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Drug Notebook

FDA Alerts

Special Alerts:

[Posted 07/08/2008] FDA notified healthcare professionals that a BOXED WARNING and Medication Guide are to be added to the prescribing information to strengthen existing warnings about the increased risk of developing tendinitis and tendon rupture in patients taking fluoroquinolones for systemic use.

Fluoroquinolones are associated with an increased risk of tendinitis and tendon rupture. This risk is further increased in those over age 60, in kidney, heart, and lung transplant recipients, and with use of concomitant steroid therapy. Physicians should advise patients, at the first sign of tendon pain, swelling, or inflammation, to stop taking the fluoroquinolone, to avoid exercise and use of the affected area, and to promptly contact their doctor about changing to a non-fluoroquinolone antimicrobial drug. Selection of a fluoroquinolone for the treatment or prevention of an infection should be limited to those conditions that are proven or strongly suspected to be caused by bacteria. For more information visit the FDA website at: http://www.fda.gov/medwatch/safety/2008/safety08.htm#Fluoroquinolone, http://www.fda.gov/cder/drug/infopage/fluoroquinolones/default.htm, http://www.fda.gov/cder/drug/InfoSheets/HCP/fluoroquinolonesHCP.htm and http://www.fda.gov/bbs/topics/NEWS/2008/NEW01858.html.

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norfloxacin
(nor FLOX a sin)

What is this medicine?
NORFLOXACIN (nor FLOX a sin) is a quinolone antibiotic. It is used to treat certain kinds of bacterial infections. It will not work for colds, flu, or other viral infections.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

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What is the price of this medication and similar alternatives?

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 09/2009. For the most current and up-to-date pricing information, please visit www.drugstore.com. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Noroxin 400MG Tablets MERCK HUMAN HEALTH20/$85.51 or 60/$235.15
Noroxin 400MG Tablets MERCK HUMAN HEALTH30/$126.12 or 90/$345.25

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What side effects may I notice from receiving this medicine?
Side effects that you should report to your doctor or health care professional as soon as possible:

  • allergic reactions like skin rash or hives, swelling of the face, lips, or tongue
  • breathing problems
  • changes in hearing
  • changes in vision
  • confusion, hallucinations, tremor
  • depression or suicidal thoughts
  • dizziness
  • fever, chills
  • irregular heartbeat, feeling faint
  • joint, muscle, tendon pain or swelling
  • redness, blistering, peeling or loosening of the skin, including inside the mouth
  • seizures
  • unusually weak or tired
  • unusual pain, numbness, tingling, or weakness
  • vaginal irritation, discharge

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

  • bitter taste
  • constipation, diarrhea
  • headache
  • loss of appetite
  • stomach upset, nausea
  • trouble sleeping

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

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How should I use this medicine?
Take this medicine by mouth with a full glass of water. Follow the directions on the prescription label. Take this medicine on an empty stomach, at least 1 hour before or 2 hours after a meal, milk and/or other dairy products. Do not take with food. Take your medicine at regular intervals. Do not take your medicine more often than directed. Take all of your medicine as directed even if you think your are better. Do not skip doses or stop your medicine early.

A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.


Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.

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What if I miss a dose?
If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

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What may interact with this medicine?
Do not take this medicine with any of the following medications:

  • cisapride
  • droperidol
  • pimozide
  • some medications for irregular heart rhythm

This medicine may also interact with the following medications:

  • antacids with aluminum, magnesium
  • caffeine
  • cyclosporine
  • didanosine buffered tablets or solution
  • digoxin
  • erythromycin
  • medicines for depression, anxiety, or psychotic disturbances
  • medicines for diabetes
  • nitrofurantoin
  • probenecid
  • some medicines for pain and swelling like ibuprofen, naproxen
  • sucralfate
  • theophylline
  • tizanidine
  • vitamins with iron or zinc
  • warfarin

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

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Who should NOT use this medication?

  • Hypersensitivity to norfloxacin or any quinolone.
  • History of tendinitis or tendon rupture with norfloxacin or any quinolone.

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What should I watch for while using this medicine?
Tell your doctor or health care professional if your symptoms do not improve or get worse. Make sure you stay well hydrated while taking this medicine. Drink several glasses of fluids a day.

If you are a diabetic monitor your blood sugar carefully. If your blood sugar reading is unusual, stop taking this medicine and call your doctor for advice.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medicine affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells.

This medicine can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.

Do not treat diarrhea with over-the-counter products. Contact your doctor if you have diarrhea that lasts more than 2 days or if the diarrhea is severe and watery.

Avoid taking didanosine, sucralfate, antacids, or iron or zinc products within 2 hours of taking this medicine.

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What should I tell my health care provider before I take this medicine?
They need to know if you have any of these conditions:

  • cerebral disease
  • glucose-6- phosphate dehydrogenase related disorder
  • history of tendon rupture
  • kidney disease
  • myasthenia gravis
  • seizure disorder
  • an unusual or allergic reaction to norfloxacin, other quinolone antibiotics, foods, dyes, or preservatives
  • pregnant or trying to get pregnant
  • breast-feeding

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Can I stop taking the medication if I feel better?
If you have been diagnosed with a disease for which an antibiotic is needed, you must complete the prescribed course of treatment. Even if you start to feel better, do not skip any doses and remember to take the medication until it is all gone.

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I am on so many medications; do I have to take them all?
This is called polypharmacy—many different medications being used at the same time by one person. Sometimes, being on multiple medications is acceptable and appropriate but at other times it may be problematic. If you are receiving your medications from multiple physicians you need to ensure that they all know what medications you are taking. The best way to do this is to make a list of all the medications you are currently using, including all nutritional supplements, homeopathic remedies, vitamins and over-the-counter drugs (if possible, also include all the diseases you have been diagnosed with). Give a copy to every doctor who takes care of you so they have it on file, this way they can avoid duplicating medications and perhaps even try to consolidate some. After every doctor's visit remember to update the list accordingly. Also, as much as you possibly can, try to use the same pharmacy to fill all your prescriptions, this way any potential drug interactions can be caught and averted.

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Where can I get more information?
More Information

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