Pharmacy Services

Fluoroquinolones Boxed Warning

March 23, 2011

The manufacturers of all fluoroquinolones, including ciprofloxacin, gemifloxacin, levofloxacin, moxifloxacin, norfloxacin, and ofloxacin, revised boxed warnings to include information related to myasthenia gravis. The fluoroquinolones may exacerbate muscle weakness in patients with myasthenia gravis. Postmarketing reports involving death have been reported in these patients. Avoid use of fluoroquinolones in patients with a known history of myasthenia gravis. Additional information about these changes can be found in the product prescribing information. The prescribing information links to some products are included below (although the same black box revision can be found in all fluoroquinolone products).

Avelox (moxifloxacin):
http://www.merck.com/product/usa/pi_circulars/a/avelox/avelox_pi.pdf

Cipro (ciprofloxacin):
http://www.merck.com/product/usa/pi_circulars/c/cipro/ciproIV_pi.pdf
http://www.merck.com/product/usa/pi_circulars/c/cipro/cipro_pi.pdf
http://www.merck.com/product/usa/pi_circulars/c/cipro/ciproXR_pi.pdf

Factive (gemifloxacin):
http://crtx.com/docs/Factive_PI.pdf

Levaquin (levofloxacin):
http://www.levaquin.com/sites/default/files/pdf/levaquin.pdf

Noroxin (norfloxacin):
http://www.merck.com/product/usa/pi_circulars/n/noroxin/noroxin_pi.pdf

Updated
March 23, 2011; University of Utah, Drug Information Service. Copyright 2011, Drug Information Service, University of Utah, Salt Lake City, UT.