Norfloxacin (United States: Not available): Drug information

For additional information see "Norfloxacin (United States: Not available): Patient drug information"

For abbreviations, symbols, and age group definitions show table

Brand Names: Canada

ALTI-Norfloxacin;
APO-Norfloxacin

Pharmacologic Category

Antibiotic, Fluoroquinolone

Dosing: Adult

Gonorrhea, uncomplicated

Gonorrhea, uncomplicated: Oral: 800 mg as a single dose. Note: Norfloxacin is not a preferred therapy for gonorrhea due to resistance (Ref).

Spontaneous bacterial peritonitis, prophylaxis

Spontaneous bacterial peritonitis, prophylaxis (off-label use):

Note: For secondary prophylaxis in patients with prior spontaneous bacterial peritonitis (SBP) and primary prophylaxis in patients at high risk for SBP (eg, low ascites protein [<1.5 g/dL] with advanced liver failure or impaired kidney function). Some experts also use for prophylaxis during hospitalization in patients with cirrhosis and either acute GI bleeding or ascites protein <1 g/dL (Ref).

Oral: 400 mg once daily (Ref). For patients with cirrhosis and acute GI bleeding, some experts use 400 mg twice daily following, or as an alternative to parenteral prophylaxis, for a total antibiotic duration of 7 days (Ref).

Urinary tract infection

Urinary tract infection:

Cystitis, acute uncomplicated or acute simple cystitis (infection limited to the bladder without signs/symptoms of upper tract, prostate, or systemic infection) (alternative agent):

Note: Use is discouraged due to safety concerns and increasing resistance; reserve for those who have no alternative treatment options (Ref). However, for men who have severe symptoms or there is concern for early prostate involvement, some experts prefer fluoroquinolones (Ref).

Oral: 400 mg twice daily for 3 days (females) or 5 days (males) (Ref).

Urinary tract infection, complicated (including pyelonephritis):

Note: If the prevalence of fluoroquinolone resistance is >10%, an initial dose of a long-acting parenteral antimicrobial (eg, ceftriaxone) followed by oral therapy is recommended for outpatients (Ref).

Oral: 400 mg twice daily for 5 to 7 days (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

eGFR ≥30 mL/minute/1.73 m²: No dosage adjustment necessary.

eGFR ≤30 mL/minute/1.73 m²: 400 mg once daily.

Dosing: Liver Impairment: Adult

No dosage adjustment provided in manufacturer’s labeling.

Dosing: Older Adult

Refer to adult dosing.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

1% to 10%:

Gastrointestinal: Nausea (2%)

Nervous system: Dizziness (1%), headache (2%)

<1%:

Dermatologic: Erythema of skin, pruritus, skin rash, urticaria

Endocrine & metabolic: Increased lactate dehydrogenase

Gastrointestinal: Abdominal pain, anorexia, diarrhea, dyspepsia, flatulence, heartburn, vomiting

Genitourinary: Proteinuria

Hematologic and oncologic: Decreased hematocrit, eosinophilia, leukopenia, neutropenia

Hepatic: Increased serum alanine aminotransferase, increased serum alkaline phosphatase, increased serum aspartate aminotransferase, increased serum bilirubin

Nervous system: Abnormal dreams, anxiety, depression, disorientation, drowsiness, euphoria, hallucination, insomnia, irritability, mood changes, nervousness, paresthesia, personality disorder

Neuromuscular & skeletal: Arthralgia, tendinopathy

Ophthalmic: Epiphora, visual disturbance

Renal: Increased blood urea nitrogen, increased serum creatinine

Frequency not defined:

Endocrine & metabolic: Hyperglycemia, hypoglycemia

Nervous system: Agitation, delirium, disturbance in attention, idiopathic intracranial hypertension, increased intracranial pressure, memory impairment, nightmares, paranoid ideation, peripheral neuropathy, restlessness, suicidal ideation, suicidal tendencies, toxic psychosis

Neuromuscular & skeletal: Rupture of tendon, tremor

Postmarketing:

Cardiovascular: Vasculitis

Dermatologic: Erythema multiforme, exfoliative dermatitis, localized erythema (periorbital), skin photosensitivity, Stevens-Johnson syndrome, toxic epidermal necrolysis

Gastrointestinal: Clostridioides difficile colitis, constipation, pancreatitis (rare), xerostomia

Genitourinary: Vulvovaginal candidiasis

Hematologic & oncologic: Hemolytic anemia (sometimes associated with G6PD deficiency), hemophthalmos, thrombocytopenia

Hepatic: Hepatitis, hepatotoxicity (idiosyncratic) (Chalasani 2014)

Hypersensitivity: Anaphylaxis, angioedema

Nervous system: Ataxia, confusion, dysarthria, dysphasia, fatigue, Guillain-Barré syndrome, hypertonia, polyneuropathy, psychotic reaction, seizure

Neuromuscular & skeletal: Arthritis, asthenia, myalgia

Ophthalmic: Conjunctivitis, eye irritation, eye pain, nystagmus disorder

Otic: Hearing loss (transient), tinnitus

Renal: Interstitial nephritis, renal failure syndrome

Respiratory: Dyspnea

Miscellaneous: Fever

Contraindications

Hypersensitivity to norfloxacin, quinolones, or any component of the formulation.

Warnings/Precautions

Concerns related to adverse effects:

• Altered cardiac conduction: Fluoroquinolones may prolong QTc interval; avoid use in patients with a history of QTc prolongation, uncorrected hypokalemia, hypomagnesemia, or concurrent administration of other medications known to prolong the QT interval (including Class Ia and Class III antiarrhythmics, cisapride, erythromycin, antipsychotics, and tricyclic antidepressants).

• Aortic aneurysm and dissection: Fluoroquinolones have been associated with aortic aneurysm ruptures or dissection within 2 months following use, particularly in elderly patients. Fluoroquinolones should not be used in patients with a known history of aortic aneurysm or those at increased risk, including patients with peripheral atherosclerotic vascular diseases, hypertension, genetic disorders involving blood vessel changes (eg, Marfan syndrome, Ehlers-Danlos syndrome), and elderly patients, unless no other treatment options are available. Longer treatment duration (eg, >14 days) may increase risk (Lee 2018).

• Glucose regulation: Fluoroquinolones have been associated with the development of serious, and sometimes fatal, hypoglycemia. These events have occurred most often in elderly patients with diabetes, but have also been reported in patients without a prior history of diabetes. Prompt identification and treatment of hypoglycemia is essential. Individual quinolones may differ in their potential to cause this effect. It was most evident with gatifloxacin (no longer marketed as s systemic formulation). Hyperglycemia has also been associated with the use of fluoroquinolones. Patients should be monitored closely for signs/symptoms of disordered glucose regulation.

• Hypersensitivity reactions: Severe hypersensitivity reactions, including anaphylaxis, have occurred with quinolone therapy. The spectrum of these reactions can vary widely; reactions may present as typical allergic symptoms (eg, itching, urticaria, rash, edema) after a single dose, or may manifest as severe idiosyncratic dermatologic (eg, Stevens-Johnson, toxic epidermal necrolysis), vascular (eg, vasculitis), pulmonary (eg, pneumonitis), renal (eg, nephritis), hepatic (eg, hepatic failure or necrosis), and/or hematologic (eg, anemia, cytopenias) events, usually after multiple doses. Prompt discontinuation of drug should occur if skin rash or other symptoms arise.

• Phototoxicity: Avoid excessive sunlight and take precautions to limit exposure (eg, loose fitting clothing, sunscreen); may cause moderate-to-severe phototoxicity reactions. Discontinue use if photosensitivity occurs.

• Serious adverse reactions: [Canadian Boxed Warning]: Fluoroquinolones are associated with disabling and potentially irreversible serious adverse reactions that may occur together, including tendinitis and tendon rupture, peripheral neuropathy, and CNS effects. Discontinue norfloxacin immediately and avoid use of fluoroquinolones in patients who experience any of these serious adverse reactions. Patients of any age or without pre-existing risk factors have experienced these reactions; may occur within hours to weeks after initiation.

- CNS effects: Fluoroquinolones have been associated with an increased risk of CNS effects including seizures, increased intracranial pressure (including pseudotumor cerebri), and toxic psychosis; may also cause nervousness, agitation, insomnia, anxiety, nightmares, paranoia, dizziness, confusion, tremors, hallucinations, depression, and suicidal thoughts or actions. May occur following the first dose; discontinue immediately and avoid further use of fluoroquinolones in patients who experience these reactions. Use with caution in patients with known or suspected CNS disorder, or risk factors that may predispose to seizures or lower the seizure threshold.

- Peripheral neuropathy: Fluoroquinolones have been associated with an increased risk of peripheral neuropathy; may occur soon after initiation of therapy and may be irreversible; discontinue if symptoms of sensory or sensorimotor neuropathy occur. Avoid use in patients who have previously experienced peripheral neuropathy.

- Tendinitis/tendon rupture: Fluoroquinolones have been associated with an increased risk of tendonitis and tendon rupture in all ages; risk may be increased with concurrent corticosteroids, solid organ transplant recipients, and in patients >60 years of age, but has also occurred in patients without these risk factors. Rupture of the Achilles tendon has been reported most frequently; but other tendon sites (eg, rotator cuff, biceps, hand) have also been reported. Inflammation and rupture may occur bilaterally. Cases have been reported within hours or days of initiation, and up to several months after discontinuation of therapy. Strenuous physical activity, renal failure, and previous tendon disorders may be independent risk factor for tendon rupture. Discontinue at first sign of tendon pain, swelling, inflammation or rupture. Avoid use in patients with a history of tendon disorders or who have experienced tendinitis or tendon rupture.

• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.

Disease-related concerns:

• Myasthenia gravis: May exacerbate muscle weakness related to myasthenia gravis; avoid use in patients with known history of myasthenia gravis. Cases of severe exacerbations, including the need for ventilatory support and deaths, have been reported.

• Renal impairment: Use caution with renal impairment; dose adjustment required. May increase risk of tendon rupture.

• Rheumatoid arthritis: Use with caution in patients with rheumatoid arthritis; may increase risk of tendon rupture.

• Syphilis: Since norfloxacin is ineffective in the treatment of syphilis and may mask symptoms, all patients should be tested for syphilis at the time of gonorrheal diagnosis and 3 months later.

Special populations:

• Older adult: Adverse effects (eg, tendon rupture, QT changes) may be increased in the elderly.

• G6PD deficiency: Hemolytic reactions may (rarely) occur with fluoroquinolone use in patients with G6PD deficiency (Luzzatto 2020).

• Pediatric: Safety and efficacy have not been established in children; other quinolones have caused transient arthropathy in children.

Product Availability

Not available in the United States.

Generic Equivalent Available: US

Yes

Pricing: US

Tablets (Noroxin Oral)

400 mg (20): $96.80

Disclaimer: The pricing data provide a representative AWP and/or AAWP price from a single manufacturer of the brand and/or generic product, respectively. The pricing data should be used for benchmarking purposes only, and as such should not be used to set or adjudicate any prices for reimbursement or purchasing functions. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Generic: 400 mg

Administration: Adult

Oral: Hold antacids, sucralfate, or multivitamins/supplements containing iron, zinc, magnesium, or aluminum for at least 2 hours before or after giving norfloxacin; do not administer together. Administer on an empty stomach with water (at least 1 hour before or 2 hours after meals, milk, or other dairy products).

Enteral feeding tube:

The following recommendations are based upon the best available evidence and clinical expertise. Senior editorial team: Joseph I. Boullata, PharmD, RPh, CNS-S, FASPEN, FACN; Peggi A. Guenter, PhD, RN, FASPEN; Kathleen Gura, PharmD, BCNSP, FASHP, FASPEN, FPPA, FMSHP; Mark G. Klang, MS, RPh, BCNSP, PhD, FASPEN; Linda Lord, NP, ACNP-BC, CNSC, FASPEN; Lucas E. Orth, PharmD, BCPPS; Russel J. Roberts, PharmD, BCCCP, FCCM.

Note: Avoid post-pyloric (eg, jejunal) administration; solubility is pH-dependent and absorption may be reduced if administered post-pylorically (Ref).

Oral tablet:

Gastric tubes (eg, NG, G-tube): Separate norfloxacin from enteral nutrition (EN). Crush tablet(s) into a fine powder and disperse in 15 to 30 mL purified water immediately prior to administration; draw up mixture into enteral dosing syringe (Ref).

Dosage form information: Some formulations may be film-coated; administration of film-coated norfloxacin tablets via feeding tube may increase the risk of clogging the tube; if used, ensure tablets are dispersed sufficiently with an adequate amount of purified water prior to administration (Ref).

General guidance: Hold EN for 1 to 2 hours prior to and 1 to 2 hours following norfloxacin administration (Ref). Flush feeding tube with an appropriate volume of purified water (eg, 15 mL) before administration (Ref). Following administration, rinse container used for preparation with purified water; draw up rinse and administer contents to ensure delivery of entire dose (Ref). Flush feeding tube with an appropriate volume of purified water (eg, 15 mL) and restart EN 1 to 2 hours after norfloxacin administration (Ref). The interruption of enteral feeding to allow for norfloxacin administration may impact patient nutrition; adjustment of feeding rates may be necessary to meet patient’s nutritional needs (Ref).

Note: Recommendations may not account for differences in inactive ingredients, osmolality, or other formulation properties that may vary among products from different manufacturers.

Use: Labeled Indications

Note: Not approved in the United States.

Uncomplicated and complicated urinary tract infections (UTIs) caused by susceptible gram-negative and gram-positive bacteria; sexually transmitted disease (eg, uncomplicated urethral and cervical gonorrhea) caused by N. gonorrhoeae.

Note: Norfloxacin is not a preferred therapy for gonorrhea due to resistance (CDC [Workowski 2021]; PHAC 2021).

Limitations of use: Because fluoroquinolones have been associated with disabling and potentially irreversible serious adverse reactions (eg, tendinitis and tendon rupture, peripheral neuropathy, CNS effects), reserve norfloxacin for use in patients who have no alternative treatment options for acute uncomplicated UTIs.

Use: Off-Label: Adult

Spontaneous bacterial peritonitis, prophylaxis

Medication Safety Issues

Sound-alike/look-alike issues:

Norfloxacin may be confused with Norflex, Noroxin [DSC]

Noroxin [DSC] may be confused with Neurontin, Norflex

Other safety concerns:

ALERT: Canadian Boxed Warning: Health Canada-approved labeling includes a boxed warning. See Warnings/Precautions section for a concise summary of this information. For verbatim wording of the boxed warning, consult the product labeling.

Metabolism/Transport Effects

Substrate of OAT1/3;

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Agents with Blood Glucose Lowering Effects: Quinolones may increase hypoglycemic effects of Agents with Blood Glucose Lowering Effects. Quinolones may decrease therapeutic effects of Agents with Blood Glucose Lowering Effects. Specifically, if an agent is being used to treat diabetes, loss of blood sugar control may occur with quinolone use. Risk C: Monitor

Aminolevulinic Acid (Systemic): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Systemic). Risk X: Avoid

Aminolevulinic Acid (Topical): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Topical). Risk C: Monitor

Amphetamines: May increase cardiotoxic effects of Quinolones. Risk C: Monitor

Antacids: May decrease absorption of Quinolones. Of concern only with oral administration of quinolones. Management: Avoid concurrent administration of quinolones and antacids to minimize the impact of this interaction. Recommendations for optimal dose separation vary by specific quinolone; see full monograph for details. Risk D: Consider Therapy Modification

Bacillus clausii: Antibiotics may decrease therapeutic effects of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider Therapy Modification

BCG (Intravesical): Antibiotics may decrease therapeutic effects of BCG (Intravesical). Risk X: Avoid

BCG Vaccine (Immunization): Antibiotics may decrease therapeutic effects of BCG Vaccine (Immunization). Risk C: Monitor

Caffeine and Caffeine Containing Products: Norfloxacin may increase serum concentration of Caffeine and Caffeine Containing Products. Risk C: Monitor

Calcium Salts: May decrease absorption of Quinolones. Of concern only with oral administration of both agents. Management: Consider administering an oral quinolone at least 2 hours before or 6 hours after the dose of oral calcium to minimize this interaction. Monitor for decreased therapeutic effects of quinolones during coadministration. Risk D: Consider Therapy Modification

Cholera Vaccine: Antibiotics may decrease therapeutic effects of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid

Corticosteroids (Systemic): May increase adverse/toxic effects of Quinolones. Specifically, the risk of tendonitis and tendon rupture may be increased. Risk C: Monitor

CycloSPORINE (Systemic): Norfloxacin may increase serum concentration of CycloSPORINE (Systemic). Risk C: Monitor

Delamanid: Quinolones may increase QTc-prolonging effects of Delamanid. Management: Avoid concomitant use if possible. If coadministration is unavoidable, frequent monitoring of electrocardiograms (ECGs) throughout the full delamanid treatment period should occur. Risk D: Consider Therapy Modification

Didanosine: Quinolones may decrease serum concentration of Didanosine. Didanosine may decrease serum concentration of Quinolones. Management: Administer oral quinolones at least 2 hours before or 6 hours after didanosine. Monitor for decreased therapeutic effects of quinolones, particularly if doses cannot be separated as recommended. This does not apply to unbuffered enteric coated didanosine. Risk D: Consider Therapy Modification

Fecal Microbiota (Live) (Oral): May decrease therapeutic effects of Antibiotics. Risk X: Avoid

Fecal Microbiota (Live) (Rectal): Antibiotics may decrease therapeutic effects of Fecal Microbiota (Live) (Rectal). Risk X: Avoid

Fexinidazole: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Management: Avoid use of fexinidazole with OAT1/3 substrates when possible. If combined, monitor for increased OAT1/3 substrate toxicities. Risk D: Consider Therapy Modification

Haloperidol: QT-prolonging Agents (Indeterminate Risk - Avoid) may increase QTc-prolonging effects of Haloperidol. Risk C: Monitor

Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may decrease therapeutic effects of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor

Iron Preparations: May decrease serum concentration of Quinolones. Management: Give oral quinolones at least several hours before (4 h for moxi- and sparfloxacin, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome-, 3 h for gemi-, and 2 h for enox-, levo-, nor-, oflox-, peflox, or nalidixic acid) oral iron. Risk D: Consider Therapy Modification

Lactobacillus and Estriol: Antibiotics may decrease therapeutic effects of Lactobacillus and Estriol. Risk C: Monitor

Lanthanum: May decrease serum concentration of Quinolones. Management: Administer oral quinolone antibiotics at least one hour before or four hours after lanthanum. Risk D: Consider Therapy Modification

Leflunomide: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor

Levoketoconazole: QT-prolonging Agents (Indeterminate Risk - Avoid) may increase QTc-prolonging effects of Levoketoconazole. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

Magnesium Salts: May decrease serum concentration of Quinolones. Management: Administer oral quinolones several hours before (4 h for moxi/pe/spar/enox-, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome/pe/enox-, 3 h for gemi-, and 2 h for levo-, nor-, or ofloxacin or nalidixic acid) oral magnesium salts. Risk D: Consider Therapy Modification

Methoxsalen (Systemic): Photosensitizing Agents may increase photosensitizing effects of Methoxsalen (Systemic). Risk C: Monitor

Methylphenidate: May increase cardiotoxic effects of Quinolones. Risk C: Monitor

Multivitamins/Minerals (with ADEK, Folate, Iron): May decrease serum concentration of Quinolones. Specifically, polyvalent cations in multivitamin products may decrease the absorption of orally administered quinolone antibiotics. Management: Administer oral quinolones at least 2 hours before, or 6 hours after, the dose of a multivitamin that contains polyvalent cations (ie, calcium, iron, magnesium, selenium, zinc). Monitor for decreased quinolone efficacy. Risk D: Consider Therapy Modification

Multivitamins/Minerals (with AE, No Iron): May decrease serum concentration of Quinolones. Specifically, minerals in the multivitamin/mineral product may impair absorption of quinolone antibiotics. Management: Administer oral quinolones at least 2 hours before, or 6 hours after, the dose of a multivitamin that contains polyvalent cations (ie, calcium, iron, magnesium, selenium, zinc). Monitor for decreased therapeutic effects of quinolones. Risk D: Consider Therapy Modification

Mycophenolate: Antibiotics may decrease active metabolite exposure of Mycophenolate. Specifically, concentrations of mycophenolic acid (MPA) may be reduced. Risk C: Monitor

Nadifloxacin: May increase adverse/toxic effects of Quinolones. Risk X: Avoid

Nitisinone: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor

Nitrofurantoin: May decrease therapeutic effects of Norfloxacin. Risk X: Avoid

Nonsteroidal Anti-Inflammatory Agents: May increase neuroexcitatory and/or seizure-potentiating effects of Quinolones. Nonsteroidal Anti-Inflammatory Agents may increase serum concentration of Quinolones. Risk C: Monitor

Polyethylene Glycol-Electrolyte Solution: May decrease absorption of Quinolones. Management: Give oral quinolones at least 2 hours before or at least 6 hours after polyethylene glycol-electrolyte solutions that contain magnesium sulfate (Suflave brand). Other products without magnesium do not require dose separation. Risk D: Consider Therapy Modification

Porfimer: Photosensitizing Agents may increase photosensitizing effects of Porfimer. Risk X: Avoid

Pretomanid: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor

Probenecid: May increase serum concentration of Quinolones. Probenecid may decrease excretion of Quinolones. Specifically, probenecid may decreased the renal excretion of quinolone antibiotics. Risk C: Monitor

QT-prolonging Agents (Highest Risk): QT-prolonging Agents (Indeterminate Risk - Avoid) may increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

Sodium Picosulfate: Antibiotics may decrease therapeutic effects of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider Therapy Modification

Strontium Ranelate: May decrease serum concentration of Quinolones. Management: In order to minimize any potential impact of strontium ranelate on quinolone antibiotic concentrations, it is recommended that strontium ranelate treatment be interrupted during quinolone therapy. Risk X: Avoid

Sucralfate: May decrease serum concentration of Quinolones. Management: Avoid concurrent administration of quinolones and sucralfate to minimize the impact of this interaction. Recommendations for optimal dose separation vary by specific quinolone. Risk D: Consider Therapy Modification

Taurursodiol: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk X: Avoid

Teriflunomide: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor

Theophylline Derivatives: Norfloxacin may increase serum concentration of Theophylline Derivatives. Risk C: Monitor

Typhoid Vaccine: Antibiotics may decrease therapeutic effects of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider Therapy Modification

Vaborbactam: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor

Vadadustat: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor

Verteporfin: Photosensitizing Agents may increase photosensitizing effects of Verteporfin. Risk C: Monitor

Vitamin K Antagonists: Quinolones may increase anticoagulant effects of Vitamin K Antagonists. Risk C: Monitor

Zinc Salts: May decrease serum concentration of Quinolones. Management: Give oral quinolones at several hours before (4 h for moxi- and sparfloxacin, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome-, 3 h for gemi-, and 2 h for enox-, levo-, nor-, pe- or ofloxacin or nalidixic acid) oral zinc salts. Risk D: Consider Therapy Modification

Food Interactions

Norfloxacin average peak serum concentrations may be decreased if taken with food or dairy products. Management: Administer on an empty stomach with water at least 1 hour before or 2 hours after meals, milk, or other dairy products.

Pregnancy Considerations

Norfloxacin crosses the placenta, distributing to cord blood and amniotic fluid (Wise 1984). Based on available data, an increased risk of teratogenic effects has not been observed following norfloxacin use during pregnancy (Bar-Oz 2009; Padberg 2014).

Breastfeeding Considerations

Norfloxacin was not detected in the milk of breastfeeding mothers administered an oral 200 mg dose. It is not known if concentrations would be detectable after a higher dose or multiple doses. Due to the potential for serious adverse reactions in the breastfeeding infant, the manufacturer recommends caution be used if administered to a breastfeeding patient.

Dietary Considerations

Oral formulations should be administered on an empty stomach with water (at least 1 hour before or 2 hours after meals, milk, or other dairy products). Maintain fluid intake to ensure adequate hydration and urinary output.

Monitoring Parameters

Monitor CBC, renal and hepatic function periodically if therapy is prolonged.

Mechanism of Action

Norfloxacin is a DNA gyrase inhibitor. DNA gyrase is an essential bacterial enzyme that maintains the superhelical structure of DNA. DNA gyrase is required for DNA replication and transcription, DNA repair, recombination, and transposition; bactericidal

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Oral: Rapid, up to 40%

Protein binding: 10% to 15%

Metabolism: Hepatic

Half-life elimination: 3 to 4 hours; Renal impairment (CrCl ≤30 mL/minute): 6.5 hours; Elderly: 4 hours

Time to peak, serum: 1 to 2 hours

Excretion: Urine (26% to 32% as unchanged drug; 5% to 8% as metabolites); feces (30%)

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AE) United Arab Emirates: Noracin | Noroxin | Spectrama | Urobacid | Uroxin;
(AR) Argentina: Actobian | Bio tarbun | Fada norfloxacina | Floxamicin | Floxatral | Frifloxacina | Memento nf | Nefronet | Norflol | Norfloxacina | Norfloxacina ahimsa | Norfloxacina craveri | Norfloxacina fabra | Norfloxacina klonal | Norfloxacina Lba | Norfloxacina northia | Norfloxacina vannier | Noroxin | Norsol | Parcetin | Ritromine | Uro-linfol | Urofos | Uronovag | Uroseptal | Urotem | Uroxacin | Wenflox;
(AT) Austria: Floxacin | Norfloxacin sandoz | Zoroxin;
(AU) Australia: Apo-norfloxacin | Cm norfloxacin | Insensye | Norflohexal | Norfloxacin an | Norfloxacin sandoz | Noroxin | Nufloxib | Roxin | Tw norfloxacin;
(BD) Bangladesh: Floxin;
(BE) Belgium: Docnorfloxa | Norfloxacin ratiopharm | Norfloxacine eg | Norfloxacine eurogenerics | Norfloxacine Sandoz | Norfloxacine teva generics belgium | Zoroxin;
(BF) Burkina Faso: Norfen | Norfloxacine tm | Norfloxine;
(BG) Bulgaria: Nolicin;
(BR) Brazil: Androfloxin | Flox | Floxacin | Floxamox | Floxatom | Floxatrat | Floxilin | Floximed | Floxin | Floxinol | Genosept | Neofloxin | Noracin | Norf | Norflamin | Norfloxacino | Norfloxan | Norfloxasan | Norfloxil | Norfloxmed | Norflurin | Norxacin | Norxin | Ocinoflox | Quinoform | Respexil | Uniao norfloxacino | Uritrat | Uroflox | Uroplex | Uroseptal | Urotrobel | Uroxazol-n;
(CH) Switzerland: Norflocin | Norfloxacin Adico | Norfloxacin hp | Noroxin | Norsol;
(CI) Côte d'Ivoire: Norfloxacine tm;
(CL) Chile: Fulgram | Noroxin | Urekolin;
(CN) China: Jin ya jie;
(CO) Colombia: Ambigram | Flox | Floxfar | Fuxacilin | Nefrixine | Noflanil | Noprose | Noraflox | Norbact | Norbagram | Norflomed | Norfloquin | Norfloxacina | Norfloxacina MK | Norfloxacino | Norigran | Uralgic | Urigen | Uriseptan | Urocyclar | Urotrin | Yeloz | Zoroxin;
(CZ) Czech Republic: Gyrablock | Nolicin;
(DE) Germany: Bactracid | Barazan | Firin | Norflohexal | Norflosal | Norflox | Norflox 1 a pharma | Norfloxacin 1 a pharma | Norfloxacin al | Norfloxacin ratiopharm | Norfloxbeta | Norfluxx | Zoroxin;
(DO) Dominican Republic: Ambigram | Floxacin | Noracina | Noractin | Norfloxacina | Norfloxacino | Noroxin | Norulox | Orsanac | Uroctal | Urofloxin;
(EC) Ecuador: Acroflox | Norflogen | Norfloxacina | Norfloxacina MK | Norfloxacino | Norfloxacino nifa | Noroxin | Orsanac | Urobacid | Uroseptal;
(EE) Estonia: Nolicin | Norfloxacin ratiopharm;
(EG) Egypt: Epinor | Neofloxin | Noracin | Norbactin | Normash | Noroxin | Spectrama;
(ES) Spain: Baccidal | Esclebin | Espeden | Nalion | Norflok | Norfloxacina inkey | Norfloxacino Acost | Norfloxacino bayvi | Norfloxacino bexal | Norfloxacino Cinfa | Norfloxacino normon | Norfloxacino pensa | Norfloxacino qualix | Norfloxacino Ranbaxy | Noroxin | Uroctal | Vicnas | Xasmun;
(ET) Ethiopia: Gyrablock | Norcin | Nortop | Trizolin | Uriflox;
(FI) Finland: Lexinor | Norfloxacin ratiopharm | Norfloxacin sandoz;
(FR) France: Norfloxacine arrow | Norfloxacine biogaran | Norfloxacine eg | Norfloxacine gnr | Norfloxacine irex | Norfloxacine ivax | Norfloxacine merck | Norfloxacine Qualimed | Norfloxacine Ratiopharm | Norfloxacine Sandoz | Norfloxacine teva | Norfloxacine Wint | Noroxine;
(GB) United Kingdom: Utinor;
(GR) Greece: Alenbit | Constilax | Fluseminal | Grenis | Norfloxacina | Norocin | Ovinol | Pistofil | Setanol | Sinobid | Sofasin | Urisold | Urobacid | Urospes n | Vetamol;
(HK) Hong Kong: Euroxacin | Floxen | Lexinor | Surflox | Uroctal;
(HR) Croatia: Noflox | Nolicin | Trizolin uro;
(HU) Hungary: Nolicin | Nolicin s | Norfloxacin ratiopharm | Norfloxacin-k;
(ID) Indonesia: Lexinor | Norbactin | Noryx | Pyrflox | Urobacid | Wianor;
(IL) Israel: Apirol;
(IN) India: Alflox | Anquin | Bacigyl | Biofloxin | Emflox | Enflox | Enteroflox | Entoflox | Flox | Flox lark | Floxacret | Floxilet | Floxin | Heliflox | Inor | Klib | Loxone | Markflox | Mediflox | Meriflox | N-200 | N-400 | N.r.flox | Nefrotab | Negaflox | Nitdin | Nor-u | Noraxin | Norbactin | Norbid | Norflot | Norflox | Norfloxain | Nori | Norilet | Norlup | Norly | Normax | Nornij | Norrit | Norspan | Norstar | Nortas | Nortee | Norzole | Osoflox | Quinobid | Quinolox | Quinotz | R-flox | Synor | Tamflox | Tyzon | Uriben | Urinor | Uroflox | Uronor | Ut-flox | Utibid | Worflox | Zeflox | Zyflox;
(IT) Italy: Diperflox | Norflox | Norfloxacina | Norfloxacina eg | Noroxin | Renoxacin | Sebercim | Uticina | Utinor;
(JO) Jordan: Noracin | Norax | Noroxin | Urobacid;
(JP) Japan: Asudufe | Baccidal | Baccidal torii | Bafurokisaru | Barocul | Basteen | Blemalart | Blemalart choseido | Mitatonin mita | Nofloxan | Nofxan | Norbaccin | Norbacdal | Norcozine | Norfloxacin emec | Noruzist | Notler | Shinun | Stbanil | Towakisan | Unasera | Xaflor;
(KE) Kenya: Asnor | Carenorfcin | Floxinor | Floxinox | Mediflox | Negaflox | Niflox | Noflox | Norfen | Norflogen | Norflopin | Norflox | Norilet | Norlab | Normax | Normed | Norzole | Surflox | Uniflox | Uriflox;
(KR) Korea, Republic of: Baccidal | Bameron | Barotam | Effectsal | Floxa | Furactam | Gramitin | Hanlim norfloxacin | Moaloxin | Neutam | Newsadal | Norfloxacin tab. 400mg huons | Norfo | Noritacin | Norocan | Noroxin | Olmaricin | Proking | Urecacin | Urekacin | Urisco | Urobid | Uroxacin;
(KW) Kuwait: Noroxin | Uroctal | Uroxin;
(LB) Lebanon: Noroxin | Urobacid | Uroctal | Uroxin;
(LT) Lithuania: Drobacid | Negaflox | Nolicin | Norbactinum | Norfloxum | Urobacid;
(LU) Luxembourg: Norfloxacine eg | Zoroxin;
(LV) Latvia: Negaflox | Nolicin | Norbactinum | Norflok | Norfloxacin ratiopharm | Norfloxum | Urobacin;
(MA) Morocco: Noracin | Noroxine | Urobacid | Uroctal;
(MX) Mexico: Axoflanol | Difoxacil | Floxacin | Microxin | Noflorox | Norfloxacina | Noroxin | Norquinol | Oranor;
(MY) Malaysia: Effectsal | Floxen | Janacin | Lexinor | Nolicin | Nor | Norbactin | Norflok | Norfloxin | Norfox | Norgan | Pharmaniaga Norfloxacin | Rexacin | Tomexin | Trizolin | Urinox | Urobacid | Utibid;
(NG) Nigeria: Norbactin | Norfen;
(NL) Netherlands: Norfloxacine | Norfloxacine actavis | Norfloxacine Ratiopharm | Norocin | Noroxin | Noroxine;
(NO) Norway: Norflohexal;
(NZ) New Zealand: Noroxin;
(PE) Peru: Ampliron | Grenis | N-flox | Norbactin | Norbiotic | Norflolip | Norfloxacina | Norfloxacino | Norilet | Noroxin | Uroflox | Uroquin;
(PH) Philippines: Ellatracid | Euroflox | Flamorel | Flornox | Heiwin | Jaydisyn | Lexiflox | Lexinor | M-flox | Norbactin | Norex | Nortram | Pharmawealth norfloxacin | Septinor | Urinox | Urobacid | Winaflox;
(PK) Pakistan: Alenbit | Bacnor | Bactinor | Floxa | Floxanor | Floxin | Helinox | Isflox | Nefrolon | Newsadal | Nicaflex | Nicoflox | Nolicin | Norfax | Norfin | Norflox | Norilet | Norocin | Noroxin | Norsept | Nortic | Novoflox | Noxacin | Qunor | Trizolin | Unique | Uracin | Urid | Uriflox | Uritac | Uroquin | Utibex | Utinor | Webnor;
(PL) Poland: Nolicin | Norbactin | Norsept;
(PR) Puerto Rico: Noroxin;
(PT) Portugal: Norfloxacina | Noroxin | Taflox | Uroflox;
(PY) Paraguay: Flomed | Nipron | Nogrixim | Norfloxacino genfar | Norfloxina | Orsanac | Uridon;
(QA) Qatar: Gyrablock | Noracin | Norax | Noroxin | Uroxin;
(RO) Romania: Epinor | Fluseminal | Nolicin | Norfloxacina atb | Urospes n | Utibid;
(RU) Russian Federation: Anquin | Gyrablock | Locsone | Loxon | Negaflox | Nolicin | Norbactin | Norbactinum | Norfacin | Norfloxum | Norilet | Normax | Renor | Utibid;
(SA) Saudi Arabia: Noracin | Noroxin | Uroxin;
(SE) Sweden: Lexinor | Norfloxacin AstraZeneca | Norfloxacin krka | Norfloxacin meda | Norfloxacin sandoz | Norfloxacin stada;
(SG) Singapore: Bexinor | Effectsal | Foxgoria | Gyrablock | Lexinor | Loxone | Nolicin | Norbactin | Urobacid;
(SI) Slovenia: Nolicin;
(SK) Slovakia: Gyrablock | Nolicin;
(TH) Thailand: B g b norflox | Benor | Canflox | Cannorflox | Cenor | Cofoxin | Crossa | Duocin | Farnoxin | Floxa | Floxenor | Floximed | Fornacin f | Foxgoria | Foxin | Foxinon | Gonorcin | Gyrablock | J.V.Flox | Janacin | Kressflox | Lexfor | Lexiflox | Leximed | Lexinor | Loxone | M-flox | Manoflox | Medic-nor | Myfloxin | N-floxa | Noflox | Nogo | Nomed | Noracin | Noraxin | Norbactin | Norcin | Norcoxa | Norfa | Norfan | Norfass | Norfcin | Norflacil | Norflo | Norflocin | Norflox Osoth | Norfloxcin | Norfloxil | Norfloxin | Norfloxno | Norfloxpac | Norfloxstar | Norfloxyl | Norfox | Norfoxcin | Norgo | Norgoria | Normed | Norraxin | Norsa | Norsep | Norspec | Norxacin | Norxia | Norxibid | Norxin | Noxcin | Noxinor | Oxacin | Paioxin | Pinflox | Proxinor | Sanorflox | Sefnor | Snoffocin | Tc noxin | Troxacin | U-Flox | Urinox | Uritracin | Vesxacin | Vifloxacin | Xacin | Zinor;
(TN) Tunisia: Noracin | Noroxine;
(TR) Turkey: Noroxin;
(TW) Taiwan: Baccidal | Baxicin | Flocidal | N.F.S | Noraxin | Norflodal | Noxacin;
(UA) Ukraine: Negaflox | Nolicin | Norbactinum | Norfloxum | Norilet | Normax | Sofasin | Synflox;
(UG) Uganda: Agonor | Asnor;
(UY) Uruguay: Ectalin | Floxuri | Uronor | Uroxacina;
(VE) Venezuela, Bolivarian Republic of: Danilon | Norbactin | Norflosan | Norfloval | Norfloxacina | Norfloxacino | Norilet | Noroxin;
(ZA) South Africa: Floxin | Norfloxacin Actor | Noroxin | Utifloxa | Utin;
(ZM) Zambia: Anquin | Floxilet | Norfen | Normax | Quinolox | Renor | Uroflox;
(ZW) Zimbabwe: Norfloxin

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Norfloxacin (United States: Not available): Drug information