could have problems with anemia.

Heart disease Gemifloxacin, lomefloxacin, or moxifloxacin may make this problem worse.

Heart rhythm problems (e.g., prolonged QT interval) or
Hypokalemia (low potassium in the blood), uncorrected Levofloxacin is not recommended in patients with these conditions .

Kidney disease or
Liver disease Patients with kidney disease or liver disease may have an increased chance of side effects with any of the fluoroquinolones.

Myasthenia gravis (muscle disease) This condition may become worse when taking a fluoroquinolone and cause your respiratory muscles to become weak which is life-threatening. Be sure and tell your doctor if you have this condition.

Organ transplant (e.g., heart, kidney, or lung), history of or
Tendinitis (previous) Fluoroquinolones may increase the risk of tendon injury .

Sensitivity of the skin to sunlight (previous) Patients taking fluoroquinolones may have an increased risk of severe reactions to sunlight.

Proper Use of This Medicine:

Do not take fluoroquinolones if you are pregnant. Do not give fluoroquinolones to infants, children, or teenagers unless otherwise directed by your doctor. These medicines have been shown to cause bone development problems in young animals.

Fluoroquinolones should be used only to treat bacterial infections and not viral infections like the common cold. To help clear up your infection completely, keep taking your medicine for the full time of treatment, even if you begin to feel better after a few days. If you stop taking this medicine too soon, your symptoms may return.

Fluoroquinolones are best taken with a full glass (8 ounces) of water. Several additional glasses of water should be taken every day, unless you are otherwise directed by your doctor. Drinking extra water will help to prevent some unwanted effects of ciprofloxacin and norfloxacin.

Norfloxacin should be taken on an empty stomach.

Ciprofloxacin, levofloxacin, lomefloxacin, moxifloxacin, or ofloxacin may be taken with meals or on an empty stomach. Ciprofloxacin should NOT be taken with dairy products or calcium-fortified juices alone, but may be taken with a meal that contains these products.

This medicine works best when there is a constant amount in the blood or urine. To help keep the amount constant, do not miss any doses. Also, it is best to take the doses at evenly spaced times, day and night. For example, if you are to take two doses a day, the doses should be spaced about 12 hours apart. If this interferes with your sleep or other daily activities, or if you need help in planning the best times to take your medicine, check with your doctor.

If you need to take this medicine for anthrax, your doctor will want you to begin taking it as soon as possible after you are exposed to anthrax.

Dosing

The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For ciprofloxacin:
- For long-acting oral dosage form (extended-release tablets):
  - Adults 500 to 1000 milligrams (mg) every twenty-four hours for three to fourteen days, depending on the medical problem being treated.
  - Children up to 18 years of age This medicine is not recommended for use in infants, children, or teenagers.
- For regular (short-acting) oral dosage form (oral suspension or tablets):
  - Adults 100 to 750 milligrams (mg) every twelve hours for three to twenty-eight days, depending on the medical problem being treated. Bone and joint infections are usually treated for at least four to six weeks. Gonorrhea is usually treated with a single oral dose of 250 mg. Inhalational anthrax is usually treated for sixty days with 500 mg every twelve hours.
  - Children up to 18 years of age This medicine is not recommended for use in infants, children, or teenagers, except in the case of inhalational anthrax. Inhalational anthrax is usually treated for sixty days with 15 mg per kilogram (kg) (6.8 mg per pound) of body weight every twelve hours.
- For injection dosage form:
  - Adults 200 to 400 milligrams (mg) every eight to twelve hours.
  - Children up to 18 years of age This medicine is not recommended for use in infants, children, or teenagers, except in the case of inhalational anthrax. Inhalational anthrax is usually treated for sixty days with 10 mg per kg (4.5 mg per pound) of body weight every twelve hours.

For gemifloxacin:
- For oral dosage form (tablets):
  - Adults 320 milligrams (mg) once a day for 5 to 7 days, depending on the medical problem being treated .
  - Children up to 18 years of age This medicine is not recommended for use in infants, children, or teenagers .

For levofloxacin:
- For oral dosage form (tablets):
  - Adults 250 to 750 milligrams (mg) once a day for three to twenty-eight days, depending on the medical problem being treated.
  - Children up to 18 years of age This medicine is not recommended for use in infants, children, or teenagers.
- For injection dosage form:
  - Adults 250 to 750 milligrams (mg), injected slowly into a vein, once a day for three to twenty-eight days, depending on the medical problem being treated.
  - Children up to 18 years of age This medicine is not recommended for use in infants, children, or teenagers.

For lomefloxacin:
- For oral dosage form (tablets):
  - Adults 400 milligrams (mg) once a day for three to fourteen days, depending on the medical problem being treated.
  - Children up to 18 years of age This medicine is not recommended for use in infants, children, or teenagers.

For moxifloxacin:
- For oral dosage form (tablets):
  - Adult 400 milligrams (mg) once a day for five to fourteen days, depending on the medical problem being treated.
  - Children up to 18 years of age This medicine is not recommended for use in infants, children, or teenagers.
- For injection dosage form:
  - Adult 400 milligrams (mg) injected in a vein once a day for five to fourteen days, depending on the medical problem being treated.
  - Children up to 18 years of age This medicine is not recommended for use in infants, children, or teenagers.

For norfloxacin:
- For oral dosage form (tablets):
  - Adults 400 milligrams (mg) every twelve hours for three to twenty-eight days, depending on the medical problem being treated. Gonorrhea is usually treated with a single oral dose of 800 mg.
  - Children up to 18 years of age This medicine is not recommended for use in infants, children, or teenagers.

For ofloxacin:
- For oral dosage form (tablets):
  - Adults 200 to 400 milligrams (mg) every twelve hours for three to fourteen days, depending on the medical problem being treated. Prostatitis is usually treated for six weeks. Gonorrhea is usually treated with a single oral dose of 400 mg.
  - Children up to 18 years of age This medicine is not recommended for use in infants, children, or teenagers.
- For injection dosage form:
  - Adults 200 to 400 milligrams (mg), injected slowly into a vein, every twelve hours for three to fourteen days, depending on the medical problem being treated. Prostatitis is usually treated for six weeks. Gonorrhea is usually treated with a single dose of 400 mg.
  - Children up to 18 years of age This medicine is not recommended for use in infants, children, or teenagers.

Missed dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ciprofloxacin oral suspension may be refrigerated. However, keep this medicine from freezing.

Precautions While Using This Medicine:

If your symptoms do not improve within a few days, or if they become worse, check with your doctor.

If you are taking aluminum- or magnesium-containing antacids, didanosine, or sucralfate, do not take them at the same time that you take this medicine. It is best to take these medicines at least 6 hours before or 2 hours after taking ciprofloxacin; at least 2 hours before or 2 hours after taking levofloxacin, norfloxacin, or ofloxacin; at least 4 hours before or 2 hours after taking lomefloxacin, and at least 8 hours before and 4 hours after taking moxifloxacin. These medicines may keep fluoroquinolones from working properly.

If you are taking metal cations such as iron, and multivitamin preparations with zinc, or didanosine (Videx) chewable/buffered tablets or the pediatric powder for oral solution take moxifloxacin at least 4 hours before or 8 hours after and take ciprofloxacin at least 2 hours before or 6 hours after taking these medicines.

If you are taking levofloxacin or lomefloxacin, you should not take certain medications which correct a fast, slow or irregular heartbeat. Check with your doctor to determine whether you are taking one of these medications.

Some people who take fluoroquinolones may become more sensitive to sunlight than they are normally. Exposure to sunlight, even for brief periods of time, may cause severe sunburn, or skin rash, redness, itching, or discoloration. When you begin taking this medicine:

Stay out of direct sunlight, especially between the hours of 10:00 a.m. and 3:00 p.m., if possible.
Wear protective clothing, including a hat and sunglasses.
Apply a sun block product that has a skin protection factor (SPF) of at least 15. Some patients may require a product with a higher SPF number, especially if they have a fair complexion. If you have any questions about this, check with your doctor.
Do not use a sunlamp or tanning bed or booth.
Stay out of direct sunlight and artificial light (e.g., sunlamp, tanning bed or booth) for the next 5 days or until the reaction has stopped.
If you get a skin rash or other signs of an allergic reaction, stop taking the fluoroquinolone and check with your doctor.

Levofloxacin may cause serious liver problems, including hepatitis. Stop taking this medicine and check with your doctor right away if you start having nausea or vomiting, dark urine, light-colored stools, stomach pain, or yellow eyes or skin while you are using this medicine .

Tell your doctor right away if you start having numbness, tingling, or burning pain in your hands, arms, legs, or feet. These may be symptoms of a condition called peripheral neuropathy .

Fluoroquinolones may also cause some people to become dizzy, lightheaded, drowsy, or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that can be dangerous if you are dizzy or are not alert. If these reactions are especially bothersome, check with your doctor.

Fluoroquinolones may rarely cause inflammation or even tearing of a tendon (the cord that attaches muscles to bones). If you get sudden pain in a tendon after exercise (for example, in your ankle, back of the knee or leg, shoulder, elbow, or wrist), stop taking the fluoroquinolone and check with your doctor. Rest and do not exercise until the doctor has made sure that you have not injured or torn the tendon.

This medicine may cause a serious type of allergic reaction which can be life-threatening and requires immediate medical attention. Stop taking this medicine and call your doctor right away if you have itching, hives, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine .

For patients with diabetes taking insulin or diabetes medicine by mouth: Levofloxacin may cause hypoglycemia (low blood sugar) in some patients. Symptoms of low blood sugar must be treated before they lead to unconsciousness (passing out). Different people may feel different symptoms of low blood sugar. If you experience symptoms of low blood sugar, stop taking levofloxacin and check with your doctor right away:

Symptoms of low blood sugar can include: Anxious feeling, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty in concentrating, drowsiness, excessive hunger, headache, nausea, nervousness, rapid heartbeat, shakiness, unusual tiredness or weakness.

For patients with low potassium levels: levofloxacin may increase your risk of experiencing a fast, slow or irregular heartbeat.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common: Fainting; irregular or slow heart rate

Less common: Blistering of skin; bloating or swelling of face, arms, hands, lower legs, or feet; blurred vision; dizziness; headache; nervousness; pounding in the ears; rapid weight gain; sensation of skin burning; skin itching, rash, redness, or swelling; slow or fast heartbeat; tingling of hands or feet; unusual weight gain or loss

Rare: Abdominal or stomach cramps and pain (severe); abdominal pain; abdominal tenderness; agitation; area rash; black, tarry stools; bleeding; blistering, itching, loosening, peeling, or redness of skin; blisters on mucous membranes, with fever; bloody or cloudy urine; coldness; burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings; chills; chest pain; clay-colored stools; confusion; cough; dark or amber urine; diarrhea (watery and severe, which may also be bloody); difficulty breathing; difficulty swallowing; discoloration of skin; dizziness; dry mouth; excessive muscle tone; fainting; faintness, dizziness, or light-headedness when getting up from a lying or sitting position suddenly; fast, pounding, or irregular heartbeat or pulse; fatigue; flushed, dry skin; feeling of pressure; feeling of unreality; feeling of warmth or heat; fever; flushing or redness of skin especially on face and neck; fruit-like breath odor; hallucinations (seeing, hearing, or feeling things that are not there); hives or welts; incoordination; increased hunger; increased thirst; increased urination; inflammation; infection; irregular or fast heart rate; itching; joint pain; lack or loss of strength; large amount of fat in the blood; loss of appetite; loss of memory; lower back, side, or stomach pain; lumps; muscle stiffness; muscle tension or tightness; nausea; noisy breathing; numbness; pain; pain at site of injection for ciprofloxacin or ofloxacin injection; pain in calves, radiating to heels; pain, warmth, or burning in fingers, toes and legs; painful or difficult urination; pale stools; palpitations; peeling of the skin; problems with memory; problems with speech or speaking; problems with vision or hearing; rash; rash with flat lesions or small raised lesions on the skin; redness; redness of skin; redness, swelling, or soreness of tongue; scarring; seizures; sense of detachment from self or body; shakiness or tremors; shortness of breath; sore throat; soreness; sores, ulcers, or white spots on lips or in mouth; stinging; stomach pain; sweating; swelling; swelling of calves, feet, or lower legs; swelling of face or neck; swelling or inflammation of the mouth; swelling or puffiness of face; tenderness; tightness in chest; tingling; troubled breathing; ulceration; unpleasant breath odor; unusual tiredness or weakness; vomiting; vomiting of blood; warmth; wheezing; yellow eyes or skin

Incidence not known: Abnormal brain wave patterns; black, tarry stools; bleeding gums; blurred vision; coma; confusion; difficult breathing; failure of the heart, lungs, kidneys and/or liver; fatigue; general body swelling; hives; inability to move arms and legs; increased bleeding time; irregular reading on an electrocardiogram (heart test); joint or muscle pain; sharp drop in blood pressure; sore throat; sudden numbness and weakness in the arms and legs; swollen glands; unsteadiness or awkwardness; unusual bleeding or bruising; weakness in arms, hands, legs, or feet

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common: Abdominal or stomach pain or discomfort (mild); diarrhea (mild); drowsiness; light-headedness; nervousness; trouble in sleeping; vaginal pain and discharge

Less common or rare: Abnormal dream; acid or sour stomach; back pain; bad, unusual, or unpleasant (after) taste; belching; bloated, full feeling; burning feeling in chest or stomach; burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings; change in sense of smell; change in sense of taste; change in vision; constipation; continuing ringing or buzzing or other unexplained noise in ears; crying; depersonalization; depression; difficulty in sleeping; difficulty in speaking; difficulty in urination; dysphoria; euphoria; excess air or gas in stomach or intestines; fear; feeling of constant movement of self or surroundings; general feeling of discomfort or illness; hearing loss; heartburn; impaired vision; increased sensitivity of skin to sunlight; indigestion; mental depression; pain, swelling, or redness in joints; paranoia; passing gas; pelvic pain; pinpoint red or purple spots on skin; puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue; quick to react or overreact emotionally; rapidly changing moods; sensation of spinning; shortness of breath; sleepiness or unusual drowsiness; sleeplessness; sore mouth or tongue, or white patches in mouth and/or on tongue; spots on skin resembling a blister or pimple; stomach discomfort, upset, or pain; tenderness in stomach area; thinking, abnormal; tongue discoloration; unable to sleep; vaginal yeast infection; vision problems; weight loss

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Last Updated: 6/12/2013

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