Moxifloxacin 400 Mg Film-Coated Tablets
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Package leaflet: Information for the user
Moxifloxacin 400 mg film-coated tablets. Adults
Active substance: Moxifloxacin
Read all of this leaflet carefully before you start taking this medicine because it contains important
information for you.
- Keep this leaflet. You may need to read it again.
- If you have more questions, ask your doctor or pharmacist.
- This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours. Do not re-use this medicine without medical prescription, even if you want to treat a similar illness.
- If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet.
What is in this leaflet
1. What Moxifloxacin tablets are and what they are used for
2. What you need to know before you take Moxifloxacin tablets
3. How to take Moxifloxacin tablets
4. Possible side effects
5. How to store Moxifloxacin tablets
6. Contents of the pack and other information
1. What Moxifloxacin tablets are and what they are used for
Moxifloxacin tablets contain the active substance moxifloxacin, which belongs to a group of antibiotics called fluoroquinolones. Moxifloxacin tablets work by killing bacteria that cause infections. Moxifloxacin tablets is used in patients aged 18 years and above for treating the following bacterial infections when caused by bacteria against which moxifloxacin is active. Moxifloxacin tablets should only be used to treat these infections when usual antibiotics cannot be used or have not worked: Infection of the sinuses, sudden worsening of long term inflammation of the airways or infection of the lungs (pneumonia) acquired outside the hospital (except severe cases).
Mild to moderate infections of the female upper genital tract (pelvic inflammatory disease), including infections of the fallopian tubes and infections of the uterus mucous membrane. Moxifloxacin tablets are not sufficient on their own for treating this kind of infection. Therefore, another antibiotic in addition to Moxifloxacin tablets should be prescribed by your doctor for the treatment of infections of the female upper genital tract (see section 2.What you need to know before you take Moxifloxacin tablets, Warnings and precautions, Talk to your doctor before taking
Moxifloxacin tablets).
If the following bacterial infections have shown improvement during initial treatment with a solution of Moxifloxacin for infusion, Moxifloxacin tablets may also be prescribed by your doctor to complete the course of therapy:
Infection of the lungs (pneumonia) acquired outside the hospital, infections of the skin and soft tissue. Moxifloxacin tablets should not be used to initiate therapy for any type of infections of the skin and soft tissue or in severe infections of the lungs.
2. What you need to know before you take Moxifloxacin tablets
Contact your doctor if you are not sure if you belong to a patient group described below.
Do not take Moxifloxacin tablets
- If you are allergic to the active substance moxifloxacin, any other quinolone antibiotics or any of the other ingredients of this medicine (listed in section 6. Further information).
- If you are pregnant or are breast-feeding.
- If you are under 18 years of age.
- If you have previously had problems with your tendons related to treatment with quinolone antibiotics (see section Warnings and Precautions...and section 4. Possible side effects).
- If you were born with or have
• any condition with abnormal heart rhythm (seen on ECG, electrical recording of the heart)
• a salt imbalance in the blood (especially low levels of potassium or magnesium in the blood)
• a very slow heart rhythm (called ‘bradycardia’)
• a weak heart (heart failure)
• a history of abnormal heart rhythms
• if you are taking other medicines that result in abnormal ECG changes (see section Other medicines and Moxifloxacin tablets). This is because Moxifloxacin tablets can cause changes on the ECG, that is a prolongation of the QT-interval, i.e., delayed conduction of electrical signals.
- If you have a severe liver disease or increased liver enzymes (transaminases) higher than 5 times the upper normal limit.
Warnings and precautions
Talk to your doctor before taking Moxifloxacin
tablets
- Moxifloxacin tablets can change your heart’s ECG, especially if you are female, or if you are elderly. If you are currently taking any medicine that decreases your blood potassium levels , consult your doctor before taking Moxifloxacin tablets (see also sections Do not take and Other medicines and Moxifloxacin tablets).
- If you suffer from epilepsy or a condition which makes you likely to have convulsions talk to your doctor before taking Moxifloxacin tablets.
- If you have or have ever had any mental health problems, consult your doctor before taking Moxifloxacin tablets.
- If you or any member of your family have glucose- 6-phosphate dehydrogenase deficiency (a rare hereditary disease), tell your doctor, who will advise whether Moxifloxacin tablets is suitable for you.
- If you suffer from myasthenia gravis (abnormal muscle fatigue leading to weakness and in serious cases paralysis), taking Moxifloxacin tablets may worsen the symptoms of your disease. If you think you are affected consult your doctor immediately.
- If you have a complicated infection of the female upper genital tract (e.g. associated with an abscess of the fallopian tubes and ovaries or of the pelvis), for which your doctor considers an intravenous treatment necessary, treatment with Moxifloxacin tablets is not appropriate.
- For the treatment of mild to moderate infections of the female upper genital tract
your doctor should prescribe another antibiotic in addition to Moxifloxacin tablets. If there is no improvement in symptoms after 3 days of treatment, please consult your doctor.
When taking Moxifloxacin tablets
- If you experience palpitations or irregular heart beat during the period of treatment, you should inform your doctor immediately. He/she may wish to perform an ECG to measure your heart rhythm.
- The risk of heart problems may increase with increase of the dose. Therefore, the recommended dosage should be followed.
- There is a rare chance that you may experience a severe, sudden allergic reaction (an anaphylactic reaction/shock) even with the first dose. Symptoms include tightness in the chest,
feeling dizzy, feeling sick or faint, or dizziness when standing up. If so, stop taking Moxifloxacin tablets and seek medical advice immediately.
- Moxifloxacin tablets may cause a rapid and severe inflammation of the liver which could lead to life-threatening liver failure (including fatal cases, see section 4 Possible side effects). If you suddenly feel unwell and/or are being sick and also have yellowing of the whites of the eyes, dark urine, itching of the skin, a tendency to bleed or liver induced disease of the brain (symptoms of a reduced liver function or a rapid and severe inflammation of the liver)
please contact your doctor before taking any more tablets.
- If you develop a skin reaction or blistering / peeling of the skin and/or mucosal reactions
(see section 4 Possible side effects) contact your doctor immediately before you continue treatment.
- Quinolone antibiotics, including Moxifloxacin tablets, may cause convulsions. If this happens, stop taking Moxifloxacin tablets and contact your doctor immediately.
- You may experience symptoms of neuropathy such as pain, burning, tingling, numbness and/or weakness. If this happens, inform your doctor immediately prior to continuing treatment with Moxifloxacin tablets.
- You may experience mental health problems
even when taking quinolone antibiotics, including Moxifloxacin tablets, for the first time. In very rare cases depression or mental health problems have led to suicidal thoughts and self-injurious behaviour such as suicide attempts (see section 4. Possible side effects).
If you develop such reactions, stop taking Moxifloxacin tablets and inform your doctor immediately.
- You may develop diarrhoea whilst or after taking antibiotics including Moxifloxacin tablets. If this becomes severe or persistent or you notice that your stool contains blood or mucus you should stop taking Moxifloxacin tablets immediately and consult your doctor. You should not take medicines that stop or slow down bowel movement.
• Moxifloxacin tablets may cause pain and inflammation of your tendons, even within 48 hours of starting treatment and up to several months after discontinuing Moxifloxacin tablets therapy. The risk of inflammation and rupture of tendons is increased if you are elderly or if you are also taking corticosteroids. At the first sign of any pain or inflammation you should stop taking Moxifloxacin tablets, rest the affected limb(s) and consult your doctor immediately. Avoid any unnecessary exercise, as this might increase the risk of a tendon rupture. (see sections Do not take Moxifloxacin tablets...and 4. Possible side effects).
- If you are elderly and have kidney problems make sure that you drink plenty whilst taking Moxifloxacin tablets. If you get dehydrated this may increase the risk of kidney failure.
- If your eyesight becomes impaired or if your eyes seem to be affected whilst taking Moxifloxacin tablets, consult an eye specialist immediately (see sections Driving and using machines and 4. Possible side effects).
- Quinolone antibiotics may make your skin become more sensitive to sunlight or UV light. You should avoid prolonged exposure to sunlight or strong sunlight and should not use a sunbed or any other UV lamp while taking Moxifloxacin tablets.
- The efficacy of Moxifloxacin tablets in the treatment of severe burns, infections of deep tissue and diabetic foot infections with osteomyelitis (infections of the bone marrow) has not been established.
Children and adolescents Do not give this medicine to children and adolescents under the age of 18 because efficacy and safety have not been established for this age group (see section Do not take Moxifloxacin tablets). Other medicines and Moxifloxacin tablets
Tell your doctor or pharmacist about any other medicines that you are taking, took recently or might take.
For Moxifloxacin tablets be aware of the following:
- If you are taking Moxifloxacin tablets and other medicines that affect your heart there is an increased risk for altering your heart rhythm. Therefore, do not take Moxifloxacin tablets together with the following medicines:
• medicines that belong to the group of anti-arrhythmics (e.g. quinidine, hydroquinidine, disopyramide, amiodarone, sotalol, dofetilide, ibutilide)
• antipsychotics (e.g. phenothiazines, pimozide, sertindole, haloperidol, sultopride)
• tricyclic antidepressants
• some antimicrobials (e.g. sparfloxacin, saquinavir,intravenous erythromycin, pentamidine, antimalarials particularly halofantrine)
• some antihistamines (e.g. terfenadine, astemizole, mizolastine)
• other medicines (e.g. cisapride, intravenous vincamine, bepridil and diphemanil).
- You must tell your doctor if you are taking other medicines that can lower your blood potassium levels (e.g. some diuretics, some laxatives and enemas [high doses] or corticosteroids [anti-inflammatory drugs], amphotericin B) or cause a slow heart rate because these can also increase the risk of serious heart rhythm disturbances while taking moxifloxacin.
- Any medicine containing magnesium or aluminium (such as antacids for indigestion), iron, zinc or didanosine or any medicine containing sucralfate (to treat stomach disorders) can reduce the action of Moxifloxacin tablets. Take your Moxifloxacin tablet 6 hours before or after taking the other medicine.
- Taking any medicine containing charcoal at the same time as Moxifloxacin tablets reduces the action of Moxifloxacin tablets. It is recommended
that these medicines are not used together.
- If you are currently taking drugs to thin your blood (oral anti-coagulants such as warfarin), it may be necessary for your doctor to monitor your blood clotting time.
Moxifloxacin tablets with food and drink
Moxifloxacin tablets can be taken with or without food (including dairy products).
Pregnancy, breast-feeding and fertility
Do not take Moxifloxacin tablets if you are pregnant or breast-feeding.
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
Animal studies do not indicate that your fertility will be impaired by taking this medicine.
Driving and using machines
Moxifloxacin tablets may make you feel dizzy or light-headed, you may experience a sudden, transient loss of vision, or you may faint for a short period. If you are affected do not drive or operate machinery.
3. How to take Moxifloxacin tablets
Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or . pharmacist if you are not sure. j The recommended dose for adults is one 400mg film-coated tablet once daily.
Moxifloxacin tablets are for oral use. Swallow the tablet whole (to mask the bitter taste) and with plenty of liquid. You can take Moxifloxacin tablets with or without food. Try to take the tablet at approximately the same time each day.
The same dose can be taken by elderly patients, patients with a low bodyweight or in patients with kidney problems.
The time you will take Moxifloxacin tablets for depends on your infection. Unless your doctor tells you otherwise, your treatment will be as follows:
- for sudden worsening (acute exacerbation) of
chronic bronchitis 5 - 10 days
- for infection of the lungs (pneumonia) except for pneumonia which starts during a stay
in hospital 10 days
- for acute infection of the sinuses (acute
bacterial sinusitis) 7 days
- Mild to moderate infections of the female upper genital tract (pelvic inflammatory disease), including infection of the fallopian tubes and infection of the uterus mucous membrane 14 days
When Moxifloxacin tablets are used to complete a course of therapy started with moxifloxacin solution for infusion, the recommended durations of use are:
- Infection of the lungs (pneumonia) acquired
outside the hospital 7 - 14 days
Most patients with pneumonia were switched to oral treatment with Moxifloxacin tablets within 4 days.
- Infections of the skin and soft tissue 7 - 21 days Most patients with infections of the skin and soft tissue were switched to oral treatment with Moxifloxacin tablets within 6 days.
It is important that you complete the course of treatment even if you begin to feel better after a few days. If you stop taking Moxifloxacin tablets too soon your infection may not be completely cured and the infection may return or your condition may get worse. The bacteria causing your infection may become resistant to Moxifloxacin tablets.
The recommended dose and duration of treatment should not be exceeded (see section 2. What you need to know before you take Moxifloxacin tablets, Warnings and precautions).
If you take more Moxifloxacin tablets than you should
If you take more than the prescribed one tablet a day, get medical help immediately. Try to take any remaining tablets, the packaging or this leaflet with you to show the doctor or pharmacist what you have taken.
If you forget to take Moxifloxacin tablets
If you forget to take your tablet you should take it as soon as you remember on the same day. If you
do not remember on the same day, take your normal dose (one tablet) on the next day. Do not take a double dose to make up for a forgotten dose.
If you are unsure about what to do ask your doctor or pharmacist.
If you stop taking Moxifloxacin tablets
If you stop taking this medicine too soon your infection may not be completely cured. Talk to your doctor if you wish to stop taking your tablets before the end of the course of treatment.
If you have any further questions about this medicine, ask your doctor or pharmacist.
4. Possible Side Effects
Like all medicines, this medicine can cause side effects, although not everybody gets them. The following side effects have been observed during treatment with Moxifloxacin tablets.
The frequency of possible side effects listed below is defined using the following convention:
Common: may affect up to 1 in 10 people Uncommon: may affect up to 1 in 100 people Rare: may affect up to 1 in 1,000 people Very rare: may affect up to 1 in 10,000 people Cardiac System (see section 2. What you need to know before you take Moxifloxacin tablets) Common: Change of the heart rhythm (ECG) in patients with low blood potassium level
Uncommon: Change of the heart rhythm (ECG), palpitations, irregular and fast heartbeat, severe heart rhythm abnormalities, chest pain (angina pectoris)
Rare: Abnormal fast heart rhythm, fainting
Very rare: Abnormal heart rhythms,
life-threatening irregular heartbeat, stopping of heartbeat
Common side effects:
• Infections caused by resistant bacteria or fungi, e.g. oral and vaginal infections caused by Candida (thrush)
• Headache
• Dizziness
• Feeling sick (nausea)
• Being sick (vomiting)
• Stomach ache
• Diarrhoea
• Increase of a special liver enzyme in the blood (transaminases)
Uncommon side effects:
• Allergic reaction
• Low red blood cell count (anaemia)
• Low white blood cells count
• Low numbers of special white blood cells (neutrophils)
• Decrease or increase of special blood cells necessary for blood clotting
• Increased specialised white blood cells (eosinophils)
• Decreased blood clotting
• Increased blood lipids (fats)
• Feeling anxious, restless, or agitated
• Tingling sensation (pins and needles) and/or numbness
• Changes in taste (in very rare cases loss of taste)
• Feeling confused and disorientated
• Sleep problems (e.g. sleeplessness or sleepiness)
• Shaking
• Sensation of dizziness (spinning or falling over)
• Problems with vision (including double or blurred vision)
• Widening of the blood vessels (flushing)
• Difficulty in breathing (including asthmatic conditions)
• Decreased appetite and food intake
• Wind and constipation
• Stomach upset (indigestion or heartburn)
• Inflammation of the stomach
• Increase of a special digestive enzyme in the blood (amylase)
• Problems with liver function (including increase of a special liver enzyme in the blood (LDH)), increase of bilirubin in the blood, increase of a special liver enzyme in the blood (gamma-glutamyl-transferase and/or alkaline phosphatase)
• Itching, rash, skin hives, dry skin
• Joint pain, muscle pain
• Dehydration
• Feeling unwell (usually weakness or tiredness), aches and pains such as back, chest, pelvic pains and pains in the extremities
• Sweating.
Rare side effects:
• Severe, sudden allergic reaction including very rarely life-threatening shock (e.g. difficulty in breathing, drop of blood pressure, fast pulse), swelling (including potentially life-threatening swelling of the airway)
• Severe diarrhoea containing blood and/or mucus (antibiotic associated colitis including pseudomembranous colitis), which very rarely, may develop into complications that are life-threatening
• Jaundice (yellowing of the whites of the eyes or skin), inflammation of the liver Pain and swelling of the tendons (tendonitis) Increased blood sugar Increased blood uric acid Feeling particularly emotional Depression (which in very rare cases may lead to self-harm, such as suicidal ideations/ thoughts, or suicide attempts)
Hallucination
Problems with skin sensations Changes in smell (including loss of smell) Unusual dreams
Problems with balance and co-ordination (due to dizziness)
Convulsions Disturbed concentration Problems with speech Partial or total loss of memory Troubles associated with the nervous system such as pain, burning, tingling, numbness and/or weakness in extremities
• Ringing or noise in the ears, hearing impairment including deafness (usually reversible)
• High or low blood pressure
• Difficulty in swallowing
• Inflammation of the mouth
• Muscle cramps or twitching
• Muscle weakness
• Kidney problems (including an increase in special kidney laboratory test results like urea and creatinine), kidney failure
• Swelling (of the hands, feet, ankles, lips, mouth or throat, oedema)
Very rare side effects:
• Severe inflammation of the liver potentially leading to life-threatening liver failure (including fatal cases)
• Changes to the skin and mucous membranes (painful blisters in the mouth/nose or at the penis/vagina), potentially life-threatening (Stevens-Johnson- Syndrome, toxic epidermal necrolysis)
• Rupture of tendons
• Increased blood clotting, significant decrease of special white blood cells (agranulocytosis)
• A feeling of self-detachment (not being yourself)
• Feeling mentally unwell (potentially leading to self-harm, such as suicidal ideations/thoughts, or suicide attempts)
Transient loss of vision Skin feeling more sensitive Inflammation of joints Muscles feeling stiff
Worsening of the symptoms of myasthenia gravis (abnormal muscle fatigue leading to weakness and in serious cases paralysis)
Also, there have been very rare cases of the following side effects reported following treatment with other quinolone antibiotics, which might possibly also occur during treatment with Moxifloxacin tablets:
• Increased blood sodium levels
• Increased blood calcium levels
• A special type of reduced red blood cell count (haemolytic anaemia)
• Muscle reactions with muscle cell damage
• Increased sensitivity of the skin to sunlight or UV light.
If you get any side effects , talk to your doctor or pharmacist. This includes any side effects not listed in this leaflet.
5. How to store Moxifloxacin tablets
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date stated on the blister and carton. The expiry date refers to the last day of the month.
Store in the original package in order to protect from moisture.
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
6. Contents of the pack and other information What Moxifloxacin tablets contain
- The active substance is moxifloxacin. Each film-coated tablet contains 400mg moxifloxacin as hydrochloride.
- The other ingredients are:
Tablet core: Microcrystalline cellulose, Croscarmellose sodium, Copovidone Pregelatinised starch, Talc, Silica colloidal anhydrous and Magnesium stearate.
Film coating: Opadry II 85F18422: Macrogol 3350, Red Iron Oxide (EH2), Polyvinyl alcohol,
Titanium dioxide (E171), Talc.
What Moxifloxacin tablets look like and contents of the pack
Each pale red coloured film coated tablet is capsule shaped and embossed with “400” on one side. Moxifloxacin tablets are packaged in cartons containing aluminium/aluminium blister.
They are available in commercial packs of 5, 7, and 10 film-coated tablets and in hospital packs of 25, 50, 70, 80, or 100 film-coated tablets.
Not all pack sizes may be marketed.
Marketing Authorisation Holder and Manufacturer Marketing Authorisation Holder:
DOUBLE-E PHARMA LTD. 7th Floor,
Hume House, Ballsbridge, Dublin 4, Ireland
Manufacturer:
Laboratoires BTT, ZI de Krafft, 67150 Erstein, France
Distributed by:
Creo Pharma Ltd, Felsted Business Centre, Felsted,
Essex CM6 3LY, UK
This leaflet was last revised in 06/2013
CRE-MOX-PIL-044_05
20/06/2013