If you need a painkiller it's fine to take paracetamol or co-codamol with Nofxan. However, don't take anti-inflammatories (NSAIDs) like aspirin, ibuprofen, diclofenac or naproxen unless these have been prescribed by your doctor.
How to take Nofxan
- Before you start taking the tablets, read the manufacturer's printed information leaflet from ins >
How to use Nofxan Tablet
Read the Medication Guide provided by your pharmacist before you start taking Nofxan and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
Take this medication by mouth as directed by your doctor, usually twice a day (every 12 hours) with a full glass of water (8 ounces/240 milliliters). Do not have any food or dairy products (such as milk/yogurt) within 2 hours before or 1 hour after taking Nofxan. Drink plenty of fluids while taking this drug unless your doctor tells you otherwise. The dosage and length of treatment are based on your medical condition and response to treatment.
Take this medication at least 2 hours before or 2 hours after taking other products that may make it work less well. Examples include quinapril, sucralfate, vitamins/minerals (including iron, zinc), and products that contain magnesium, aluminum, or calcium (such as antacids, didanosine solution, calcium-enriched juice), among others. Ask your pharmacist about all the products you take.
Avoid taking large amounts caffeine (such as coffee, energy drinks) since this drug may increase and/or make the effects of caffeine last longer.
For the best effect, take this antibiotic at evenly spaced times. To help you remember, take this medication at the same times every day.
Continue to take this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.
Tell your doctor if your condition lasts or gets worse.
Nofxan is usually taken every 12 hours. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.
Take this medicine with a full glass of water (8 ounces). Drink several extra glasses of fluid each day while you are taking Nofxan.
Take Nofxan on an empty stomach 1 hour before or 2 hours after eating a meal, drinking milk, or eating a dairy product such as yogurt.
Use this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Nofxan will not treat a viral infection such as the common cold or flu.
If you are being treated for gonorrhea, your doctor may also have you tested for syphilis, another sexually transmitted disease.
Do not share this medication with another person (especially a child), even if they have the same symptoms you have.
Store at room temperature away from moisture and heat.
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
Nofxan , a poorly absorbed fluoroquinolone, has been used to achieve selective intestinal decontamination in cirrhotic patients; Nofxan has several characteristics that make it suitable for prophylaxis: ▪
Poor absorption when taken orally
Effectiveness against enteric gram-negative organisms
Sparing of gram-positive and anaerobic organisms to maintain their protective role in the normal gut flora
Nofxan reduces the incidence of SBP, delays progression to hepatorenal syndrome, and improves overall survival (see Table 11.8 ).
In patients who have survived an episode of SBP: ▪
Recurrence can be as high as 68% at 1 year without antibiotic prophylaxis.
Nofxan, 400 mg orally daily, has been shown to decrease the probability of recurrent SBP to 20% at 1 year.
Nofxan prophylaxis is cost effective in reducing recurrent SBP.
However, Nofxan treatment does not alter the overall mortality in these patients.
In patients with cirrhosis and gastrointestinal hemorrhage: ▪
The incidence of SBP can be as high as 45% to 66% at 1 year without antibiotic prophylaxis.
Antibiotic prophylaxis started immediately and continued for 7 days decreases the incidence of SBP to 10% to 20%.
Antibiotic prophylaxis may improve survival in these patients.
Intravenous ceftriaxone has been shown to be more effective than oral Nofxan for SBP prophylaxis in patients with advanced cirrhosis and gastrointestinal hemorrhage.
In hospitalized patients with ascitic flu > ▪
The overall probability of new-onset SBP is 20% in 1 year.
Prophylaxis with Nofxan 400 mg orally daily decreases in-hospital incidence of SBP from 22% to 0% without an effect on in-hospital mortality.
Trimethoprim–sulfamethoxazole, one double-strength tablet orally daily, has also been reported to be effective in preventing SBP.
Quinolones, including NOROXIN, have been shown in vitro to inhibit CYP1A2. Concomitant use with drugs metabolized by CYP1A2 (e.g., caffeine, clozapine, ropinirole, tacrine, theophylline, tizanidine) may result in increased substrate drug concentrations when given in usual doses. Patients taking any of these drugs concomitantly with Nofxan should be carefully monitored.
Elevated plasma levels of theophylline have been reported with concomitant quinolone use. There have been reports of theophylline-related side effects in patients on concomitant therapy with Nofxan and theophylline. Therefore, monitoring of theophylline plasma levels should be considered and dosage of theophylline adjusted as required.
Elevated serum levels of cyclosporine have been reported with concomitant use of cyclosporine with NOROXIN. Therefore, cyclosporine serum levels should be monitored and appropriate cyclosporine dosage adjustments made when these drugs are used concomitantly.
Quinolones, including NOROXIN, may enhance the effects of oral anticoagulants, including warfarin or its derivatives or similar agents. When these products are administered concomitantly, prothrombin time or other suitable coagulation tests should be closely monitored.
The concomitant administration of quinolones including NOROXIN with glyburide (a sulfonylurea agent) has, on rare occasions, resulted in severe hypoglycemia. Therefore, monitoring of blood glucose is recommended when these agents are co-administered.
Diminished urinary excretion of NOROXIN has been reported during the concomitant administration of probenecid and NOROXIN.
The concomitant use of nitrofurantoin is not recommended since nitrofurantoin may antagonize the antibacterial effect of NOROXIN in the urinary tract.
Multivitamins, or other products containing iron or zinc, antacids or sucralfate, should not be administered concomitantly with, or within 2 hours of, the administration of NOROXIN, because they may interfere with absorption resulting in lower serum and urine levels of NOROXIN.
Videx® (Didanosine) chewable/buffered tablets or the pediatric powder for oral solution should not be administered concomitantly with, or within 2 hours of, the administration of NOROXIN, because these products may interfere with absorption resulting in lower serum and urine levels of NOROXIN.
Some quinolones have also been shown to interfere with the metabolism of caffeine. This may lead to reduced clearance of caffeine and a prolongation of the plasma half-life that may lead to accumulation of caffeine in plasma when products containing caffeine are consumed while taking NOROXIN.
The concomitant administration of a non-steroidal anti-inflammatory drug (NSAID) with a quinolone, including NOROXIN, may increase the risk of CNS stimulation and convulsive seizures. Therefore, NOROXIN should be used with caution in individuals receiving NSAIDS concomitantly.
Nofxan has not been shown to be effective in the treatment of syphilis. Antimicrobial agents used in high doses for short periods of time to treat gonorrhea may mask or delay the symptoms of incubating syphilis. All patients with gonorrhea should have a serologic test for syphilis at the time of diagnosis. Patients treated with Nofxan should have a follow-up serologic test for syphilis after three months.
You may be taking certain other medicines that should not be taken at the same time as Nofxan. Avoid taking the following medicines within 2 hours before or after you take Nofxan. These other medicines can make Nofxan much less effective when taken at the same time:
- antacids that contain magnesium or aluminum (such as Maalox, Mylanta, or Rolaids), or the ulcer medicine sucralfate (Carafate);
- didanosine (Videx) powder or chewable tablets;
- vitamin or mineral supplements that contain iron or zinc.
Do not take Nofxan with dairy products such as milk or yogurt. They could make the medication less effective.
Avoid caffeine while you are taking Nofxan, because the medication can make the effects of caffeine stronger.
Avoid exposure to sunlight or tanning beds. Nofxan can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Call your doctor if you have severe burning, redness, itching, rash, or swelling after being in the sun.
Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking Nofxan and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.
Nofxan may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Tell your doctor about all medicines you use, and those you start or stop using during your treatment with Nofxan, especially:
- cisapride, cyclosporine, erythromycin, nitrofurantoin, probenecid, ropinirole, tacrine, theophylline, tizanidine;
- a diuretic or "water pill";
- heart rhythm medication--amiodarone, disopyramide, dofetilide, dronedarone, procainamide, quinidine, sotalol, and others;
- medicine to treat depression or mental illness--amitriptylline, clomipramine, clozapine, desipramine, duloxetine, iloperidone, imipramine, nortriptyline, thioridazine, ziprasidone, and others; or
- NSAIDs (nonsteroidal anti-inflammatory drugs)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.
This list is not complete. Other drugs may interact with Nofxan, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
Needle-shaped crystals were found in the urine of some volunteers who received either placebo, 800 mg Nofxan, or 1600 mg Nofxan (at or twice the recommended daily dose, respectively) while participating in a double-blind, crossover study comparing single doses of Nofxan with placebo. While crystalluria is not expected to occur under usual conditions with a dosage regimen of 400 mg b.i.d., as a precaution, the daily recommended dosage should not be exceeded and the patient should drink sufficient fluids to ensure a proper state of hydration and adequate urinary output.
Alteration in dosage regimen is necessary for patients with impaired renal function (see DOSAGE AND ADMINISTRATION).
Moderate to severe photosensitivity/phototoxicity reactions, the latter of which may manifest as exaggerated sunburn reactions (e.g., burning, erythema, exudation, vesicles, blistering, edema) involving areas exposed to light (typically the face, “V” area of the neck, extensor surfaces of the forearms, dorsa of the hands), can be associated with the use of quinolone antibiotics after sun or UV light exposure.
Therefore, excessive exposure to these sources of light should be avoided. Drug therapy should be discontinued if phototoxicity occurs (see ADVERSE REACTIONS, Post-Marketing).
Rarely, hemolytic reactions have been reported in patients with latent or actual defects in glucose-6phosphate dehydrogenase activity who take quinolone antibacterial agents, including Nofxan (see ADVERSE REACTIONS).
Prescribing NOROXIN in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.
- Tendon Rupture and tendinopathy
Like other FQs Nofxan can lead to an enhanced chance of inflammation and rupture of the tendons. The risk increases in elderly persons, patients taking steroids and persons with kidney or liver dysfunction.
- Central Nervous System Effects
Nofxan like other FQs can lead to seizures, increased intracranial pressure tremors, hallucinations, restlessness, anxious behaviour, confusion, depressive state, vivid dreams, and decreased sleep.
- Clostridium difficile-Associated enterocolitis
Clostridium difficile-associated enterocolitis can be seen with Nofxan like other antibiotics.
Rarely large or small sized neurons may be affected by polyneuropathy due to Nofxan leading to altered sensations.
- Rarely, haemolytic reactions can occur in glucose-6-phosphate dehydrogenase deficient patients receiving quinolones including Nofxan.
DOSAGE AND ADMINISTRATION
Tablets NOROXIN should be taken at least one hour before or at least two hours after a meal or ingestion of milk and/or other dairy products. Multivitamins, other products containing iron or zinc, antacids containing magnesium and aluminum, sucralfate, or Videx® (Didanosine), chewable/buffered tablets or the pediatric powder for oral solution, should not be taken within 2 hours of administration of Nofxan. Tablets NOROXIN should be taken with a glass of water. Patients receiving NOROXIN should be well hydrated (see PRECAUTIONS).
Which drugs or supplements interact with Nofxan?
: Nofxan should be used with caution with medications like caffeine, clozapine (Clozaril), ropinorole (Requip), cyclosporine (Neoral, Sandimmune, Gengraf), theophylline (Theo-24), and tizanidine (Zanaflex) because Nofxan can slow down breakdown of these medications in and increase their levels in the body.
Nofxan should be separated from aluminum and magnesium containing antacids, sucralfate (Carafate), and multivitamins because they can lower absorption of Nofxan and reduce its effectiveness. They should be administered 2 hours before Nofxan.
Nofxan should be used with caution with warfarin (Coumadin) because Nofxan can increase the risks of bleeding and bruising.
Nofxan should be used with caution with medications used for treating abnormal heart beats because it can affect heart rhythm.
What is the most important information I should know about Nofxan?
You should not use this medication if you have ever had swelling or tearing of a tendon caused by taking Nofxan or similar antibiotics.
You may not be able to use Nofxan if you have a muscle disorder. Tell your doctor if you have a history of myasthenia gravis.
Nofxan may cause swelling or tearing of a tendon (the fiber that connects bones to muscles in the body), especially in the Achilles' tendon of the heel. This effect may be more likely to occur if you are over 60, if you take steroid medication, or if you have had a kidney, heart, or lung transplant.
Stop taking Nofxan and call your doctor at once if you have sudden pain, swelling, bruising, tenderness, stiffness, or movement problems in any of your joints. Rest the joint until you receive medical care or instructions.
What do I need to tell my doctor BEFORE I take this drug?
For all patients taking this drug:
- If you have an allergy to Nofxan or any other part of this drug.
- If you are allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had.
- If you have any of these health problems: Long QT on ECG, low magnesium levels, or low potassium levels.
- If you have ever had any of these health problems: Nerve problems or tendon problems.
- If you have had tendons get irritated or torn when taking this drug or an alike drug in the past.
- If you are not able to pass urine.
- If you are taking probenecid.
- If you have been taking any drugs to treat a heartbeat that is not normal.
- If you are taking any drugs that can cause a certain type of heartbeat that is not normal (prolonged QT interval). There are many drugs that can do this. Ask your doctor or pharmacist if you are not sure.
- If the patient is a child. This drug is not approved for use in children.
This is not a list of all drugs or health problems that interact with this drug.
Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.