about Norfloxacin class, uses, side effects contraindications
Norfloxacin
Short Description
Norfloxacin, a quinolone antibiotic, has been in use since 1986, when it is used to treat infections in the urinary tract.
There is a similarity between the composition of norfloxacin and nalidixic acid used 40 years ago to treat infections in the urinary tract, but the difference between them is that the effectiveness of norfloxacin has a wider range of bacteria, and there are those who use norfloxacin to treat?gonorrhea??and bacterial enteritis, but these days this antibiotic is used in Only for veterinary purposes.
The main side effects of norfloxacin are nausea, headache, and in rare cases, especially at high doses, crystals can form in the kidneys.
Category
Chemical class: Fluoroquinolone
Therapeutic class: Antibiotic
Pregnancy category: C
Indications
To treat uncomplicated UTI caused by Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis
Adults. 400 mg every 12 hr for 3 days. To treat uncomplicated UTI caused by Citrobacter freundii, Enterobacter aerogenes, Enterobacter cloacae, Enterococcus faecalis, Proteus species, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus, or Streptococcus agalactiae
Adults. 400 mg every 12 hr for 7 to 10 days. To treat complicated UTI caused by E. coli, E. faecalis, K. pneumoniae, P. aeruginosa, P. mirabilis, or Serratia marcescens
Adults. 400 mg every 12 hr for 10 to 21 days. Maximum: 800 mg daily. To treat uncomplicated gonorrhea
Adults. 800 mg as a single dose. To treat prostatitis caused by E. coli
Adults. 400 mg every 12 hr for 28 days.
DOSAGE ADJUSTMENT Dosage reduced to 400 mg daily for patients with creatinine clearance of 30 ml/min/1.73 m2or less.
Mechanism of Action
Inhibits the enzyme DNA gyrase, which unwinds and supercoils bacterial DNA before it replicates. By inhibiting this enzyme, norfloxacin interferes with bacterial cell replication and causes cell death.
Contraindications
Hypersensitivity to norfloxacin, other fluoroquinolones, or their components
Interactions
aluminum-, calcium-, or magnesiumcontaining antacids; ferrous sulfate; magnesium-containing laxatives; sucralfate; zinc: Possibly decreased absorption and blood level of norfloxacin caffeine, clozapine, ropinirole, tacrine, theophylline, tizanidine: Possibly increased blood level of these class IA antiarrhythmics, such as quinidine; class III antiarrhythmics, such as sotalol; other known to prolong QTc interval, such as disopyramide and pentamidine: Possibly prolonged QTc interval cyclosporine: Possibly increased serum creatinine and blood cyclosporine levels didanosine: Possibly decreased norfloxacin absorption glyburide: Risk of severe hypoglycemia nitrofurantoin: Possibly decreased norfloxacin effectiveness
NSAIDs: Possibly increased risk of CNS stimulation and seizures probenecid: Decreased norfloxacin excretion and risk of toxicity
warfarin: Possibly increased anticoagulant effect and risk of bleeding caffeine: Reduced clearance of caffeine leading to accumulation of caffeine in blood
Side Efect
CNS: Ataxia, confusion, dizziness, drowsiness, fever, Guillian-Barré syndrome, headache, hypoesthesia, insomnia, paresthesia, peripheral neuropathy, psychosis, seizures, tremors
CV: Prolonged QT interval, torsades de pointes, vasculitis
EENT: Decreased taste sensation, diplopia, hearing loss, stomatitis, taste perversion, tinnitus, visual changes
GI: Abdominal cramps or pain, acute hepatic necrosis or failure, diarrhea, elevated liver function test results, hepatitis, jaundice, nausea, pancreatitis, pseudomembranous colitis, vomiting
GU: Interstitial nephritis, renal failure, vaginal candidiasis
HEME: Agranulocytosis, aplastic anemia, hemolytic anemia, leukopenia, neutropenia, pancytopenia, thrombocytopenia
MS: Arthralgia; myasthenia gravis exacerbation; myalgia; tendinitis; tendon inflammation, pain, or rupture
RESP: Allergic pneumonitis, dyspnea
SKIN: Blisters, diaphoresis, erythema, erythema multiforme, exfoliative dermatitis, photosensitivity, pruritus, rash, StevensJohnson syndrome, toxic epidermal necrolysis, urticaria
Other: Anaphylaxis, angioedema, serum sickness
Cautions
Obtain urine specimen for culture and sensitivity tests before starting drug, if possible. Determine if patient has a history of CNS disorder because drug may lower seizure threshold. Notify prescriber before starting drug, and institute seizure precautions.
WARNING Before starting therapy, determine if patient takes a class IA antiarrhythmic, such as quinidine; a class III antiarrhythmic, such as sotalol; or other that prolong the QTc interval. Also find out if patient has hypokalemia or an underlying QT-interval prolonging condition. These and conditions, especially in the elderly, may prolong the QTc interval and lead to life-threatening ventricular tachycardia or torsades de pointes in a patient taking norfloxacin. Give drug on an empty stomach 2 hours before or after antacids, didanosine, sucralfate, or vitamins that contain iron or zinc. Keep emergency resuscitation equipment readily available, and watch for signs of hypersensitivity, such as angioedema, dysnorfloxacin 750 pnea, jaundice, rash, and urticaria. If you suspect anaphylaxis, prepare to give epinephrine, corticosteroids, and diphenhydramine, as prescribed. If patient has myasthenia gravis, assess her often for a change in respiratory status because drug may lead to life-threatening weakness of respiratory muscles. Notify prescriber if patient has symptoms of peripheral neuropathy (pain, burning, tingling, numbness, weakness, or altered sensations of light touch, pain, temperature, position sense, or vibration sense), which could be permanent. Expect to stop nofloxacin. Monitor patients prone to tendinitis, such as the elderly, athletes, and those taking corticosteroids, for complaints of tendon pain, inflammation, or rupture. If present, notify prescriber and expect to discontinue norfloxacin, place patient on bedrest with no exercise of affected limb, and obtain diagnostic tests to confirm rupture. Monitor patient for diarrhea, which may indicate pseudomembranous colitis caused by Clostridium difficile. If diarrhea occurs, notify prescriber and expect to withhold norfloxacin and treat with fluids, electrolytes, protein, and an antibiotic effective against C. difficile. PATIENT SAFTY
Instruct patient to take drug on an empty stomach with a large glass of water to prevent crystalluria. Urge her to drink several glasses of water daily during therapy. Instruct patient to take norfloxacin at least 2 hours before or after eating, drinking milk, or taking antacids, didanosine, sucralfate, or vitamins that contain iron or zinc. Advise patient to avoid hazardous activities until drug’s CNS effects are known. Tell patient to stop drug and report tendon pain or inflammation or abnormal changes in motor or sensory function. Urge patient to protect skin from sunlight and to report photosensitivity at once. Tell patient to take drug exactly as prescribed, even if symptoms subside. Urge patient to tell prescriber about diarrhea that’s severe or lasts longer than 3 days. Remind patient that watery or bloody stools can occur 2 or more months after antibiotic therapy and can be serious, requiring prompt treatment.
Trade Name & Company Name
effect of Norfloxacin in Pregnancy, Fetal Health
and Breast feeding
Pregnancy
. There are no adequate reports or well-controlled studies of norfloxacin in pregnant women (see Ciprofloxacin). Fetal Health
There are no adequate reports or well-controlled studies in human fetuses. It is unknown whether norfloxacin crosses the human placenta. The limited human experience is reassuring, as 1st trimester use does not appear to be associated with an increased risk of malformations or musculoskeletal problems. Animal studies (rodent, monkey) are reassuring, revealing no evidence of teratogenicity or IUGR despite the use of doses 6-50higher than those used clinically. Breastfeeding
There is no published experience in nursing women. It is unknown whether norfloxacin enters human breast milk.
the follwing drugs will increse Norfloxacin by inhepiting cyp450
the follwing drugs will decrease Norfloxacin by inhancing cyp450
trad drugs based on Norfloxacin
| Gen name | Trade name | Catagory name |
| norfloxacin | Noroxin | Quinolones |
| Norfloxacin | APIFLOX 0.3% EYE DROPS | |
| Norfloxacin | NORACIN 400MG TAB | |
| Norfloxacin | NOROXIN 400MG TABLETS | |
| Norfloxacin | UROXIN 400MG TAB | |
other drugs from same cataogory