Most popular brand: Noroxin
Active ingredient: Norfloxacin
Available dosage forms: 400 mg
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Norfloxacin general information
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norfloxacin (Norfloxacin): instruction, and the use of a formula
1 – Ethyl – 6 – fluoro – 1,4 – dihydro – 4 – oxo – 7 – (1 – piperazinyl) – 3 – quinolinecarboxylic acid (and as hydrochloride)
Gross – formula
Therapeutic substance norfloxacin
The nosological classification (ICD – 10)
Feature substance norfloxacin
Antibacterial fluoroquinolones II generation. Pyridone synthetic analogue of nalidixic acid; has a fluorine atom in position 6 (increases effect on gram-negative bacteria) and piperazine group in position 7 (provides activity against Pseudomonas). Norfloxacin is a metabolite of pefloxacin, which differs by the absence of a methyl group at the piperazine nucleus.
White or pale – yellow crystalline powder. octanol / water ; 0.46. The easily soluble in glacial acetic acid, very slightly ; ethanol, methanol and water. Solubility at 25 ° C (mg / ml) in water ; 0.28; methanol ; 0.98; ethanol ; 1.9; acetone ; 5.1; chloroform ; 5.5; ether ; 0.01; benzene ; 0.15; ethyl acetate ; 0.94; octyl alcohol ; 5.1; glacial acetic acid ; 340. The solubility in water depends on the pH. increases sharply at pH < 5 and pH> 10. Hygroscopic hemihydrate forms air. The molecular weight of ; 319,34.
Mode of action – antibacterial broad-spectrum bactericidal.
inhibits bacterial DNA – gyrase (enzyme necessary for the replication, transcription and repair of bacterial DNA) violates the synthesis of DNA and proteins, leading to death of the bacteria.
Norfloxacin is active (like in vitro and the results of clinical trials of the oral route for the treatment of a number of infections.) Against most strains of the following microorganisms: aerobic Gram-positive bacteria ; Enterococcus faecalis, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus, Streptococcus agalactiae, aerobic gram-negative bacteria ; Citrobacter freundii, Enterobacter aerogenes, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Neisseria gonorrhoeae, Proteus mirabilis, Proteus vulgaris, Pseudomonas aeruginosa, Serratia marcescens .
Active also against Gram-negative microorganisms such as Salmonella spp. Shigella spp. , Yersinia enterocolitica, Haemophilus influenzae.
Effective (in vitro and the results of clinical trials in the treatment of eye infections) against most strains of the following microorganisms: Gram-positive bacteria, including Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus warneri . Streptococcus pneumoniae, Gram-negative bacteria, including Acinetobacter calcoaceticus, Aeromonas hydrophila, Haemophilus influenzae, Proteus mirabilis, Pseudomonas aeruginosa, Serratia marcescens .
Norfloxacin is active in vitro against most strains of the following microorganisms: aerobic Gram-positive bacteria ; Bacillus cereus . Aerobic gram-negative bacteria ; Citrobacter diversus, Edwardsiella tarda, Enterobacter agglomerans, Hafnia alvei , Haemophilus aegyptius (Koch’s bacillus – Weeks), Haemophilus ducreyi, Klebsiella oxytoca, Klebsiella rhinoscleromatis, Morganella morganii, Providencia alcalifaciens, Providencia rettgeri, Providencia stuartii, Pseudomonas fluorescens, Pseudomonas stutzeri, Salmonella typhi, Vibrio cholerae, Vibrio parahaemolyticus, Yersinia enterocolitica, as well as for Ureaplasma urealyticum .
In most cases, inactive against obligate anaerobes, shows no activity against Treponema pallidum.
Resistance to norfloxacin due to spontaneous mutations of in vitro . uncommon (range: 10 – 9 – 10 – 12 cells). The emergence of resistance to norfloxacin in the treatment process is observed in less than 1% of patients. The development of resistance reported in Pseudomonas aeruginosa . Klebsiella pneumoniae . Acinetobacter spp. Enterococcus spp. Therefore, in the absence of satisfactory clinical response, repeat susceptibility testing. Microorganisms that are resistant to nalidixic acid, in most cases are sensitive to norfloxacin in vitro, but these microorganisms may have higher values of MIC of norfloxacin than strains that are sensitive to nalidixic acid. Generally, cross-resistance between norfloxacin and other classes of antibacterial agents is not observed. Therefore, norfloxacin may be active against microorganisms resistant to other antimicrobial drugs. including aminoglycosides, penicillins, cephalosporins, tetracyclines, macrolides, sulfonamides, including a combination of sulfamethoxazole and trimethoprim. Antagonism in vitro demonstrated between norfloxacin and nitrofurantoin.
If ingestion is rapidly absorbed from the gastrointestinal tract (in healthy volunteers on an empty stomach ; 30 – 40%), food slows absorption. After oral administration at a dose of 200, 400 and 800 mg of C max in the blood is 0.8; 1.5 and 2.4 ug / ml, respectively, and is achieved in about 1 hour plasma protein binding .; 10 – 15%. T 1/2 from plasma ; 3 –. 4 hours Equilibrium concentration of norfloxacin achieved within two days after the start of.
In healthy volunteers, 65 – 75 years from the normal for their age, renal function excretion of norfloxacin slower due to the reduced number of the elderly kidney function; after receiving a single 400 mg dose, and AUC value of C max comprise 9.8 ug · h / mL and 2.02 ug / ml, respectively; wherein the amount of the exposure system is somewhat higher than in younger patients (AUC 6,4 mcg · h / mL and C max 1,5 mg / ml) and T 1/2 ; 4 h. Norfloxacin most widely distributed in the body fluids and tissues. 2 – 3 h after administration of a single dose of 400 mg norfloxacin concentration in urine is 200 pg / ml or more. In healthy volunteers 12 h after administration of 400 mg norfloxacin concentrations are about 30 ug / ml. After 1 – 4 hours post-dose of 400 mg norfloxacin concentration in various tissues are as follows: 7.3 ug / g (renal parenchyma), 1.6 mg / g (testes), 2.7 ug / ml (seminiferous tubule fluid) 2.5 mg / g (prostate), 3.0 mg / g (uterus / cervix), 1.9 mg / g (fallopian tube), 4.3 mg / g (vagina), 6.9 ug / ml (bile after receiving two doses of 200 mg). It is metabolized to a small extent by the liver and excreted in the bile and urine. Excretion by the kidneys is carried by both glomerular filtration and tubular secretion. Within 24 hours, 26 – 32% of the dose is excreted in the urine in unchanged form, 5 – 8% ; 6 as active metabolites possess an antimicrobial activity at about 30% ; with feces.
In animals, systemic absorption after instillation of norfloxacin eye was minimal.
in animal pharmacology
norfloxacin orally single dose, 6 * times the recommended therapeutic dose for humans, caused lameness in young growing dogs.
[Hereinafter symbol * denotes the rate of excess doses for humans weighing 50 kg, based in mg / kg base].
The histological study of bearing the main weight-bearing joints of these dogs revealed permanent lesions of the cartilage. Other quinolones also cause the destruction of the cartilage of the joints, weight-bearing, and other signs of arthropathy in immature animals.
On the background of norfloxacin was observed crystalluria. In dogs, needle-like crystals were found in the urine of a substance in doses of 50 mg / kg / day. Rats appeared crystals norfloxacin at doses of 200 mg / kg / day.
Signs ophthalmic toxicity when taking norfloxacin nor in any of the tested animal species were observed.
carcinogenicity, mutagenicity, effects on fertility
There was no increase in the frequency of tumors (compared to control) in rats, long-term (96 weeks) treated with norfloxacin in doses 8 – * 9 times the normal human dose.
The mutagenic activity of norfloxacin was evaluated in a number of tests in vivo and in vitro . Norfloxacin had no mutagenic effects in the test of dominant lethals mice did not induce chromosomal aberrations in hamsters and rats fed him in doses of 30 – 60 * times the normal human dose. I do not exhibit mutagenic activity in the Ames test, in the test using Chinese hamster fibroblasts and test V – 79 mammalian cells. Although norfloxacin gave weakly positive results in Rec – DNA repair test. Other tests for mutagenicity were negative, including a more sensitive test V – 79.
norfloxacin no adverse effect on fertility in male and female mice when used orally in doses up to 30 * times the normal human dose.
Pregnancy. Teratogenic effects. Embrioletalnost and low toxicity to the mother (vomiting and anorexia) were observed in monkeys Cynomolgus at doses of norfloxacin 150 mg / kg / day and above. Norfloxacin caused embryo loss in monkeys when used orally in doses 10 times higher than MRDCH *. observed with the values C max were approximately 2-fold higher than those in humans. There was no evidence of teratogenicity in test animals (rats, rabbits, mice, monkeys), norfloxacin treated at doses of 6 – 50 times the MRDC *.
Application of the substance norfloxacin
Infections caused by pathogens sensitive to norfloxacin:
inside ; acute and chronic urinary tract infections (including pyelonephritis, cystitis, urethritis), genital infections (including prostatitis, cervicitis, endometritis), uncomplicated gonorrhea, gastrointestinal (including salmonellosis, shigellosis); prevention of infections in patients with granulocytopenia;
locally ; otitis externa, and acute exacerbation of chronic otitis media; eye infections, including conjunctivitis, keratitis, keratoconjunctivitis, corneal ulcers, blepharitis, Blepharoconjunctivitis.
Hypersensitivity (including history), tendinitis or tendon rupture associated with taking norfloxacin or other drugs from the group of quinolones; glucose deficit – 6 – phosphate dehydrogenase, childhood and adolescence to 18 years, drip ; up to 12 years (safety and efficacy of norfloxacin in children and adolescents are not defined; it should be borne in mind that norfloxacin cause arthropathy in immature animals).
Restrictions on the use
Cerebral arteriosclerosis, stroke, epilepsy and convulsions, myastenia gravis, renal / hepatic failure.
Application of pregnancy and breastfeeding
When pregnancy is possible if the expected effect of therapy for the mother outweighs the potential risk to the fetus (adequate and well-controlled studies safety of norfloxacin in pregnant women is not carried out, including for local application in the form of droplets).
Category effects on the fetus by FDA ; C.
It is not known whether norfloxacin penetrates into milk in lactating women. After receiving norfloxacin nursing mothers at low doses (200 mg) inside it was not detected in breast milk. Note, however, that other quinolone derivatives for systemic effects penetrate into breast milk and there is a potential risk of serious adverse reactions in children are breastfed. Nursing women should either stop breast-feeding or receiving norfloxacin (taking into account the importance of the drug to the mother), including: for local action in the form of droplets.
Side effects of substance norfloxacin
From the digestive tract: loss of appetite, nausea, vomiting, bitter taste in the mouth (including after instillation into the eyes), abdominal pain, diarrhea, increase in liver transaminases, alkaline phosphatase. LDH; pseudomembranous colitis (with prolonged use).
With the genitourinary system: crystalluria, glomerulonephritis, dysuria, polyuria, albuminuria, hypercreatininemia, urethral bleeding.
From the nervous system and sensory organs: headache, dizziness, insomnia, hallucinations, fainting.
From the cardio – vascular system and blood (blood, hemostasis): tachycardia, irregular heartbeat, blood pressure reduction. vasculitis, leukopenia, eosinophilia, decreased hematocrit.
From the musculo – skeletal system: tendonitis, tendon rupture, arthralgia.
Allergic reactions: itching, hives, swelling, Stevens – Johnson.
When instillation in the eye : blurred vision, burning and pain in the eye, conjunctival hyperemia, chemosis, photophobia, allergic reactions.
Pharmacokinetic ; simultaneous intake of antacids containing aluminum hydroxide or magnesium hydroxide, PM. containing iron, zinc and sucralfate reduces the absorption of norfloxacin (the time interval between their appointment should be at least 2 – 4 hours). Cnizhaet clearance of theophylline by 25% (while the application should reduce the theophylline dose) increases the serum concentration of indirect anticoagulants, cyclosporine (mutually). Pharmacodynamic ; simultaneous administration with medicines that have the potential to reduce blood pressure. it can cause a sharp decline; in such cases, as well as simultaneous administration of barbiturates and other drugs for general anesthesia, the heart rate should be controlled. BP and ECG. The simultaneous use of drugs. lowering seizure threshold may lead to the development of epileptiform seizures. Reduces the effect of nitrofurans.
Symptoms (3 g per 45 min): dizziness, nausea, vomiting, drowsiness, cold sweat appearance (no change basic hemodynamic parameters), convulsions.
Treatment: gastric lavage, adequate hydration therapy with forced diuresis, symptomatic of the appointment. There is no specific antidote.
Dosing and Administration
inside . 400 mg 2 times a day. Course duration depends on indication for use, the severity of infection and pathogen activity: in uncomplicated infections of the urinary tract ; for 7 – 10 days for uncomplicated cystitis ; 3 – 7 days, chronic recurrent urinary tract infection ; up to 12 weeks. acute bacterial gastroenteritis ; 5 days. In acute uncomplicated gonococcal infections – 800 mg once.
Patients with impaired renal function if Cl creatinine less than 30 mL / min and in patients on hemodialysis, appoint half the therapeutic dose 2 times a day or a full dose of 1 times a day.
Local ; 1 – 2 drops in the affected eye or ear 4 times daily. Depending on the degree of infection dose on the first day can be 1 – 2 drops every 2 hours.
Precautions substance norfloxacin
Prolongation of QT / torsades de pointes interval. There are rare reports of the development of torsades de pointes during post-marketing studies in patients receiving quinolones, including norfloxacin. These rare cases are associated with the following factors: age over 60 years, female gender, prior heart disease and / or the use of combination therapy. Norfloxacin should not be used in patients with known prolongation of the QT interval. with uncorrectable hypokalemia, and patients receiving class IA antiarrhythmics (quinidine, procainamide), or class III (amiodarone, sotalol).
cramps. reported on the development of seizures in patients treated with norfloxacin. In patients treated with other drugs in this class, it was reported on the development of seizures, accompanied by increased intracranial pressure, and toxic psychosis. Quinolones may also cause central nervous system stimulation. resulting in tremor, anxiety, mild dizziness, confusion and hallucinations. When such reactions against the backdrop of norfloxacin should immediately stop the drug and conduct appropriate therapy.
The effect of norfloxacin on the functioning and the electrical activity of the brain has not been studied. Therefore caution should be exercised in patients with diagnosed or suspected CNS disorders (including cerebral arteriosclerosis, epilepsy, and other factors that predispose to the development of seizures) (see. “Restrictions on the use»).
Hypersensitivity / anaphylaxis. reported cases of serious hypersensitivity reactions (anaphylactic and anaphylactoid), when receiving the first dose of quinolones. In some cases, these reactions were accompanied by cardiac collapse, loss of consciousness, fainting, swelling of the throat or face, dyspnea, urticaria, itching; Only a few patients had a history of hypersensitivity reactions. In the case of allergic reactions to the drug norfloxacin should be abolished. With the development of severe acute hypersensitivity reactions require immediate administration of epinephrine and conducting related activities (oxygen / in the introduction of fluids, antihistamines drugs. Corticosteroids, and others.). Patients with hypersensitivity to norfloxacin systemic effects or to other quinolones may be sensitive to norfloxacin and local administration (in the form of droplets).
pseudomembranous colitis. It is important to take into account the possibility of pseudomembranous colitis, if the intake of antibacterial drugs in patients appear diarrhea. Treatment with antibacterial agents leads to a modification of the normal flora of the colon and can cause increased growth of Clostridia. Studies indicate that a toxin produced by the Clostridium difficile, is the root cause of “antibiotic – associated colitis.” If the diagnosis “pseudomembranous colitis” should start appropriate therapy.