From the Guidelines
Moxifloxacin is contraindicated in patients with hypersensitivity to moxifloxacin or other quinolones, tendon damage, pregnancy, breastfeeding, children, and certain cardiovascular conditions, including congenital or documented acquired QT prolongation, as stated in the British Thoracic Society guidelines 1. The contraindications for moxifloxacin administration can be summarized as follows:
- Hypersensitivity to moxifloxacin or other quinolones
- Tendon damage, particularly in patients with a history of tendon disorders related to quinolone use, aged over 60 years, or concomitant use of corticosteroids
- Pregnancy, as animal studies have shown quinolones cause arthropathy
- Breastfeeding, as moxifloxacin is present in milk in animal studies
- Children, as moxifloxacin is contraindicated in the UK for use in children or growing adolescents due to the risk of arthropathy
- Cardiovascular conditions, including congenital or documented acquired QT prolongation, clinically relevant bradycardia, clinically relevant heart failure with reduced left ventricular ejection fraction, history of symptomatic arrhythmias, or electrolyte disturbances, particularly in uncorrected hypokalaemia
- Liver disease, particularly chronic liver disease with a Child-Pugh severity score C and in those patients with transaminase levels fivefold greater than the upper limit of normal
- Concurrent use with other drugs that prolong the QT interval, as this can increase the risk of life-threatening cardiac arrhythmias, as noted in the guidelines 1. The use of moxifloxacin should be avoided in these patient populations to minimize the risk of adverse effects and ensure optimal treatment outcomes, as recommended by the British Thoracic Society guidelines 1.
From the FDA Drug Label
Moxifloxacin ophthalmic solution is contraindicated in patients with a history of hypersensitivity to moxifloxacin, to other quinolones, or to any of the components in this medication. The contraindications for moxifloxacin administration are:
- A history of hypersensitivity to moxifloxacin
- A history of hypersensitivity to other quinolones
- A history of hypersensitivity to any of the components in this medication 2, 2, 2
From the Research
Contraindications for Moxifloxacin Administration
The following are contraindications for moxifloxacin administration:
- Myasthenia gravis: Moxifloxacin may exacerbate myasthenia gravis, a chronic disease that causes varying levels of weakness in the skeletal muscles of the body 3.
- Hypersensitivity reactions: Patients with a history of hypersensitivity reactions to moxifloxacin or other fluoroquinolones should avoid moxifloxacin due to the risk of cross-reactivity 4, 5, 6.
- QT interval prolongation: Moxifloxacin should be avoided in patients with known prolongation of the QT interval, patients with uncorrected hypokalaemia or hypomagnesaemia, and patients receiving class IA or class III antiarrhythmic agents 7.
- Tendinitis and tendon ruptures: Moxifloxacin may cause tendinitis and tendon ruptures, especially in patients with chronic renal diseases, concomitant use of corticosteroids, and age >60 years 7.
- CNS disorders: Moxifloxacin should be used with caution in patients with known or suspected CNS disorders that predispose to seizures, such as severe cerebral arteriosclerosis or epilepsy 7.
Special Considerations
- Renal function: Moxifloxacin doses may need to be adjusted in patients with clinically relevant reduction of creatinine clearance 7.
- Elderly patients: Moxifloxacin should be used with caution in elderly patients due to the risk of adverse reactions, such as confusion, weakness, loss of appetite, tremor, or depression 7.