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)
Pharmacology
Mechanism of Action
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.
Pharmacokinetics/Pharmacodynamics
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.
Use: Off Label
Surgical (ophthalmic) prophylaxisyes
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
Dosage and Administration
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
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
Pregnancy Risk Factor
C
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 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.
Frequently reported side effects of this drug
- Short-term pain
- Watery eyes
- Dry eyes
Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:
- Vision changes
- Eye pain
- Severe eye irritation
- Signs of a significant reaction like 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. 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 brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.
