In some cases, after the first use of the drug may develop hypersensitivity and allergic reactions, which should immediately inform the doctor. Very rarely, even after the first use of the drug, anaphylactic reactions can progress to a life-threatening anaphylactic shock. In these cases, treatment with Avelox® should be discontinued and immediately begin the necessary medical measures (including anti-shock).
With the use of the drug Avelox®, some patients may experience an elongation of the interval QT. Because women have a longer interval than men QT, they may be more sensitive to drugs that extend the interval QT.
Elderly patients are also more prone to the effects of drugs that affect the interval QT, Interval lengthening QT is associated with an increased risk of ventricular arrhythmias, including polymorphic ventricular tachycardia.
Degree of lengthening interval QT may increase with increasing drug concentration, therefore, do not exceed the recommended dose and infusion rate (400 mg for 60 min). However, in patients with pneumonia, the correlation between the concentration of moxifloxacin in the blood plasma and the lengthening of the interval QT was not noted. None of the 9,000 patients who received Avelox® received cardiovascular complications and lethal cases associated with the prolongation of the QT interval. When using Avelox®, the risk of developing ventricular arrhythmias in patients with predisposing arrhythmias may increase.
In this regard, the drug is contraindicated in:
- changes in the electrophysiological parameters of the heart, expressed in the lengthening of the interval QT: Congenital or acquired documented lengthening interval QT, electrolyte disturbances, especially notcorrected hypokalemia; clinically significant bradycardia; clinically significant heart failure with a reduced fraction of the left ventricular ejection; in the presence of a history of rhythm disturbances, accompanied by a clinical symptomtomatics;
- use with other drugs that extend the interval QT (see the section "Interaction with other medicinal products").
Avelox® should be used with caution:
- in patients with potentially proarrhythmic conditions, such as acute myocardial ischemia and cardiac arrest;
- in patients with cirrhosis of the liver (since this category of patients can not exclude the risk of developing an extension of the interval QT).
When using Avelox®, cases of fulminant hepatitis, potentially leading to liver failure (including fatal cases), have been reported (see "Side effect" section). The patient should be informed that if symptoms of hepatic insufficiency occur, the doctor should be consulted before continuing treatment with Avelox®
When using the drug Avelox®, cases of developing bullous skin lesions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis, have been reported. The patient should be informed that if skin or mucous membrane symptoms occur, see a doctor before continuing with Avelox®.
The use of drugs quinolone series is associated with a possible risk of seizures. Avelox® should be used with caution in patients with CNS diseases and with CNS disorders that predispose to seizures or reduce the threshold of seizure activity.
The use of broad-spectrum antibacterial drugs, including Avelox®, is associated with a risk of developing pseudomembranous colitis. This diagnosis should be borne in mind in patients who have developed severe diarrhea during treatment with Avelox. In this case, immediate therapy should be prescribed.
Drugs that inhibit the peristalsis of the intestine are contraindicated in the development of severe diarrhea.
Avelox® should be used with caution in patients with myasthenia gravis gravis in connection with a possible exacerbation of the disease.
Against the background of quinolone therapy, including moxifloxacin, tendonitis and tendon rupture are possible, especially in the elderly and patients receiving glucocorticosteroids. Cases which have arisen within several months after the end of treatment are described. At the first symptoms of pain or inflammation at the site of damage, the drug should be stopped and unloaded.
When applying quinolones, photosensitivity reactions are noted. However, in pre-clinical and clinical studies, as well as with the use of the drug Avelox®, no photosensitivity reactions were observed in practice. However, patients receiving Avelox® should avoid exposure to direct sunlight and ultraviolet light.
It is not recommended to use moxifloxacin for the treatment of infections caused by strains Staphylococcus aureus, resistant to methicillin (MRSA). In the case of suspected or confirmed infections caused by MRSA, should be prescribed treatment with appropriate antibacterial drugs (see the section "Pharmacodynamics").
The ability of moxifloxacin to inhibit the growth of mycobacteria can cause interaction in vitro moxifloxacin with a Mycobacterium spp., leading to false-negative results in the analysis of samples of patients treated with Avelox® during this period.
Patients undergoing treatment with quinolones, including Avelox®, described cases of sensory or sensorimotor polyneuropathy leading to paresthesia, kinesthesias, dysesthesias, or weakness. Patients undergoing treatment with Avelox®, should be warned about the need to immediately seek medical attention before continuing treatment in case of symptoms of neuropathy, including pain, burning, tingling, numbness or weakness (see section "Side effect").
Reactions from the psyche may occur even after the first use of fluoroquinolones, including moxifloxacin. In very rare cases, depression or psychotic reactions progress to the occurrence of suicidal thoughts and behavior with a tendency to self-harm, including suicidal attempts (see "Side effect" section).If patients develop such reactions, Avelox® should be discontinued and appropriate measures taken. Caution should be exercised when using Avelox® in patients with psychosis and / or psychiatric illnesses in the anamnesis.
Disglycemia
As in the case of other fluoroquinolones, the use of the drug Avelox® marked a change in the concentration of glucose in the blood, including hypo- and hyperglycemia. Against the background of therapy with Avelox® dysglycemia occurred mainly in elderly patients with diabetes mellitus receiving concomitant therapy with oral hypoglycemic drugs (eg, sulfonylureas) or insulin. When performing treatment in patients with diabetes, careful monitoring of the concentration of glucose in the blood is recommended (see section "Side effect").
Patients who follow a diet with a low salt content (with heart failure, kidney failure, with nephrotic syndrome) should take into account that the infusion solution contains sodium chloride.
The daily dose of sodium in the preparation is 34 mmol.