Norfloxacin

The usual recommended adult dose is 400 mg twice daily, taken with a glass of water at least one hour before or 2 hours after a meal or milk. You should drink plenty of liquids (water or juice) every day unless your doctor has told you otherwise. Norfloxacin should not be taken within 2 hours of taking iron, zinc supplements, or multivitamins containing them. The dose of norfloxacin can vary depending on the circumstances and the condition being treated.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the one above, do not change the way that you are taking the medication without consulting your doctor.

It is important to take Norfloxacin exactly as prescribed by your doctor. Finish all Norfloxacin, even if you have started to feel better. If you miss a dose, take it as soon as possible and continue on with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue on with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Norfloxacin at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause headaches; it may cause dizziness - use caution when getting up from a lying or sitting position and use caution if driving; it may cause abdominal discomfort; it may cause nausea or, rarely, vomiting; it may make your skin more sensitive to UV rays (e.g., sunlight, tanning lamps) - avoid exposure to UV rays as much as possible and protect yourself when out in the sun. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

Each white, oval, biconvex, film-coated tablet, scored and engraved "APO 400" on one side and plain on the other, contains norfloxacin 400 mg. Nonmedicinal ingredients: crospovidone, magnesium stearate, colloidal silicon dioxide, hydroxypropyl cellulose, hydroxypropyl methylcellulose, polyethylene glycol, and titanium dioxide.

Do not take norfloxacin if you are allergic to norfloxacin, other quinolones (e.g., ciprofloxacin, nalidixic acid), or any other ingredients of the medication.

There may be an interaction between norfloxacin and any of the following:

• Alfuzosin
• Amiodarone
• antacids containing aluminum, calcium or magnesium (do not take within 2 hours of norfloxacin)
• antipsychotics (e.g., Chlorpromazine, Clozapine, Haloperidol, Olanzapine, Quetiapine, Risperidone)
• BCG
• caffeine
• calcium supplements and multivitamins containing calcium (do not take within 2 hours of norfloxacin)
• Cholera vaccine
• chloroquine
• corticosteroids (e.g., Dexamethasone, Hydrocortisone, Prednisone)
• Cyclosporine
• diabetes medications (e.g., chlorpropamide, glipizide, Glyburide, insulin, Metformin, Rosiglitazone)
• didanosine (do not take within 2 hours of norfloxacin)
• Disopyramide
• dofetilide
• Domperidone
• Dronedarone
• efavirenz
• Eplerenone
• Fentanyl
• Flecainide
• iron supplements, such as ferrous sulfate, or multivitamins containing iron (do not take within 2 hours of norfloxacin)
• Lanreotide
• Leuprolide
• lopinavir
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• magnesium supplements, such as magnesium sulfate, or multivitamins containing magnesium (do not take within 2 hours of norfloxacin)
• Methadone
• mifepristone
• multivitamins with minerals
• mycophenolate
• Nilotinib
• Nitrofurantoin
• nonsteroidal anti-inflammatory medications (e.g., Diclofenac, Ibuprofen, Ketoprofen, Naproxen)
• Octreotide
• Pasireotide
• Pazopanib
• Pimozide
• Porfimer
• Primaquine
• procainamide
• Quinapril
• quinidine
• quinine
• other quinolone antibiotics (e.g., ciprofloxacin, moifloxacin, sparfloxacin)
• saquinavir
• selective serotonin reuptake inhibitors (SSRIs; e.g., Citalopram, Fluoxetine, Paroxetine, Sertraline)
• serotonin antagonists (anti-emetic medications; e.g., Granisetron, Ondansetron)
• sevelamer
• sodium picosulfate
• somatostatin
• Sotalol
• Sucralfate (do not take within 2 hours of norfloxacin)
• sulfonamide antibiotics ('sulfas'; e.g., sulfisoxazole, sulfamethoxazole)
• Tetrabenazine
• theophyllines (e.g., Aminophylline, Oxtriphylline, Theophylline)
• Tizanidine
• Trazodone
• typhoid vaccine
• Varenicline
• Voriconazole
• Warfarin
• zinc supplements or multivitamins containing zinc (do not take within 2 hours of norfloxacin)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Norfloxacin. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Norfloxacin.

HEALTH CANADA ADVISORY

January 23, 2017

Health Canada has issued new restrictions concerning the use of norfloxacin. To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.

Bacterial resistance: Misuse of an antibiotic such as norfloxacin may lead to the growth of resistant bacteria that will not be killed by the antibiotic. If this happens, the antibiotic may not work for you in the future. Although you may begin to feel better early in your course of treatment with norfloxacin, you need to take the full course exactly as directed to finish ridding your body of the infection and to prevent resistant bacteria from taking hold. Do not take norfloxacin or other antibiotics to treat a viral infection such as The Common Cold; antibiotics do not kill viruses, and using them to treat viral infections can lead to the growth of resistant bacteria.

Blood sugar levels: Norfloxacin may cause a loss of control of blood sugar levels and glucose tolerance may change. People with Diabetes may find it necessary to monitor their blood sugar more frequently while using Norfloxacin. People without diabetes have also been known to experience high or low blood sugars while taking norfloxacin.

If you have diabetes or are at risk for developing diabetes, discuss with your doctor how Norfloxacin may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Norfloxacin, and whether any special monitoring is needed.

If you experience signs of high blood sugar (fruity breath odour, weight loss, increased thirst, or increased need to urinate) or low blood sugar (cold sweat, cool pale skin, headache, or weakness) contact your doctor.

Diarrhea: People taking Norfloxacin may develop diarrhea caused by an infection with the bacteria C. difficile. If you have loose, watery and bloody bowel movements, with or without fever or stomach cramps, after taking norfloxacin, get medical attention as soon as possible. Diarrhea caused by C. difficile infection can lead to serious health problems if it is not properly treated.

Kidney: Norfloxacin is passed from the body mostly by the kidney. If you have reduced kidney function, discuss with your doctor how Norfloxacin may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Norfloxacin, and whether any special monitoring is needed.

Neuromuscular disorders: Norfloxacin may cause increased muscle weakness for people with Myasthenia Gravis (an autoimmune disorder that causes muscle weakness). If you have myasthenia gravis, discuss with your doctor how Norfloxacin may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Norfloxacin, and whether any special monitoring is needed.

Nervous System Although rare, norfloxacin has been reported to cause problems with the nervous system, including nerve damage in the hands and feet, and changes in mental health. These side effects can occur while taking norfloxacin or after completing treatment with norfloxacin. If you experience tingling, numbness, weakness or other sensation changes while taking or after stopping Norfloxacin, contact your doctor as soon as possible. Other changes that should be reported to your doctor immediately, include agitation, hallucinations, confusion, depression or thoughts or suicide or self-harm.

Seizures: Rarely, seizures have been reported with Norfloxacin. If you have a history of Epilepsy or medical conditions that increase the risk of seizures, discuss with your doctor how Norfloxacin may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Norfloxacin, and whether any special monitoring is needed. If you have a seizure while taking Norfloxacin, stop taking it and get immediate medical attention.

Sunburn: People who take norfloxacin are more likely to suffer from sunburn. Avoid exposure to excessive sunlight, including sunlamps and tanning beds, and use sunblock with minimum SPF 15. Stop taking the medication if sun sensitivity occurs.

Tendons: Rarely, people taking norfloxacin have experienced tendonitis and/or tendon rupture, especially if they were also taking corticosteroids. This can happen at any time while taking norfloxacin or after finishing the medication. Tendonitis can continue for a lengthy period of time and be disabling. If you experience any joint or tendon pain or swelling, contact your doctor as soon as possible. If you have experienced this effect as a result of taking norfloxacin or another similar antibiotic in the past, norfloxacin should be avoided.

Pregnancy: Norfloxacin should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking Norfloxacin, contact your doctor immediately.

Breast-feeding: Norfloxacin may pass into breast milk. If you are a breast-feeding mother and are taking Norfloxacin, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using Norfloxacin have not been established for children less than 16 years of age.

This medication is typically used twice a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. Generally, a treatment with this medication lasts several days. Take it for the entire time prescribed in order to achieve the medication's full benefit. If you forget a dose, take it as soon as you remember -- unless it is almost time for your next dose. In that case, skip the missed dose. Do not double the next dose to catch up. This medication should not be taken with food. It is best taken on an empty stomach, one hour before or 2 hours after a meal. To ensure effectiveness, avoid taking milk, dairy products, antacids or calcium supplements for at least 6 hours before and 2 hours after this medication. Also avoid mineral supplements (iron, magnesium or zinc). It is recommended to drink plenty of water while using this medication.