MOXEZA- moxifloxacin hydrochloride solution

MOXEZA by

Drug Labeling and Warnings

MOXEZA by is a Prescription medication manufactured, distributed, or labeled by Alcon Laboratories, Inc.. Drug facts, warnings, and ingredients follow.

Drug Details [pdf]

  • 1 INDICATIONS AND USAGE

    MOXEZA® solution is indicated for the treatment of bacterial conjunctivitis caused by susceptible strains of the following organisms:

    Aerococcus viridans*
    Corynebacterium macginleyi*
    Enterococcus faecalis*
    Micrococcus luteus*
    Staphylococcus arlettae*
    Staphylococcus aureus
    Staphylococcus capitis
    Staphylococcus epidermidis
    Staphylococcus haemolyticus
    Staphylococcus hominis
    Staphylococcus saprophyticus*
    Staphylococcus warneri*
    Streptococcus mitis*
    Streptococcus pneumoniae
    Streptococcus parasanguinis*
    Escherichia coli*
    Haemophilus influenza
    Klebsiella pneumoniae*
    Propionibacterium acnes
    Chlamydia trachomatis*
    *Efficacy for this organism was studied in fewer than 10 infections.

  • 2 DOSAGE AND ADMINISTRATION

    Instill 1 drop in the affected eye(s) 2 times daily for 7 days.

  • 3 DOSAGE FORMS AND STRENGTHS

    4 mL bottle filled with 3 mL of sterile ophthalmic solution of moxifloxacin 0.5%.

  • 4 CONTRAINDICATIONS

    None.

  • 5 WARNINGS AND PRECAUTIONS

    5.1 Topical Ophthalmic Use Only

    NOT FOR INJECTION. MOXEZA® solution is for topical ophthalmic use only and should not be injected subconjunctivally or introduced directly into the anterior chamber of the eye.

    5.2 Hypersensitivity Reactions

    In patients receiving systemically administered quinolones, including moxifloxacin, serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported, some following the first dose. Some reactions were accompanied by cardiovascular collapse, loss of consciousness, angioedema (including laryngeal, pharyngeal or facial edema), airway obstruction, dyspnea, urticaria, and itching. If an allergic reaction to moxifloxacin occurs, discontinue use of the drug. Serious acute hypersensitivity reactions may require immediate emergency treatment. Oxygen and airway management should be administered as clinically indicated.

    5.3 Growth of Resistant Organisms with Prolonged Use

    As with other anti-infectives, prolonged use may result in overgrowth of non-susceptible organisms, including fungi. If superinfection occurs, discontinue use and institute alternative therapy. Whenever clinical judgment dictates, the patient should be examined with the aid of magnification, such as slit-lamp biomicroscopy, and, where appropriate, fluorescein staining.

    5.4 Avoidance of Contact Lens Wear

    Patients should be advised not to wear contact lenses if they have signs or symptoms of bacterial conjunctivitis.

  • 6 ADVERSE REACTIONS

    Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to the rates in the clinical trials of another drug and may not reflect the rates observed in practice.

    The data described below reflect exposure to MOXEZA® solution in 1263 patients, between 4 months and 92 years of age, with signs and symptoms of bacterial conjunctivitis. The most frequently reported adverse reactions were eye irritation, pyrexia and conjunctivitis, reported in 1-2% of patients.

  • 8 USE IN SPECIFIC POPULATIONS

    8.1 Pregnancy

    Pregnancy Category C. Moxifloxacin was not teratogenic when administered to pregnant rats during organogenesis at oral doses as high as 500 mg/kg/day (approximately 25,000 times the highest recommended total daily human ophthalmic dose); however, decreased fetal body weights and slightly delayed fetal skeletal development were observed. There was no evidence of teratogenicity when pregnant Cynomolgus monkeys were given oral doses as high as 100 mg/kg/day (approximately 5,000 times the highest recommended total daily human ophthalmic dose). An increased incidence of smaller fetuses was observed at 100 mg/kg/day.

    Since there are no adequate and well-controlled studies in pregnant women, MOXEZA® solution should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

    8.3 Nursing Mothers

    Moxifloxacin has not been measured in human milk, although it can be presumed to be excreted in human milk. Caution should be exercised when MOXEZA® solution is administered to a nursing mother.

    8.4 Pediatric Use

    The safety and effectiveness of MOXEZA® solution in infants below 4 months of age have not been established.

    There is no evidence that the ophthalmic administration of moxifloxacin has any effect on weight bearing joints, even though oral administration of some quinolones has been shown to cause arthropathy in immature animals.

    8.5 Geriatric Use

    No overall differences in safety and effectiveness have been observed between elderly and younger patients.

  • 11 DESCRIPTION

    MOXEZA® is a sterile solution for topical ophthalmic use.

    Moxifloxacin hydrochloride is an 8-methoxy fluoroquinolone anti-infective, with a diazabicyclononyl ring at the C7 position.

    chemical

    C21H24FN3O4HCl                   Mol Wt 437.9

    Chemical Name: 1-Cyclopropyl-6-fluoro-1,4-dihydro-8-methoxy-7-[(4aS,7aS)-octahydro-6H-pyrrolol[3,4-b]pyridin-6-yl]-4-oxo-3-quinolinecarboxylic acid, monohydrochloride.

    Each mL of MOXEZA® solution contains 5.45 mg moxifloxacin hydrochloride, equivalent to 5 mg moxifloxacin base.

    Inactives: Sodium chloride, xanthan gum, boric acid, sorbitol, tyloxapol, purified water, and hydrochloric acid and/or sodium hydroxide to adjust pH.

    MOXEZA® is a greenish-yellow, isotonic solution with an osmolality of 300-370 mOsm/kg and a pH of approximately 7.4. Moxifloxacin hydrochloride is a slightly yellow to yellow crystalline powder.

  • 12 CLINICAL PHARMACOLOGY

    12.1 Mechanism of Action

    Moxifloxacin is a member of the fluoroquinolone class of anti-infective drugs [see Clinical Pharmacology (12.4)].

    12.3 Pharmacokinetics

    Moxifloxacin steady-state plasma pharmacokinetics were evaluated in healthy adult male and female subjects who were administered multiple, bilateral, topical ocular doses of MOXEZA® solution two times daily for four days with a final dose on day 5. The average steady-state AUC0-12 was 8.17 ± 5.31 ng*h/mL. Moxifloxacin Cmax following twice-daily bilateral ophthalmic administration of moxifloxacin 0.5% for 5 days is approximately 0.02% of that achieved with the oral formulation of moxifloxacin hydrochloride (Cmax following oral dosing of 400 mg AVELOX*, 4.5 ± 0.5 mcg/mL).

    12.4 Microbiology

    The antibacterial action of moxifloxacin results from inhibition of the topoisomerase II (DNA gyrase) and topoisomerase IV. DNA gyrase is an essential enzyme that is involved in the replication, transcription and repair of bacterial DNA. Topoisomerase IV is an enzyme known to play a key role in the partitioning of the chromosomal DNA during bacterial cell division.

    The mechanism of action for quinolones, including moxifloxacin, is different from that of macrolides, aminoglycosides, or tetracyclines. Therefore, moxifloxacin may be active against pathogens that are resistant to these antibiotics and these antibiotics may be active against pathogens that are resistant to moxifloxacin. There is no cross-resistance between moxifloxacin and the aforementioned classes of antibiotics. Cross-resistance has been observed between systemic moxifloxacin and some other quinolones.

    In vitro resistance to moxifloxacin develops via multiple-step mutations. Resistance to moxifloxacin occurs in vitro at a general frequency of between 1.8 x 10-9 to < 1x10-11 for Gram-positive bacteria.

    Moxifloxacin has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections as described in the INDICATIONS AND USAGE section:

    Aerococcus viridans*
    Corynebacterium macginleyi*
    Enterococcus faecalis*
    Micrococcus luteus*
    Staphylococcus arlettae*
    Staphylococcus aureus
    Staphylococcus capitis
    Staphylococcus epidermidis
    Staphylococcus haemolyticus
    Staphylococcus hominis
    Staphylococcus saprophyticus*
    Staphylococcus warneri*
    Streptococcus mitis*
    Streptococcus pneumoniae
    Streptococcus parasanguinis*
    Escherichia coli*
    Haemophilus influenza
    Klebsiella pneumoniae*
    Propionibacterium acnes
    Chlamydia trachomatis*

    *Efficacy for this organism was studied in fewer than 10 infections.

    The following in vitro data are available, but their clinical significance in ophthalmic infections is unknown. The safety and effectiveness of MOXEZA® solution in treating ophthalmic infections due to these organisms have not been established in adequate and well-controlled trials.

    Moxifloxacin has been shown to be active in vitro against most strains of the microorganisms listed below. These organisms are considered susceptible when evaluated using systemic breakpoints; however, a correlation between the in vitro systemic breakpoint and ophthalmologic efficacy has not been established. The list of organisms is provided as guidance only in assessing the potential treatment of conjunctival infections. Moxifloxacin exhibits in vitro minimal inhibitory concentrations (MICs) of 2 mcg/mL or less (systemic susceptible breakpoint) against most (≥ 90%) strains of the following ocular pathogens.

    Aerobic Gram-positive microorganisms:
    Staphylococcus caprae
    Staphylococcus cohnii
    Staphylococcus lugdunensis
    Staphylococcus pasteuri
    Streptococcus agalactiae
    Streptococcus milleri group
    Streptococcus oralis
    Streptococcus pyogenes
    Streptococcus salivarius
    Streptococcus sanguis

    Aerobic Gram-negative microorganisms:
    Acinetobacter baumannii
    Acinetobacter calcoaceticus
    Acinetobacter junii
    Enterobacter aerogenes
    Enterobacter cloacae
    Haemophilus parainfluenzae
    Klebsiella oxytoca
    Moraxella catarrhalis
    Moraxella osloensis
    Morganella morganii
    Neisseria gonorrhoeae
    Neisseria meningitides
    Pantoea agglomerans
    Proteus vulgaris
    Pseudomonas stutzeri
    Serratia liquefaciens
    Serratia marcescens
    Stenotrophomonas maltophilia

    Anaerobic microorganisms:
    Clostridium perfringens
    Peptostreptococcus anaerobius
    Peptostreptococcus magnus
    Peptostreptococcus micros
    Peptostreptococcus prevotii

    Other microorganisms:
    Mycobacterium tuberculosis
    Mycobacterium avium
    Mycobacterium kansasii
    Mycobacterium marinum

  • 13 NONCLINICAL TOXICOLOGY

    13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

    Long-term studies in animals to determine the carcinogenic potential of moxifloxacin have not been performed.

    Moxifloxacin was not mutagenic in four bacterial strains used in the Ames Salmonella reversion assay. As with other quinolones, the positive response observed with moxifloxacin in strain TA 102 using the same assay may be due to the inhibition of DNA gyrase. Moxifloxacin was not mutagenic in the CHO/HGPRT mammalian cell gene mutation assay. An equivocal result was obtained in the same assay when v79 cells were used. Moxifloxacin was clastogenic in the v79 chromosome aberration assay, but it did not induce unscheduled DNA synthesis in cultured rat hepatocytes. There was no evidence of genotoxicity in vivo in a micronucleus test or a dominant lethal test in mice.

    Moxifloxacin had no effect on fertility in male and female rats at oral doses as high as 500 mg/kg/day, approximately 25,000 times the highest recommended total daily human ophthalmic dose. At 500 mg/kg orally there were slight effects on sperm morphology (head-tail separation) in male rats and on the estrous cycle in female rats.

  • 14 CLINICAL STUDIES

    In one randomized, double-masked, multicenter, vehicle-controlled clinical trial in which patients with bacterial conjunctivitis were dosed with MOXEZA® solution 2 times a day, MOXEZA® was superior to its vehicle for both clinical and microbiological outcomes. Clinical cure achieved on Day 4 was 63% (265/424) in MOXEZA® solution treated patients, versus 51% (214/423) in vehicle treated patients. Microbiologic success (eradication of baseline pathogens) was achieved on Day 4 in 75% (316/424) of MOXEZA® solution treated patients versus 56% (237/423) of vehicle treated patients. Microbiologic eradication does not always correlate with clinical outcome in anti-infective trials.

  • 16 HOW SUPPLIED/STORAGE AND HANDLING

    MOXEZA® solution is supplied as a sterile ophthalmic solution in the Alcon DROP-TAINER® dispensing system consisting of a natural low density polyethylene bottle and dispensing plug and tan polypropylene closure. Tamper evidence is provided with a shrink band around the closure and neck area of the package.

    3 mL in a 4 mL bottle - NDC: 0065-0006-03

    Storage: Store at 2°C - 25°C (36°F - 77°F).

  • 17 PATIENT COUNSELING INFORMATION

    17.1 Avoid Contamination of the Product

    Advise patients not to touch the dropper tip to any surface to avoid contaminating the contents.

    17.2 Avoid Contact Lens Wear

    Advise patients not to wear contact lenses if they have signs and symptoms of bacterial conjunctivitis.

    17.3 Hypersensitivity Reactions

    Systemically administered quinolones, including moxifloxacin, have been associated with hypersensitivity reactions, even following a single dose. Patients should be told to discontinue use immediately and contact their physician at the first sign of a rash or allergic reaction.

    Licensed to Alcon by Bayer Pharma AG.

    ©2010, 2012, 2016 Novartis
    *AVELOX is a registered trademark of Bayer AG.

    Alcon ®
    a Novartis company

    Distributed by:
    ALCON LABORATORIES, INC.
    6201 South Freeway
    Fort Worth, Texas 76134 USA

    alcon.medinfo@alcon.com

    T2017-23
    February 2017

  • PRINCIPAL DISPLAY PANEL

    Alcon
    NDC 0065-0006-03               STERILE

    Moxeza®
    (moxifloxacin ophthalmic solution)
    0.5%

    Alcon®                                  3 mL
    Rx Only

    carton
  • INGREDIENTS AND APPEARANCE
    MOXEZA  
    moxifloxacin hydrochloride solution
    Product Information
    Product TypeHUMAN PRESCRIPTION DRUGItem Code (Source)NDC: 0065-0006
    Route of AdministrationOPHTHALMIC
    Active Ingredient/Active Moiety
    Ingredient NameBasis of StrengthStrength
    MOXIFLOXACIN HYDROCHLORIDE (UNII: C53598599T) (MOXIFLOXACIN - UNII:U188XYD42P) MOXIFLOXACIN5 mg  in 1 mL
    Inactive Ingredients
    Ingredient NameStrength
    SODIUM CHLORIDE (UNII: 451W47IQ8X)  
    XANTHAN GUM (UNII: TTV12P4NEE)  
    BORIC ACID (UNII: R57ZHV85D4)  
    SORBITOL (UNII: 506T60A25R)  
    TYLOXAPOL (UNII: Y27PUL9H56)  
    WATER (UNII: 059QF0KO0R)  
    HYDROCHLORIC ACID (UNII: QTT17582CB)  
    SODIUM HYDROXIDE (UNII: 55X04QC32I)  
    Packaging
    #Item CodePackage DescriptionMarketing Start DateMarketing End Date
    1NDC: 0065-0006-033 mL in 1 BOTTLE; Type 0: Not a Combination Product01/18/2011
    Marketing Information
    Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
    NDANDA02242801/18/2011
    Labeler - Alcon Laboratories, Inc. (008018525)

    • Trademark Results [MOXEZA]

    Mark Image

    Registration | Serial
    Company
    Trademark
    Application Date
    MOXEZA
    MOXEZA
    85032907 3928077 Live/Registered
    NOVARTIS AG
    2010-05-07
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