Names and pronunciation
(gem-ah-flox′a-sin)
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Drug reference
(gem-ah-flox′a-sin)
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Func. class.: Antibiotic
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Chem. class.: Fluoroquinolone
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ACTION: Inhibits DNA gyrase, which is an enzyme involved in replication, tran- scription, and repair of bacterial DNA
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USES: Acute bacterial exacerbation of chronic bronchitis caused by Strepto- coccus pneumoniae, Haemophilus influenzae, Haemophilus parainfluen- zae, Moraxella catarrhalis; community- acquired pneumonia caused by Strepto- coccus pneumoniae including multiproduct-resistant strains, H. influ- enzae, M. catarrhalis, Mycoplasma pneumoniae, Chlamydia pneumoniae, Klebsiella pneumoniae
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CONTRAINDICATIONS: Hyper- sensitivity to quinolones Precautions: Pregnancy, breastfeeding, children, geriatric patients, hypokalemia, hypomagnesemia, renal disease, seizure disorders, excessive exposure to sun- light, psychosis, increased intracranial pressure, history of QT interval prolonga- tion, dysrhythmias, myasthenia gravis, torsades de pointes
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Black Box Warning: Tendon pain/rupture, tendinitis, myasthenia gravis, neurotoxicity Black Box Warning: Increase: tendon rupture—corticosteroids • Increase: QT prolongation—class IA, III antidysrhythmics, tricyclics, amoxapine, maprotiline, phenothiazines, haloperidol, pimozide, risperiDONE, sertindole, ziprasi- done, β-blockers, chloroquine, cloZAPine, dasatinib, dolasetron, droperidol, drone- darone, flecainide, halogenated/local anesthetics, local anesthetics, lapatinib, methadone, erythromycin, telithromycin, troleandomycin, octreotide, ondansetron, palonosetron, pentamidine, propafenone, ranolazine, SUNItinib, tacrolimus, varden afil, vorinostat Decrease: absorption antacids containing aluminum, magnesium, sucralfate, zinc, iron; give 2 hr before or 3 hr after meals Drug/Lab Test Increase: LFTs, bilirubin, creatinine, BUN, GGT, potassium Decrease: sodium, albumin Interference: calcium, Hb, Hct, neutro- phils, RBCs Black Box Warning: Tendon rupture: tendon pain, inflammation; if present, dis- continue use; more common when used with corticosteroids; discontinue imme- diately if tendon pain, inflammation occur • Toxic psychosis/pseudotumor cere- bri: headache, blurred vision, neck/shoul- der pain, nausea, vomiting, dizziness, tinnitus; discontinue immediately; may occur within hours to weeks after starting product • Pregnancy/breastfeeding: Use only if benefits outweigh fetal/infant risk
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SIDE EFFECTS CNS: Dizziness, headache, somnolence GI: Diarrhea, nausea, vomiting, anorexia, flatulence, abdominal pain, CDAD INTEG: Rash, photosensitivity
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INTERACTIONS Increase: CNS stimulation—NSAIDs Increase: toxicity of gemifloxacin— probenecid
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DOSAGE AND ROUTES Adult: PO 320 mg/day × 5-7 days Renal dose/hemodialysis • Adult: PO CCr ≤40 mL/min, 160 mg q24hr
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Available forms: Tabs 320 mg
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Administer: • 2 hr before or 3 hr after aluminum/ magnesium antacids, iron, zinc products, multivitamins, buffered products • Without regard to food • Provide adequate hydration • Use recommended dose to prevent QTc prolongation
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Assess: • Renal, hepatic studies: BUN, creatinine, AST, ALT; I&O ratio, electrolytes • CNS symptoms: insomnia, vertigo, headache, agitation, confusion • Allergic reactions and anaphylaxis: rash, flushing, urticaria, pruritus, chills, fever, joint pain; may occur a few days G after therapy begins; EPINEPHrine and resuscitation equipment should be avail- able for anaphylactic reaction • CDAD: bowel pattern daily; if severe diarrhea, fever, abdominal pain occur, product should be discontinued • QT prolongation: avoid use of quinolones in patients with known QT prolongation; fe- males and those with ongoing proarrhyth- mic conditions (TdP) are at a greater risk; monitor ECG and/or Holter monitoring if product is used • Overgrowth of infection: Perineal itch- ing, fever, malaise, redness, pain, swell- ing, drainage, rash, diarrhea, change in cough, sputum
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Evaluate: • Therapeutic response: negative C&S, absence of signs, symptoms of infection
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To take with/without food • That fluids must be increased to 2 L/ day to avoid crystallization in kidneys • That if dizziness or light-headedness occurs, to perform activities with assistance • To complete full course of product therapy • To avoid iron- or mineral-containing supplements or aluminum/magnesium ant- acids, buffered products within 2 hr before and 3 hr after dosing, 2 hr before sucralfate • That photosensitivity may occur and sunscreen should be used • To avoid other medication unless ap- proved by prescriber • To immediately report pain, inflammation in tendons, weakness, tingling in extremities, signs of aortic aneurysm, hypersensitivity • To report rash, and stop product if it occurs • To monitor blood glucose more often, blood glucose levels are affected
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PHARMACOKINETICS Rapidly absorbed; bioavailability 71%; peak ½-2 hr; half-life 4-12 hr; excreted in urine as active product, metabolites
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• Adult: PO CCr ≤40 mL/min, 160 mg q24hr
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