Norfloxacin

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trade name: Noroxin; drug class: fluoroquinolone antiinfective; action: a broad-spectrum bactericidal agent that inhibits the enzyme DNA gyrase needed for replication of DNA; uses: adult urinary tract infections.

Brand names: Chibroxin®Noroxin®

Chemical formula:

Español:
• Norfloxacino, Tableta oral

Norfloxacin Oral tablet

What is this medicine?

NORFLOXACIN is a quinolone antibiotic. It is used to treat certain kinds of bacterial infections. It will not work for colds, flu, or other viral infections.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:
•cerebral disease
•glucose-6- phosphate dehydrogenase related disorder
•history of tendon rupture
•kidney disease
•myasthenia gravis
•seizure disorder
•an unusual or allergic reaction to norfloxacin, other quinolone antibiotics, foods, dyes, or preservatives
•pregnant or trying to get pregnant
•breast-feeding

How should I use this medicine?

Take this medicine by mouth with a full glass of water. Follow the directions on the prescription label. Take this medicine on an empty stomach, at least 1 hour before or 2 hours after a meal, milk and/or other dairy products. Do not take with food. Take your medicine at regular intervals. Do not take your medicine more often than directed. Take all of your medicine as directed even if you think your are better. Do not skip doses or stop your medicine early.
 
A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.
 
Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.
 
 
Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.

What may interact with this medicine?

Do not take this medicine with any of the following medications:
•cisapride
•droperidol
•pimozide
•some medications for irregular heart rhythm

This medicine may also interact with the following medications:
•antacids with aluminum, magnesium
•caffeine
•cyclosporine
•didanosine buffered tablets or solution
•digoxin
•erythromycin
•medicines for depression, anxiety, or psychotic disturbances
•medicines for diabetes
•nitrofurantoin
•probenecid
•some medicines for pain and swelling like ibuprofen, naproxen
•sucralfate
•theophylline
•tizanidine
•vitamins with iron or zinc
•warfarin

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Tell your doctor or health care professional if your symptoms do not improve or get worse. Make sure you stay well hydrated while taking this medicine. Drink several glasses of fluids a day.

If you are a diabetic monitor your blood sugar carefully. If your blood sugar reading is unusual, stop taking this medicine and call your doctor for advice.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medicine affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells.

This medicine can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.

Do not treat diarrhea with over-the-counter products. Contact your doctor if you have diarrhea that lasts more than 2 days or if the diarrhea is severe and watery.

Avoid taking didanosine, sucralfate, antacids, or iron or zinc products within 2 hours of taking this medicine.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:
•allergic reactions like skin rash or hives, swelling of the face, lips, or tongue
•breathing problems
•changes in hearing
•changes in vision
•confusion, hallucinations, tremor
•depression or suicidal thoughts
•dizziness
•fever, chills
•irregular heartbeat, feeling faint
•joint, muscle, tendon pain or swelling
•redness, blistering, peeling or loosening of the skin, including inside the mouth
•seizures
•unusually weak or tired
•unusual pain, numbness, tingling, or weakness
•vaginal irritation, discharge

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
•bitter taste
•constipation, diarrhea
•headache
•loss of appetite
•stomach upset, nausea
•trouble sleeping

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Keep bottle closed tightly. Throw away any unused medicine after the expiration date.

Last updated: 7/1/2002

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

An oral quinoline antibacterial agent used in the treatment of urinary tract infections.

A fluoroquinolone antibiotic, used particularly in urinary tract infection.

Norfloxacin
Systematic (IUPAC) name
1-ethyl-6-fluoro-4-oxo-7-piperazin-1-yl-1H-quinoline- 3-carboxylic acid
Identifiers
CAS number	70458-96-7
ATC code	J01MA06 S01AX12
PubChem	4539
DrugBank	APRD00469
Chemical data
Formula	C16H18FN3O3
Mol. mass	319.331 g/mol
Pharmacokinetic data
Bioavailability	30 to 40%
Protein binding	10 to 15%
Metabolism	Hepatic
Half life	3 to 4 hours
Excretion	Renal and fecal
Therapeutic considerations
Pregnancy cat.	C(US)
Legal status	℞ Prescription only
Routes	Oral

Norfloxacin, sold in English speaking countries under the following brand names, Apo-Norflox, Chibroxin, Floxin, Insensye, Norflohexal, Noroxin, Norfocin, Nufloxib, Roxin, Utin and Utinor is an oral broad-spectrum fluoroquinolone antibacterial agent used in the treatment of urinary tract infections. It is also sometimes used to treat stomach infections.

Adverse effects

See also: Adverse effects of fluoroquinolones

Fluoroquinolones are generally well tolerated with most side effects being mild and serious adverse effects being rare.^[1][2] Some of the serious adverse effects which occur more commonly with fluoroquinolones than with other antibiotic drug classes include CNS and tendon toxicity.^[3][4] The currently marketed quinolones have safety profiles similar to that of other antimicrobial classes.^[5]

The serious events may occur with therapeutic or with acute overdose. At therapeutic doses they include: central nervous system toxicity, cardiovascular toxicity, tendon / articular toxicity, and rarely hepatic toxicity.^[6] Events that may occur in acute overdose are rare and include: renal failure and seizure.^[6] Children and the elderly are at greater risk.^[4][1] Adverse reactions may manifest during, as well as after fluoroquinolone therapy.^[7] Acute pancreatitis has been reported as a rare but serious adverse reaction of norfloxacin.^[8]

Some groups refer to these adverse events as "fluoroquinolone toxicity". These groups of people claim to have suffered serious long term harm to their health from using fluoroquinolones. This has led to a class action lawsuit by people harmed by the use of fluoroquinolones as well as action by the consumer advocate group Public Citizen.^[9][10] Partly as a result of the efforts of Public Citizen the FDA ordered a black box warnings on all fluoroquinolones advising consumers of the possible toxic effects of fluoroquinolones on tendons.^[11]

Mechanism of action

The mechanism of action of norfloxacin involves inhibition of the A subunit of bacterial DNA gyrase, an enzyme which is essential for DNA replication.^[12]

References

1. ^ ^{a b} Owens RC, Ambrose PG (July 2005). "Antimicrobial safety: focus on fluoroquinolones". Clin. Infect. Dis. 41 Suppl 2: S144–57. doi:10.1086/428055. PMID 15942881. 
2. ^ Ball P, Mandell L, Niki Y, Tillotson G (November 1999). "Comparative tolerability of the newer fluoroquinolone antibacterials". Drug Saf 21 (5): 407–21. doi:10.2165/00002018-199921050-00005. PMID 10554054. 
3. ^ Owens RC, Ambrose PG (July 2005). "Antimicrobial safety: focus on fluoroquinolones". Clin. Infect. Dis. 41 Suppl 2: S144–57. doi:10.1086/428055. PMID 15942881. http://www.journals.uchicago.edu/cgi-bin/resolve?CID34940. 
4. ^ ^{a b} Iannini PB (June 2007). "The safety profile of moxifloxacin and other fluoroquinolones in special patient populations". Curr Med Res Opin 23 (6): 1403–13. doi:10.1185/030079907X188099. PMID 17559736. 
5. ^ Owens RC, Ambrose PG (July 2005). "Antimicrobial safety: focus on fluoroquinolones". Clin. Infect. Dis. 41 Suppl 2: S144–57. doi:10.1086/428055. PMID 15942881. http://www.journals.uchicago.edu/cgi-bin/resolve?CID34940. 
6. ^ ^{a b} Nelson, Lewis H.; Flomenbaum, Neal; Goldfrank, Lewis R.; Hoffman, Robert Louis; Howland, Mary Deems; Neal A. Lewin (2006). Goldfrank's toxicologic emergencies. New York: McGraw-Hill, Medical Pub. Division. ISBN 0-07-143763-0. OCLC url=http://books.google.com/books?id=cvJuLqBxGUcC&pg=PA849&dq=goldfranks+Fluoroquinolone+toxicity. 
7. ^ Saint F, Gueguen G, Biserte J, Fontaine C, Mazeman E (September 2000). "[Rupture of the patellar ligament one month after treatment with fluoroquinolone]" (in French). Rev Chir Orthop Reparatrice Appar Mot 86 (5): 495–7. PMID 10970974. http://www.masson.fr/masson/MDOI-RCO-09-2000-86-5-0035-1040-101019-ART7. 
8. ^ Drabo YJ, Niakara A, Ouedraogo H (January 2002). "[Acute pancreatitis secondary to administration or norfloxacin]" (in French). Ann Fr Anesth Reanim 21 (1): 68–9. doi:10.1016/S0750-7658(01)00562-7. PMID 11878127. 
9. ^ http://www.consumeraffairs.com/news04/2006/08/pubcit_cipro.html
10. ^ http://www.mnd.uscourts.gov/MDL-Levaquin/index.shtml
11. ^ "FDA orders 'black box' label on some antibiotics". http://www.cnn.com/2008/HEALTH/07/08/antibiotics.risk/index.html. Retrieved on 2008-07-08. 
12. ^ Goldstein E (1987). "Norfloxacin, a fluoroquinolone antibacterial agent. Classification, mechanism of action, and in vitro activity". Am J Med 82 (6B): 3–17. doi:10.1016/0002-9343(87)90612-7. PMID 3111257. 

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