Pharmacy Guide

Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.

Pharmacy Guide

Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.

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Avelox 400 mg film-coated tablets

⚠ This medicine appears to have been discontinued

The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.

If you were prescribed this medicine, other products containing Moxifloxacin hydrochloride may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.

Active substance: Moxifloxacin hydrochloride

Equivalent medicines (same active substance, strength and form)

Source: electronic medicines compendium (emc)
Official leaflet: Read the PIL on emc

What it is and what it is used for

for

Avelox contains the active substance moxifloxacin, which belongs to a group of antibiotics called fluoroquinolones. Avelox works by killing bacteria that cause infections. Avelox is used in patients aged 18 years and above for treating the following bacterial infections when caused by bacteria against which moxifloxacin is active. Avelox 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. Avelox tablets are not sufficient on their own for treating this kind of infection. Therefore, another antibiotic in addition to Avelox 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 Avelox, Warnings and precautions, Talk to your doctor before taking Avelox). If the following bacterial infections have shown improvement during initial treatment with Avelox solution for infusion, Avelox 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.

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Avelox 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 it

e Avelox

Contact your doctor if you are not sure if you belong to a patient group described below.

Do not take Avelox –

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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.). 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 or
  • if you are taking other medicines that result in abnormal ECG changes (see section Other medicines and Avelox). This is because Avelox 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 Before taking this medicine You should not take fluoroquinolone/quinolone antibacterial medicines, including Avelox, if you have experienced any serious adverse reaction in the past when taking a quinolone or fluoroquinolone. In this situation, you should inform your doctor as soon as possible. Talk to your doctor before taking Avelox Avelox 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 Avelox (see also sections Do not take Avelox and Other medicines and Avelox). If you have ever developed a severe skin rash or skin peeling, blistering and/or mouth sores after taking moxifloxacin. If you suffer from epilepsy or a condition which makes you likely to have convulsions talk to your doctor before taking Avelox. If you have or have ever had any mental health problems, consult your doctor before taking Avelox. If you suffer from myasthenia gravis (abnormal muscle fatigue leading to weakness and in serious cases paralysis), taking Avelox may worsen the symptoms of your disease. If you think you are affected consult your doctor immediately. If you have been diagnosed with an enlargement or "bulge" of a large blood vessel (aortic aneurysm or large vessel peripheral aneurysm). If you have experienced a previous episode of aortic dissection (a tear in the aorta wall). If you have been diagnosed with leaking heart valves (heart valve regurgitation).

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If you have a family history of aortic aneurysm or aortic dissection or congenital heart valve disease, or other risk factors or predisposing conditions (e.g. connective tissue disorders such as Marfan syndrome or Ehlers-Danlos syndrome, Turner syndrome, Sjögren ́s syndrome [an inflammatory autoimmune disease], or vascular disorders such as Takayasu arteritis, giant cell arteritis, Behçet ́s disease, high blood pressure, or known atherosclerosis, rheumatoid arthritis [a disease of the joints] or endocarditis [an infection of the heart]). If you are diabetic because you may experience a risk of change in blood sugar levels with moxifloxacin. 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 Avelox is suitable for you. 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 Avelox 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 Avelox. If there is no improvement in symptoms after 3 days of treatment, please consult your doctor.

When taking Avelox 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 Avelox and seek medical advice immediately.- Prolonged, disabling and potentially irreversible serious side effects. Fluoroquinolone/quinolone antibacterial medicines, including Avelox, have been associated with rare but serious side effects, some of them being long lasting (continuing for months or years), disabling or potentially irreversible. This includes tendon, muscle and joint pain of the upper and lower limbs, difficulty in walking, abnormal sensations such as pins and needles, tingling, tickling, numbness or burning (paraesthesia), sensory disorders including impairment of vision, taste and smell, and hearing, mental health effects which may include, but are not necessarily limited to, anxiety, panic attacks, confusion, or depression, memory impairment, severe fatigue, and severe sleep disorders. There are no medicines that have been established as being effective treatments for the symptoms of long lasting or disabling side effects associated with fluoroquinolones. If you experience any of these side effects after taking Avelox, then do not take any further doses and contact your doctor immediately. You and your doctor will decide on whether to continue treatment, considering alternative options. You may experience psychiatric reactions when taking Avelox, including when taking it for the first time. If you suffer from depression or psychosis, your symptoms may become worse under treatment with Avelox. In rare cases, depression or psychosis can progress to thoughts of suicide or suicide attempts. If this happens, stop taking Avelox and contact your doctor immediately. You may not notice some changes in your mood and behaviour so it is very important to tell your friends and family that you are taking Avelox, and that there may be rare psychiatric side effects. Others may notice changes and help you quickly identify any symptoms that you need to talk to your doctor about. 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. Avelox 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. Serious skin reactions Serious skin reactions including Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalised exanthematous pustulosis (AGEP) and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) have been reported with the use of moxifloxacin. v038_0

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SJS/TEN can appear initially as reddish target-like spots or circular patches often with central blisters on the trunk. Also, ulcers of mouth, throat, nose, genitals and eyes (red and swollen eyes) can occur. These serious skin rashes are often preceded by fever and/or flu-like symptoms. The rashes may progress to widespread peeling of the skin and life-threatening complications or be fatal. • AGEP appears at the initiation of treatment as a red, scaly widespread rash with bumps under the skin and blisters accompanied by fever. The most common location: mainly localized on the skin folds, trunk, and upper extremities. • DRESS appears initially as flu-like symptoms and a rash on the face then an extended rash with a high body temperature, increased levels of liver enzymes seen in blood tests and an increase in a type of white blood cell (eosinophilia) and enlarged lymph nodes. If you develop a serious rash or another of these skin symptoms, stop taking moxifloxacin and contact your doctor or seek medical attention immediately. Quinolone antibiotics, including Avelox, may cause convulsions. If this happens, stop taking Avelox and contact your doctor immediately. You may rarely experience symptoms of nerve damage (neuropathy) such as pain, burning, tingling, numbness and/or weakness especially in the feet and legs or hands and arms. If this happens, stop taking Avelox and inform your doctor immediately in order to prevent the development of potentially irreversible condition. You may develop diarrhoea whilst or after taking antibiotics including Avelox. If this becomes severe or persistent or you notice that your stool contains blood or mucus you should stop taking Avelox immediately and consult your doctor. You should not take medicines that stop or slow down bowel movement. Pain and swelling in the joints and inflammation or rupture of tendons may occur rarely (see sections Do not take Avelox and 4. Possible side effects). Your risk is increased if you are elderly (above 60 years of age), have received an organ transplant, have kidney problems or if you are also taking corticosteroids. Inflammation and ruptures of tendons may occur within the first 48 hours of treatment and even up to several months after stopping of Avelox therapy. At the first sign of pain or inflammation of a tendon (for example in your ankle, wrist, elbow, shoulder or knee), stop taking Avelox, contact your doctor and rest the painful area. Avoid any unnecessary exercise as this might increase the risk of a tendon rupture. If you feel sudden, severe pain in your abdomen, chest or back, which can be symptoms of aortic aneurysm and dissection, go immediately to an emergency room. Your risk may be increased if you are being treated with systemic corticosteroids. If you start experiencing a rapid onset of shortness of breath, especially when you lie down flat in your bed, or you notice swelling of your ankles, feet or abdomen, or a new onset of heart palpitations (sensation of rapid or irregular heartbeat), you should inform a doctor immediately. If you are elderly and have kidney problems make sure that you drink plenty whilst taking Avelox. If you get dehydrated this may increase the risk of kidney failure. If your eyesight becomes impaired or if your eyes seem to be otherwise affected, consult an eye specialist immediately (see sections Driving and using machines and 4. Possible side effects). Fluoroquinolone antibiotics may cause an increase of your blood sugar levels above normal levels (hyperglycemia), or lowering of your blood sugar levels below normal levels (hypoglycaemia), potentially leading to loss of consciousness (hypoglycaemic coma) in severe cases (see section 4. Possible side effects). If you suffer from diabetes, your blood sugar should be carefully monitored. 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 Avelox (see section 4. Possible side effects). The efficacy of Avelox 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 Avelox). Other medicines and Avelox Tell your doctor or pharmacist about any other medicines that you are taking, took recently or might take. v038_0

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For Avelox, be aware of the following: If you are taking Avelox and other medicines that affect your heart there is an increased risk for altering your heart rhythm. Therefore, do not take Avelox 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. saquinavir, sparfloxacin, 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 Avelox. 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 Avelox tablets. Take your Avelox tablet 6 hours before or after taking the other medicine. Taking any medicine containing charcoal at the same time as Avelox tablets reduces the action of Avelox. 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. Avelox with food and drink Avelox can be taken with or without food (including dairy products). Pregnancy, breast-feeding and fertility Do not take Avelox 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 Avelox 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. Avelox contains lactose and sodium If you have been told by your doctor that you have an intolerance to some sugars, speak to your doctor before taking Avelox. This medicine contains less than 1 millimol sodium (23 milligramm) per film-coated tablet, that is to say essentially "sodium-free".

3.

How to take it

Avelox

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. The recommended dose for adults is one 400mg film-coated tablet once daily. Avelox tablets are for oral use. Swallow the tablet whole (to mask the bitter taste) and with plenty of liquid. You can take Avelox 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.

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The time you will take Avelox for depends on your infection. Unless your doctor tells you otherwise, your treatment will be as follows:

  • for sudden worsening of chronic bronchitis (acute exacerbation of chronic obstructive pulmonary disease including 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 Avelox film-coated tablets are used to complete a course of therapy started with Avelox solution for infusion, the recommended durations of use are: –

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Infection of the lungs (pneumonia) acquired outside the hospital 7 -14 days Most patients with pneumonia were switched to oral treatment with Avelox film-coated 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 Avelox film-coated 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 Avelox 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 Avelox. The recommended dose and duration of treatment should not be exceeded (see section 2. What you need to know before you take Avelox, Warnings and precautions). If you take more Avelox 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 Avelox 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 Avelox 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 most serious side effects observed during treatment with Avelox are listed below: If you notice • an abnormal fast heart rhythm (rare side effect) • that you suddenly start feeling unwell or notice yellowing of the whites of the eyes, dark urine, itching of the skin, a tendency to bleed or disturbances of thought or wakefulness (these can be signs and symptoms of fulminant inflammation of the liver potentially leading to life-threating liver failure (very rare side effect, fatal cases have been observed)) v038_0

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serious skin rashes including Stevens-Johnson syndrome and toxic epidermal necrolysis. These can appear as reddish target-like macules or circular patches often with central blisters on the trunk, skin peeling, ulcers of the mouth, throat, nose, genitals and eyes and can be preceded by fever and flu-like symptoms (very rare side effects, potentially life threatening) • a red, scaly widespread rash with bumps under the skin and blisters accompanied by fever at the initiation of treatment (acute generalised exanthematous pustulosis) (frequency of this side effect is 'not known') • Widespread rash, high body temperature, liver enzyme elevations, blood abnormalities (eosinophilia), enlarged lymph nodes and other body organs involvement (drug reaction with eosinophilia and systemic symptoms which is also known as DRESS or drug hypersensitivity syndrome) (frequency of this side effect is 'not known'). • syndrome associated with impaired water excretion and low levels of sodium (SIADH) (very rare side effect) • loss of consciousness due to severe decrease in blood sugar levels (hypoglycaemic coma) (very rare side effect) • inflammation of blood vessels (signs could be red spots on your skin, usually on your lower legs or effects like joint pain) (very rare side effect) • a severe, sudden generalised allergic reaction incl. very rarely a life-threatening shock (e.g. difficulty in breathing, drop of blood pressure, fast pulse) (rare side effect) • swelling incl. swelling of the airway (rare side effect, potentially life-threatening) • convulsions (rare side effect) • troubles associated with the nervous system such as pain, burning, tingling, numbness and/or weakness in extremities (rare side effect) • depression (in very rare cases leading to self-harm, such as suicidal ideations/thoughts, or suicide attempts) (rare side effect) • insanity (potentially leading to self-harm, such as suicidal ideations/thoughts, or suicide attempts) (very rare side effect) • severe diarrhoea containing blood and/or mucus (antibiotic associated colitis incl. pseudomembranous colitis), which in very rare circumstances, may develop into complications that are life-threatening (rare side effects) • pain and swelling of the tendons (tendonitis) (rare side effect) or a tendon rupture (very rare side effect) • muscle weakness, tenderness or pain and particularly, if at the same time, you feel unwell, have a high temperature or have dark urine. They may be caused by an abnormal muscle breakdown which can be life threatening and lead to kidney problems (a condition called rhabdomylosis) (frequency of this side effect is 'not known') stop taking Avelox and tell your doctor immediately as you may need urgent medical advice. In addition, if you notice • transient loss of vision (very rare side effect), • discomfort or pain to the eyes, especially due to light exposure (very rare to rare side effect) contact an eye specialist immediately. If you have experienced life-threatening irregular heart beat (Torsade de Pointes) or stopping of heart beat while taking Avelox (very rare side effects), tell your treating doctor immediately that you have taken Avelox and do not restart the treatment. A worsening of the symptoms of myasthenia gravis has been observed in very rare cases. If this happens, consult your doctor immediately. If you suffer from diabetes and you notice that your blood sugar is increased or decreased (rare or very rare side effect), inform your doctor immediately. If you are elderly with existing kidney problems and you notice decrease in urine output, swelling in your legs, ankles or feet, fatigue, nausea, drowsiness, shortness of breath or confusion (these can be signs and symptoms of kidney failure, a rare side effect), consult your doctor immediately. v038_0

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Other side effects which have been observed during treatment with Avelox are listed below by how likely they are: Common (may affect up to 1 in 10 people) • nausea • diarrhoea • dizziness • stomach and abdominal ache • vomiting • headache • increase of a special liver enzyme in the blood (transaminases) • infections caused by resistant bacteria or fungi e.g. oral and vaginal infections caused by Candida • change of the heart rhythm (ECG) in patients with low blood potassium level Uncommon (may affect up to 1 in 100 people) • rash • stomach upset (indigestion/heartburn) • changes in taste (in very rare cases loss of taste) • sleep problems (predominantly sleeplessness) • increase of a special liver enzyme in the blood (gamma-glutamyl-transferase and/or alkaline phosphatase) • low number of special white blood cells (leukocytes, neutrophils) • constipation • itching • sensation of dizziness (spinning or falling over) • sleepiness • wind • change of the heart rhythm (ECG) • impaired liver function (incl. increase of a special liver enzyme in the blood (LDH)) • decreased appetite and food intake • low white blood cells count • aches and pains such as back, chest, pelvic and extremities pains • increase of special blood cells necessary for blood clotting • sweating • increased specialised white blood cells (eosinophils) • anxiety • feeling unwell (predominantly weakness or tiredness) • shaking • joint pain • palpitations • irregular and fast heart beat • difficulty in breathing incl. asthmatic conditions • increase of a special digestive enzyme in the blood (amylase) • restlessness / agitation • tingling sensation (pins and needles) and/or numbness • skin hives • widening of blood vessels • confusion and disorientation • decrease of special blood cells necessary for blood clotting • visual disturbances incl. double and blurred vision • decreased blood clotting • increased blood lipids (fats) • low red blood cell count v038_0

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muscle pain allergic reaction increase of bilirubin in the blood inflammation of the stomach dehydration severe heart rhythm abnormalities dry skin angina pectoris

Rare (may affect up to 1 in 1,000 people) • Cases of long lasting (up to months or years) or permanent adverse drug reactions have been associated with quinolone and fluoroquinolone antibiotics.These may include tendon inflammation, tendon rupture, joint pain, pain in the limbs, difficulty in walking, abnormal sensations such as pins and needles, tingling, pricking, burning, numbness or pain (neuropathy), fatigue, sleep disorders, memory impairment, mental health effects which may include, but are not necessarily limited to, anxiety, panic attacks, confusion, or depression, as well as impairment of hearing, vision, and taste and smell. There are no medicines that have been established as being effective treatments for the symptoms of long lasting or disabling side effects associated with fluoroquinolones. • muscle twitching • muscle cramp • hallucination • high blood pressure • swelling (of the hands, feet, ankles, lips, mouth, throat) • low blood pressure • kidney impairment (incl. increase in special kidney laboratory test results like urea and creatinine) • inflammation of the liver • inflammation of the mouth • ringing/noise in the ears • jaundice (yellowing of the whites of the eyes or skin) • impairment of skin sensation • abnormal dreams • disturbed concentration • difficulty in swallowing • changes in smell (incl. loss of smell) • balance disorder and poor co-ordination (due to dizziness) • partial or total loss of memory • hearing impairment including deafness (usually reversible) • increased blood uric acid • emotional instability • impaired speech • fainting • muscle weakness Very rare (may affect up to 1 in 10,000 people) • a drop in the number of red and white blood cells and platelets (pancytopenia) • inflammation of joints • abnormal heart rhythms • increase of skin sensitivity • a feeling of self-detachment (not being yourself) • increased blood clotting • muscle rigidity • significant decrease of special white blood cells (agranulocytosis)

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Not known (frequency cannot be estimated from the available data) •

Increased sensitivity of the skin to sunlight or UV light (see also section 2, Warnings and precautions).

•

Sharply demarcated, erythematous patches with/without blistering that develop within hours of administration of moxifloxacin and heals with post inflammatory residual hyperpigmentation; it usually recurs at the same site of the skin or mucous membrane upon subsequent exposure to moxifloxacin

Cases of an enlargement and weakening of the aortic wall or tear in the aortic wall (aneurysms and dissections), which may rupture and may be fatal, and of leaking heart valves have been reported in patients receiving fluoroquinolones (see also section 2, Warnings and precautions). Furthermore, 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 Avelox:

  • Raised pressure in the skull (symptoms include headache, visual problems including blurred vision, "blind" spots, double vision, loss of vision)
  • Increased blood sodium levels
  • Increased blood calcium levels
  • A special type of reduced red blood cell count (haemolytic anaemia) Reporting of side effects If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly (see details below). By reporting side effects, you can help provide more information on the safety of this medicine. United Kingdom Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store 5.

How to store it

Avelox

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 on the carton. The expiry date refers to the last day of that month. Do not store above 25°C. 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 Avelox contains –

The active substance is moxifloxacin. Each film-coated tablet contains 400 milligram moxifloxacin as hydrochloride. The other ingredients are: Tablet core: Microcrystalline cellulose, Croscarmellose sodium, Lactose monohydrate (see section Avelox contains lactose) and Magnesium stearate. Film coating: Hypromellose, Macrogol 4000, Ferric oxide (E172) and Titanium dioxide (E171).

What Avelox looks like and contents of the pack v038_0

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Each dull red film-coated tablet with an oblong, convex shape with facet and a dimension of 17 x 7 millimeter is marked with "M400" on one side and "BAYER" on the other side. Avelox is packaged in cartons containing colourless transparent or white opaque polypropylene/aluminium blisters or colourless transparent polyvinyl chloride/polyvinylidene chloride/aluminium blisters. Avelox is available in commercial packs containing 5, 7, and 10 film-coated tablets, in hospital packs containing 25, 50 or 70 film-coated tablets and in hospital multipacks comprising 5 cartons, each containing 16 film-coated tablets, or 10 cartons, each containing 10 film-coated tablets. Avelox is also available in a sample pack of 1 film-coated tablet in a carton containing aluminium/aluminium blisters. Not all pack sizes may be marketed. Marketing Authorisation Holder and Manufacturer Marketing Authorisation holder:

Bayer plc 400 South Oak Way Reading RG2 6AD

Manufacturer: The manufacturer can be identified by the batch number printed on the side flap of the carton and on each blister: •

If the first and second characters are BX, the manufacturer is Bayer AG Kaiser-Wilhelm-Allee 51368 Leverkusen Germany

•

If the first and second characters are IT, the manufacturer is Bayer HealthCare Manufacturing S.r.l. Via delle Groane, 126 20024 Garbagnate Milanese Italy

This leaflet was last revised in April 2024 Product Licence Number : PL 00010/0291

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Frequently asked questions about Avelox 400 mg film-coated tablets

How do I take Avelox 400 mg film-coated tablets?

Avelox 400 mg film-coated tablets comes as tablet containing 400mg. Always follow the dose your doctor or pharmacist has given you, and read the leaflet that comes with the medicine.

What is the active substance in Avelox 400 mg film-coated tablets?

The active substance in Avelox 400 mg film-coated tablets is moxifloxacin hydrochloride.

Are there equivalent medicines to Avelox 400 mg film-coated tablets?

Medicines with the same active substance, strength and form include: Moxifloxacin 400 mg film-coated tablets, Moxifloxacin Tillomed 400mg Film Coated Tablets. They are interchangeable only if your prescriber or pharmacist says so.

Where does this information come from?

This leaflet reproduces the patient information leaflet approved for Avelox 400 mg film-coated tablets, as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.

Can I get Avelox 400 mg film-coated tablets without a prescription?

Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.

About this leaflet

The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.

Medical disclaimer: This page is for information only and does not replace advice from your doctor or pharmacist. Always read the leaflet supplied with your medicine. If you are unwell, call NHS 111; in an emergency, call 999.

Medicines with the same active substance: Moxifloxacin hydrochloride (5 medicines)
See every medicine containing this substance, or browse the full A–Z of active substances.
⚕For healthcare professionals — Summary of Product Characteristics (SmPC)Full SmPC: dosage, interactions, contraindications, warnings+
Technical information intended for healthcare professionals (doctors and pharmacists). The Summary of Product Characteristics (SmPC) is the official document approved by the MHRA/EMA. It does not replace the patient leaflet or a doctor’s advice.

4.1. Therapeutic indications

Because of the risk of prolonged, disabling and potentially irreversible serious adverse drug reactions (see section 4.4 and section 4.8) this product must only be prescribed when other antibiotics that are commonly recommended for the infection are inappropriate. This applies to all indications listed below. Situations where other antibiotics are considered to be inappropriate are where:

• there is resistance to other first-line antibiotics recommended for the infection;

• other first-line antibiotics are contraindicated in an individual patient;

• other first-line antibiotics have caused side effects requiring treatment to be stopped;

• treatment with other first-line antibiotics has failed.

Avelox 400 mg film-coated tablets are indicated for the treatment of the following bacterial infections in patients of 18 years and older caused by bacteria susceptible to moxifloxacin (see sections 4.4, 4.8 and 5.1):

- Acute bacterial sinusitis

- Acute exacerbation of chronic obstructive pulmonary disease including bronchitis

- Community acquired pneumonia, except severe cases

- Mild to moderate pelvic inflammatory disease (i.e. infections of female upper genital tract, including salpingitis and endometritis), without an associated tubo-ovarian or pelvic abscess. Avelox 400 mg film-coated tablets are not recommended for use in monotherapy of mild to moderate pelvic inflammatory disease but should be given in combination with another appropriate antibacterial agent (e.g. a cephalosporin) due to increasing moxifloxacin resistance of Neisseria gonorrhoeae unless moxifloxacin-resistant Neisseria gonorrhoeae can be excluded (see sections 4.4 and 5.1).

Avelox 400 mg film-coated tablets may also be used to complete a course of therapy in patients who have shown improvement during initial treatment with intravenous moxifloxacin for the following indications:

- Community-acquired pneumonia

- Complicated skin and skin structure infections

Avelox 400 mg film-coated tablets should not be used to initiate therapy for any type of skin and skin structure infection or in severe community-acquired pneumonia.

Consideration should be given to official guidance on the appropriate use of antibacterial agents.

4.2. Posology and method of administration

Posology (adults)

The recommended dose is one 400 mg film-coated tablet once daily.

Renal/hepatic impairment

No adjustment of dosage is required in patients with mild to severely impaired renal function or in patients on chronic dialysis i.e. haemodialysis and continuous ambulatory peritoneal dialysis (see section 5.2 for more details).

There is insufficient data in patients with impaired liver function (see section 4.3).

Other special populations

No adjustment of dosage is required in the elderly and in patients with low bodyweight.

Paediatric population

Moxifloxacin is contraindicated in children and adolescents (< 18 years). Efficacy and safety of moxifloxacin in children and adolescents have not been established (see section 4.3).

Method of administration

The film-coated tablet should be swallowed whole with sufficient liquid and may be taken independent of meals.

Duration of administration

Avelox 400 mg film-coated tablets should be used for the following treatment durations:

- Acute exacerbation of chronic obstructive pulmonary disease including bronchitis

5 - 10 days

- Community acquired pneumonia

10 days

- Acute bacterial sinusitis

7 days

- Mild to moderate pelvic inflammatory disease

14 days

Avelox 400 mg film-coated tablets have been studied in clinical trials for up to 14 days treatment.

Sequential (intravenous followed by oral) therapy

In clinical studies with sequential therapy most patients switched from intravenous to oral therapy within 4 days (community-acquired pneumonia) or 6 days (complicated skin and skin structure infections). The recommended total duration of intravenous and oral treatment is 7 -14 days for community-acquired pneumonia and 7 - 21 days for complicated skin and skin structure infections

The recommended dose (400 mg once daily) and duration of therapy for the indication being treated should not be exceeded.

4.3. Contraindications

- Hypersensitivity to moxifloxacin, other quinolones or to any of the excipients listed in section 6.1.

- Pregnancy and lactation (see section 4.6).

- Patients below 18 years of age.

- Patients with a history of tendon disease/disorder related to quinolone treatment.

Both in preclinical investigations and in humans, changes in cardiac electrophysiology have been observed following exposure to moxifloxacin, in the form of QT prolongation. For reasons of drug safety, moxifloxacin is therefore contraindicated in patients with:

- Congenital or documented acquired QT prolongation

- Electrolyte disturbances, particularly in uncorrected hypokalaemia

- Clinically relevant bradycardia

- Clinically relevant heart failure with reduced left-ventricular ejection fraction

- Previous history of symptomatic arrhythmias

Moxifloxacin should not be used concurrently with other drugs that prolong the QT interval (see also section 4.5).

Due to limited clinical data, moxifloxacin is also contraindicated in patients with impaired liver function (Child Pugh C) and in patients with transaminases increase > 5fold ULN.

4.4. Special warnings and precautions for use

The use of moxifloxacin should be avoided in patients who have experienced serious adverse reactions in the past when using quinolone or fluoroquinolone containing products (see section 4.8). Treatment of these patients with moxifloxacin should only be initiated in the absence of alternative treatment options and after careful benefit/risk assessment (see also section 4.3).

The benefit of moxifloxacin treatment especially in infections with a low degree of severity should be balanced with the information contained in the warnings and precautions section.

Prolonged, disabling and potentially irreversible serious adverse drug reactions

Cases of prolonged (continuing for months or years), disabling and potentially irreversible serious adverse drug reactions affecting different, sometimes multiple, body systems (including musculoskeletal, nervous, psychiatric and senses) have been reported in patients receiving quinolones and fluoroquinolones irrespective of their age and pre-existing risk factors. There are no pharmacological treatments established to be effective treatments of the symptoms of long lasting or disabling side effects associated with fluoroquinolones. Moxifloxacin should be discontinued immediately at the first signs or symptoms of any serious adverse reaction and patients should be advised to contact their prescriber for advice, so that symptoms can be appropriately investigated and to avoid further exposure which could potentially worsen adverse reactions.

Prolongation of QTc interval and potentially QTc-prolongation-related clinical conditions

Moxifloxacin has been shown to prolong the QTc interval on the electrocardiogram in some patients. In the analysis of ECGs obtained in the clinical trial program, QTc prolongation with moxifloxacin was 6 msec ± 26 msec, 1.4% compared to baseline. As women tend to have a longer baseline QTc interval compared with men, they may be more sensitive to QTc-prolonging medications. Elderly patients may also be more susceptible to drug-associated effects on the QT interval.Medication that can reduce potassium levels should be used with caution in patients receiving moxifloxacin (see also sections 4.3 and 4.5).

Moxifloxacin should be used with caution in patients with ongoing proarrhythmic conditions (especially women and elderly patients), such as acute myocardial ischaemia or QT prolongation as this may lead to an increased risk for ventricular arrhythmias (incl. torsade de pointes) and cardiac arrest (see also section 4.3). The magnitude of QT prolongation may increase with increasing concentrations of the drug. Therefore, the recommended dose should not be exceeded.If signs of cardiac arrhythmia occur during treatment with moxifloxacin, treatment should be stopped and an ECG should be performed.

Hypersensitivity/allergic reactions

Hypersensitivity and allergic reactions have been reported for fluoroquinolones including moxifloxacin after first administration. Anaphylactic reactions can progress to a life-threatening shock, even after the first administration. In cases of clinical manifestations of severe hypersensitivity reactions moxifloxacin should be discontinued and suitable treatment (e.g. treatment for shock) initiated.

Severe liver disorders

Cases of fulminant hepatitis potentially leading to liver failure (including fatal cases) have been reported with moxifloxacin (see section 4.8). Patients should be advised to contact their doctor prior to continuing treatment if signs and symptoms of fulminant hepatic disease develop such as rapidly developing asthenia associated with jaundice, dark urine, bleeding tendency or hepatic encephalopathy.Liver function tests/investigations should be performed in cases where indications of liver dysfunction occur.

Severe cutaneous adverse reactions

Severe cutaneous adverse reactions (SCARs) including toxic epidermal necrolysis (TEN: also known as Lyell's syndrome), Stevens Johnson syndrome (SJS), Acute Generalised Exanthematous Pustulosis (AGEP) and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), which could be life-threatening or fatal, have been reported with moxifloxacin (see section 4.8). At the time of prescription, patients should be advised of the signs and symptoms of severe skin reactions and be closely monitored. If signs and symptoms suggestive of these reactions appear, moxifloxacin should be discontinued immediately, and an alternative treatment should be considered. If the patient has developed a serious reaction such as SJS, TEN, AGEP or DRESS with the use of moxifloxacin, treatment with moxifloxacin must not be restarted in this patient at any time.

Patients predisposed to seizures

Quinolones are known to trigger seizures. Use should be with caution in patients with CNS disorders or in the presence of other risk factors which may predispose to seizures or lower the seizure threshold. In case of seizures, treatment with moxifloxacin should be discontinued and appropriate measures instituted.

Peripheral neuropathy

Cases of sensory or sensorimotor polyneuropathy resulting in paraesthesia, hypoaesthesia, dysaesthesia, or weakness have been reported in patients receiving quinolones and fluoroquinolones. Patients under treatment with moxifloxacin should be advised to inform their doctor prior to continuing treatment if symptoms of neuropathy such as pain, burning, tingling, numbness, or weakness develop in order to prevent the development of potentially irreversible condition (see section 4.8).

Psychiatric reactions

Psychiatric reactions may occur even after the first administration of quinolones, including moxifloxacin. In very rare cases depression or psychotic reactions have progressed to suicidal thoughts and self-injurious behaviour such as suicide attempts (see section 4.8). In the event that the patient develops these reactions, moxifloxacin should be discontinued and appropriate measures instituted. Caution is recommended if moxifloxacin is to be used in psychotic patients or in patients with history of psychiatric disease.

Antibiotic-associated diarrhoea incl. colitis

Antibiotic-associated diarrhoea (AAD) and antibiotic-associated colitis (AAC), including pseudomembranous colitis and Clostridium difficile-associated diarrhoea, has been reported in association with the use of broad spectrum antibiotics including moxifloxacin and may range in severity from mild diarrhoea to fatal colitis. Therefore it is important to consider this diagnosis in patients who develop serious diarrhoea during or after the use of moxifloxacin. If AAD or AAC is suspected or confirmed, ongoing treatment with antibacterial agents, including moxifloxacin, should be discontinued and adequate therapeutic measures should be initiated immediately. Furthermore, appropriate infection control measures should be undertaken to reduce the risk of transmission. Drugs inhibiting peristalsis are contraindicated in patients who develop serious diarrhoea.

Patients with myasthenia gravis

Moxifloxacin should be used with caution in patients with myasthenia gravis because the symptoms can be exacerbated.

Tendinitis and tendon rupture

Tendinitis and tendon rupture (especially but not limited to Achilles tendon), sometimes bilateral, may occur as early as within 48 hours of starting treatment with quinolones and fluoroquinolones and have been reported to occur even up to several months after discontinuation of treatment (see sections 4.3 and 4.8). The risk of tendinitis and tendon rupture is increased in older patients, patients with renal impairment, patients with solid organ transplants, and those treated concurrently with corticosteroids. Therefore, concomitant use of corticosteroids should be avoided.

At the first sign of tendinitis (e.g. painful swelling, inflammation) the treatment with moxifloxacin should be discontinued and alternative treatment should be considered. The affected limb(s) should be appropriately treated (e.g. immobilisation). Corticosteroids should not be used if signs of tendinopathy occur.

Aortic aneurysm and dissection, and heart valve regurgitation/incompetence

Epidemiologic studies report an increased risk of aortic aneurysm and dissection, particularly in elderly patients, and of aortic and mitral valve regurgitation after intake of fluoroquinolones. Cases of aortic aneurysm and dissection, sometimes complicated by rupture (including fatal ones), and of regurgitation/incompetence of any of the heart valves have been reported in patients receiving fluoroquinolones (see section 4.8).

Therefore, fluoroquinolones should only be used after careful benefit-risk assessment and after consideration of other therapeutic options in patients with positive family history of aneurysm disease or congenital heart valve disease, or in patients diagnosed with pre-existing aortic aneurysm and/or dissection or heart valve disease, or in presence of other risk factors or conditions predisposing

- for both aortic aneurysm and dissection and heart valve regurgitation/incompetence (e.g. connective tissue disorders such as Marfan syndrome or Ehlers-Danlos syndrome, Turner syndrome, Behçet´s disease, hypertension, rheumatoid arthritis) or additionally

- for aortic aneurysm and dissection (e.g. vascular disorders such as Takayasu arteritis or giant cell arteritis, or known atherosclerosis, or Sjögren´s syndrome) or additionally

- for heart valve regurgitation/incompetence (e.g. infective endocarditis).

The risk of aortic aneurysm and dissection, and their rupture may also be increased in patients treated concurrently with systemic corticosteroids.

In case of sudden abdominal, chest or back pain, patients should be advised to immediately consult a physician in an emergency department.

Patients should be advised to seek immediate medical attention in case of acute dyspnoea, new onset of heart palpitations, or development of oedema of the abdomen or lower extremities.

Patients with renal impairment

Elderly patients with renal disorders should use moxifloxacin with caution if they are unable to maintain adequate fluid intake, because dehydration may increase the risk of renal failure.

Vision disorders

If vision becomes impaired or any effects on the eyes are experienced, an eye specialist should be consulted immediately (see sections 4.7 and 4.8).

Dysglycemia

As with all fluoroquinolones, disturbances in blood glucose, including both hypoglycemia and hyperglycemia have been reported with moxifloxacin (see section 4.8). In moxifloxacin-treated patients, dysglycemia occurred predominantly in elderly diabetic patients receiving concomitant treatment with an oral hypoglycemic agent (e.g. sulfonylurea) or with insulin. Cases of hypoglycaemic coma have been reported. In diabetic patients, careful monitoring of blood glucose is recommended.

Prevention of photosensitivity reactions

Quinolones have been shown to cause photosensitivity reactions in patients. However, studies have shown that moxifloxacin has a lower risk to induce photosensitivity. Nevertheless patients should be advised to avoid exposure to either UV irradiation or extensive and/or strong sunlight during treatment with moxifloxacin (see section 4.8).

Patients with glucose-6-phosphate dehydrogenase deficiency

Patients with a family history of, or actual glucose-6-phosphate dehydrogenase deficiency are prone to haemolytic reactions when treated with quinolones. Therefore, moxifloxacin should be used with caution in these patients.

Patients with pelvic inflammatory disease

For patients with complicated pelvic inflammatory disease (e.g. associated with a tubo-ovarian or pelvic abscess), for whom an intravenous treatment is considered necessary, treatment with Avelox 400 mg film-coated tablets is not recommended.

Pelvic inflammatory disease may be caused by fluoroquinolone-resistant Neisseria gonorrhoeae. Therefore in such cases empirical moxifloxacin should be co-administered with another appropriate antibiotic (e.g. a cephalosporin) unless moxifloxacin-resistant Neisseria gonorrhoeae can be excluded. If clinical improvement is not achieved after 3 days of treatment, the therapy should be reconsidered.

Patients with special cSSSI

Clinical efficacy of intravenous moxifloxacin in the treatment of severe burn infections, fasciitis and diabetic foot infections with osteomyelitis has not been established.

Interference with biological tests

Moxifloxacin therapy may interfere with the Mycobacterium spp. culture test by suppression of mycobacterial growth causing false negative results in samples taken from patients currently receiving moxifloxacin.

Patients with MRSA infections

Moxifloxacin is not recommended for the treatment of MRSA infections. In case of a suspected or confirmed infection due to MRSA, treatment with an appropriate antibacterial agent should be started (see section 5.1).

Paediatric population

Due to adverse effects on the cartilage in juvenile animals (see section 5.3) the use of moxifloxacin in children and adolescents < 18 years is contraindicated (see section 4.3).

Information about excipients

Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicine.

This medicine contains less than 1 mmol sodium (23 mg) per film-coated tablet, that is to say essentially “sodium-free”.

4.5. Interaction with other medicinal products and other forms of interaction

Interactions with medicinal products

An additive effect on QT interval prolongation of moxifloxacin and other medicinal products that may prolong the QTc interval cannot be excluded. This might lead to an increased risk of ventricular arrhythmias, including torsade de pointes. Therefore, co-administration of moxifloxacin with any of the following medicinal products is contraindicated (see also section 4.3):

- anti-arrhythmics class IA (e.g. quinidine, hydroquinidine, disopyramide)

- anti-arrhythmics class III (e.g. amiodarone, sotalol, dofetilide, ibutilide)

- antipsychotics (e.g. phenothiazines, pimozide, sertindole, haloperidol, sultopride)

- tricyclic antidepressive agents

- certain antimicrobial agents (saquinavir, sparfloxacin, erythromycin IV, pentamidine, antimalarials particularly halofantrine)

- certain antihistaminics (terfenadine, astemizole, mizolastine)

- others (cisapride, vincamine IV, bepridil, diphemanil).

Moxifloxacin should be used with caution in patients who are taking medication that can reduce potassium levels (e.g. loop and thiazide-type diuretics, laxatives and enemas [high doses], corticosteroids, amphotericin B) or medication that is associated with clinically significant bradycardia.

An interval of about 6 hours should be left between administration of agents containing bivalent or trivalent cations (e.g. antacids containing magnesium or aluminium, didanosine tablets, sucralfate and agents containing iron or zinc) and administration of moxifloxacin.

Concomitant administration of charcoal with an oral dose of 400 mg moxifloxacin led to a pronounced prevention of drug absorption and a reduced systemic availability of the drug by more than 80%. Therefore, the concomitant use of these two drugs is not recommended (except for overdose cases, see also section 4.9).

After repeated dosing in healthy volunteers, moxifloxacin increased Cmax of digoxin by approximately 30% without affecting AUC or trough levels. No precaution is required for use with digoxin.

In studies conducted in diabetic volunteers, concomitant administration of oral moxifloxacin with glibenclamide resulted in a decrease of approximately 21% in the peak plasma concentrations of glibenclamide. The combination of glibenclamide and moxifloxacin could theoretically result in a mild and transient hyperglycaemia. However, the observed pharmacokinetic changes for glibenclamide did not result in changes of the pharmacodynamic parameters (blood glucose, insulin). Therefore no clinically relevant interaction was observed between moxifloxacin and glibenclamide.

Changes in INR

A large number of cases showing an increase in oral anticoagulant activity have been reported in patients receiving antibacterial agents, especially fluoroquinolones, macrolides, tetracyclines, cotrimoxazole and some cephalosporins. The infectious and inflammatory conditions, age and general status of the patient appear to be risk factors. Under these circumstances, it is difficult to evaluate whether the infection or the treatment caused the INR (international normalised ratio) disorder. A precautionary measure would be to more frequently monitor the INR. If necessary, the oral anticoagulant dosage should be adjusted as appropriate.

Clinical studies have shown no interactions following concomitant administration of moxifloxacin with: ranitidine, probenecid, oral contraceptives, calcium supplements, morphine administered parenterally, theophylline, cyclosporine or itraconazole.

In vitro studies with human cytochrome P450 enzymes supported these findings. Considering these results a metabolic interaction via cytochrome P450 enzymes is unlikely.

Interaction with food

Moxifloxacin has no clinically relevant interaction with food including dairy products.

4.6. Fertility, pregnancy and lactation

Pregnancy

The safety of moxifloxacin in human pregnancy has not been evaluated.. Animal studies have shown reproductive toxicity (see section 5.3). The potential risk for humans is unknown. Due to the experimental risk of damage by fluoroquinolones to the weight-bearing cartilage of immature animals and reversible joint injuries described in children receiving some fluoroquinolones, moxifloxacin must not be used in pregnant women (see section 4.3).

Breastfeeding

There is no data available in lactating or nursing women. Preclinical data indicate that small amounts of moxifloxacin are secreted in milk. In the absence of human data and due to the experimental risk of damage by fluoroquinolones to the weight-bearing cartilage of immature animals, breast-feeding is contraindicated during moxifloxacin therapy (see section 4.3).

Fertility

Animal studies do not indicate impairment of fertility (see section 5.3).

4.7. Effects on ability to drive and use machines

No studies on the effects of moxifloxacin on the ability to drive and use machines have been performed. However, fluoroquinolones including moxifloxacin may result in an impairment of the patient's ability to drive or operate machinery due to CNS reactions (e.g. dizziness; acute, transient loss of vision, see section 4.8) or acute and short lasting loss of consciousness (syncope, see section 4.8). Patients should be advised to see how they react to moxifloxacin before driving or operating machinery.

4.8. Undesirable effects

Adverse reactions based on all clinical trials and derived from post-marketing reports with moxifloxacin 400 mg (oral and sequential therapy) sorted by frequencies are listed below:

Apart from nausea and diarrhoea all adverse reactions were observed at frequencies below 3%.

Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness. Frequencies are defined as:

- common (≥ 1/100 to < 1/10)

- uncommon (≥ 1/1,000 to < 1/100)

- rare (≥ 1/10,000 to < 1/1,000)

- very rare (< 1/10,000)

- not known (cannot be estimated from the available data)

System Organ Class (MedDRA)

Common

Uncommon

Rare

Very Rare

Not known

Infections and infestations

Superinfections due to resistant bacteria or fungi e.g. oral and vaginal candidiasis

Blood and lymphatic system disorders

Anaemia

Leucopenia(s)

Neutropenia

Thrombocytopenia

Thrombocythemia

Blood eosinophilia

Prothrombin time prolonged/INR increased

Prothrombin level increased/INR decreased Agranulocytosis Pancytopenia

Immune system disorders

Allergic reaction (see section 4.4)

Anaphylaxis incl. very rarely life-threatening shock (see section 4.4)

Allergic oedema / angiooedema (incl. laryngeal oedema, potentially life-threatening, see section 4.4)

Endocrine disorders

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Metabolism and nutrition disorders

Hyperlipidemia

Hyperglycemia

Hyperuricemia

Hypoglycemia

Hypoglycaemic coma

Psychiatric disorders*

Anxiety reactions

Psychomotor hyperactivity/ agitation

Emotional lability

Depression (in very rare cases potentially culminating in self-injurious behaviour, such as suicidal ideations/ thoughts, or suicide attempts, see section 4.4)

Hallucination

Delirium

Depersonalization

Psychotic reactions (potentially culminating in self- injurious behaviour, such as suicidal ideations/ thoughts, or suicide attempts, see section 4.4)

Nervous system disorders*

Headache Dizziness

Par- and DysaesthesiaTaste disorders (incl. ageusia in very rare cases) Confusion and disorientation Sleep disorders (predominantly insomnia) Tremor Vertigo Somnolence

Hypoaesthesia Smell disorders (incl. anosmia) Abnormal dreams Disturbed coordination (incl. gait disturbances, esp. due to dizziness or vertigo) Seizures incl. grand mal convulsions (see section 4.4) Disturbed attention Speech disorders Amnesia Peripheral neuropathy and polyneuropathy

Hyperaesthesia

Eye disorders*

Visual disturbances incl. diplopia and blurred vision (especially in the course of CNS reactions, see section 4.4)

Photophobia

Transient loss of vision (especially in the course of CNS reactions, see sections 4.4 and 4.7) Uveitis and bilateral acute iris transillumination (see section 4.4)

Ear and labyrinth disorders*

Tinnitus

Hearing impairment incl. deafness (usually reversible)

Cardiac disorders**

QT prolongation in patients with hypokalaemia (see sections 4.3 and 4.4)

QT prolongation (see section 4.4)

Palpitations

Tachycardia

Atrial fibrillation

Angina pectoris

Ventricular tachyarrhythmias

Syncope (i.e., acute and short lasting loss of consciousness)

Unspecified arrhythmias

Torsade de Pointes (see section 4.4)

Cardiac arrest (see section 4.4)

Vascular disorders**

Vasodilatation

Hypertension

Hypotension

Vasculitis

Respiratory, thoracic and mediastinal disorders

Dyspnea (including asthmatic conditions)

Gastrointestinal disorders

Nausea Vomiting Gastrointestinal and abdominal pains Diarrhoea

Decreased appetite and food intake

Constipation

Dyspepsia

Flatulence

Gastritis

Increased amylase

Dysphagia

Stomatitis

Antibiotic associated colitis (incl. pseudo-membranous colitis, in very rare cases associated with life-threatening complications, see section 4.4)

Hepatobiliary disorders

Increase in transaminases

Hepatic impairment (incl. LDH increase)

Increased bilirubin

Increased gamma-glutamyl-transferase

Increase in blood alkaline phosphatase

Jaundice Hepatitis (predominantly cholestatic)

Fulminant hepatitis potentially leading to life-threatening liver failure (incl. fatal cases, see section 4.4)

Skin and subcutaneous tissue disorders

Pruritus Rash Urticaria Dry skin

Bullous skin reactions like Stevens-Johnson syndrome or toxic epidermal necrolysis (potentially life-threatening, see section 4.4)

Acute Generalised Exanthematous Pustulosis (AGEP)

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) (see section 4.4), Fixed drug eruption, Photosensitivity reactions (see section 4.4)

Musculoskeletal and connective tissue disorders*

Arthralgia

Myalgia

Tendonitis (see section 4.4)

Tendon rupture (see section 4.4)

Muscle cramp

Muscle twitching

Muscle weakness

Arthritis

Muscle rigidity

Exacerbation of symptoms of myasthenia gravis (see section 4.4)

Rhabdomyolysis

Renal and urinary disorders

Dehydration

Renal impairment (incl. increase in BUN and creatinine) Renal failure (see section 4.4)

General disorders and administration site conditions*

Feeling unwell (predominantly asthenia or fatigue)

Painful conditions (incl. pain in back, chest, pelvic and extremities)

Sweating

Oedema

*Cases of prolonged (up to months or years), disabling and potentially irreversible serious drug reactions affecting several, sometimes multiple, system organ classes and senses (including reactions such as tendonitis, tendon rupture, arthralgia, pain in extremities, gait disturbance, neuropathies associated with paraesthesia, fatigue, psychiatric symptoms, memory impairment, and impairment of hearing, vision, taste and smell) have been reported in association with the use of quinolones and fluoroquinolones in some cases irrespective of pre-existing risk factors (see section 4.4). A range of psychiatric symptoms may occur as part of these side effects, which may include, but are not necessarily limited to, sleep disorders, anxiety, panic attacks, confusion, or depression. There are no pharmacological treatments established to be effective treatments of the symptoms of long lasting or disabling side effects associated with fluoroquinolones. The frequency of these prolonged, disabling and potentially irreversible serious drug reactions cannot be estimated with precision using available data, but the reporting incidence from adverse drug reaction reports indicates the frequency is at minimum between 1/1,000 and 1/10,000 (corresponding to the Rare frequency category).

**Cases of aortic aneurysm and dissection, sometimes complicated by rupture (including fatal ones), and of regurgitation/incompetence of any of the heart valves have been reported in patients receiving fluoroquinolones (see section 4.4).

There have been very rare cases of the following side effects reported following treatment with other fluoroquinolones, which might possibly also occur during treatment with moxifloxacin: increased intracranial pressure (including pseudotumor cerebri), hypernatraemia, hypercalcaemia, haemolytic anaemia.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme, Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

4.9. Overdose

No specific countermeasures after accidental overdose are recommended. In the event of overdose, symptomatic treatment should be implemented. ECG monitoring should be undertaken, because of the possibility of QT interval prolongation. Concomitant administration of charcoal with a dose of 400 mg oral moxifloxacin will reduce systemic availability of the drug by more than 80%. The use of charcoal early during absorption may be useful to prevent excessive increase in the systemic exposure to moxifloxacin in cases of oral overdose.

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