Norpress
Generic Name
Norfloxacin
Manufacturer
Reputable Pharmaceutical Company
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| norpress 100 mg tablet | ৳ 1.25 | N/A |
Description
Overview of the medicine
Norpress 100 mg tablet contains Norfloxacin, a fluoroquinolone antibiotic used to treat bacterial infections, primarily those of the urinary tract. It is effective against a broad spectrum of gram-positive and gram-negative bacteria.
Uses & Indications
Dosage
Adults
For uncomplicated lower urinary tract infections: 100 mg to 200 mg (1-2 tablets) twice daily for 7-10 days. For other indications or severe infections, higher doses (e.g., 400 mg twice daily) may be prescribed, requiring multiple 100 mg tablets per dose.
Elderly
Dosage adjustment may not be necessary based on age alone, but renal function should be closely monitored. Refer to renal impairment guidelines if applicable.
Renal_impairment
For creatinine clearance 10-30 mL/min, 100 mg once daily. For creatinine clearance <10 mL/min or hemodialysis, 100 mg once every 24-48 hours.
How to Take
Oral administration. Take with a glass of water, at least one hour before or two hours after meals or dairy products. Do not take with antacids containing magnesium or aluminum, or iron/zinc supplements, as these can significantly reduce absorption.
Mechanism of Action
Norfloxacin inhibits bacterial DNA gyrase (topoisomerase II) and topoisomerase IV, essential enzymes for bacterial DNA replication, transcription, repair, and recombination, leading to bacterial cell death.
Pharmacokinetics
Onset
Therapeutic effects typically begin within a few hours of the first dose, with full bacterial eradication requiring the completion of the prescribed course.
Excretion
Primarily excreted unchanged in urine via glomerular filtration and tubular secretion (about 30-35% of the dose within 24 hours). Also excreted in feces via bile.
Half life
Approximately 3-4 hours in healthy adults; can be prolonged in patients with renal impairment.
Absorption
Rapidly but incompletely absorbed from the gastrointestinal tract (30-40%). Peak plasma concentrations occur 1-2 hours after administration.
Metabolism
Minimally metabolized in the liver (less than 10% of the dose).
Side Effects
Contraindications
- Hypersensitivity to Norfloxacin or any other fluoroquinolone antibiotics
- History of tendinitis or tendon rupture associated with quinolone use
- Children and adolescents (generally not recommended due to risk of cartilage damage)
- Patients with a history of myasthenia gravis
Drug Interactions
NSAIDs
Concurrent use may increase the risk of CNS stimulation and convulsions.
Warfarin
May enhance anticoagulant effects, increasing bleeding risk. Close monitoring of INR is recommended.
Theophylline
May increase serum concentrations of theophylline, leading to toxicity. Monitor theophylline levels and adjust dose if necessary.
Corticosteroids
Increased risk of tendinopathy and tendon rupture, especially in older patients.
Antacids (containing Mg/Al), Sucralfate, Iron/Zinc supplements
Reduce absorption of Norfloxacin. Administer Norfloxacin 2 hours before or 4-6 hours after these agents.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose may include nausea, vomiting, diarrhea, dizziness, headache, fatigue, confusion, and convulsions. Management involves emptying the stomach by induced vomiting or gastric lavage, followed by supportive care and maintaining adequate hydration. Hemodialysis is not effective in removing Norfloxacin from the body.
Pregnancy & Lactation
Pregnancy Category C. Studies in animals have shown adverse effects on the fetus. Norfloxacin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Norfloxacin is excreted in breast milk. A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother and the potential risks to the infant.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Generally 2-3 years from the date of manufacture, specific expiry date is printed on the packaging.
Availability
Available in pharmacies and hospitals
Approval Status
Approved by national health authorities
Patent Status
Generic (Patent expired)
WHO Essential Medicine
YesClinical Trials
Norfloxacin has undergone extensive clinical trials demonstrating its efficacy and safety for various bacterial infections, particularly in the urinary tract. Post-marketing surveillance and ongoing studies continue to monitor its long-term effects and patterns of antimicrobial resistance.
Lab Monitoring
- Renal function tests (e.g., serum creatinine, creatinine clearance), especially in elderly or renally impaired patients
- Liver function tests (e.g., ALT, AST, bilirubin) periodically if treatment is prolonged
- INR (International Normalized Ratio) if co-administered with warfarin
- Theophylline levels if co-administered with theophylline
Doctor Notes
- Emphasize the importance of completing the full course of Norfloxacin to prevent the development of antibiotic resistance and ensure complete eradication of infection.
- Educate patients about the black box warnings, particularly regarding the risk of tendinitis, tendon rupture, and peripheral neuropathy. Advise immediate discontinuation and medical consultation if these symptoms occur.
- Carefully review concomitant medications, especially those that interact with Norfloxacin, such as warfarin, theophylline, and corticosteroids, and adjust dosages or monitor closely as needed.
- Advise patients to separate Norfloxacin administration from dairy products, antacids, and mineral supplements by at least 2 hours.
Patient Guidelines
- Complete the full course of treatment as prescribed, even if symptoms improve, to prevent recurrence and antibiotic resistance.
- Drink plenty of fluids to prevent crystallization in the urinary tract.
- Avoid prolonged exposure to direct sunlight or artificial UV light, as photosensitivity can occur.
- Report any pain, swelling, or inflammation of a tendon immediately to your doctor.
- Do not take this medicine with dairy products, antacids, or iron/zinc supplements; separate administration by several hours.
- Discontinue if you experience symptoms of peripheral neuropathy (e.g., pain, burning, tingling, numbness, or weakness) or CNS effects (e.g., seizures, confusion).
Missed Dose Advice
If a dose is missed, take it as soon as remembered. If it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one.
Driving Precautions
Norfloxacin may cause dizziness, lightheadedness, or visual disturbances, which can impair your ability to drive or operate machinery. Patients should be advised to know how they react to Norfloxacin before driving or performing hazardous tasks.
Lifestyle Advice
- Maintain good personal hygiene to prevent recurrence of urinary tract infections.
- Stay well-hydrated throughout the day.
- For sexually transmitted infections, ensure partners are also treated to prevent reinfection and spread.
- Avoid alcohol consumption as it may exacerbate side effects like dizziness.
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