- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Oral formulations of moxonidine
Hypertension - mild to moderate
Initial dose 200 micrograms in the morning. After 3 weeks the dose may be titrated to 400 micrograms daily as one dose or two divided doses (morning and evening). If response still unsatisfactory after a further 3 weeks the dose may be increased to a maximum of 600 micrograms daily in two divided doses (morning and evening).
Do not exceed a single dose of 400 micrograms or a daily dose of 600 micrograms in divided doses.
No dosage adjustment is necessary provided renal function is normal (See Dosage; Adult).
The elderly population may be more susceptible to the cardiovascular effects of hypotensive drugs. Dose increment should be introduced with caution.
Children aged 16 years and above
(See Dosage; Adult)
Patients with Renal Impairment
In patients with moderate renal dysfunction (Glomerular Filtration Rate (GFR) above 30 ml/minute but below 60 ml/minute or serum creatinine above 105 but below 160 micromol/litre), the single dose should not exceed 200 micrograms and the daily dose should not exceed 400 micrograms of moxonidine.
Moxonidine is excreted primarily via the kidneys.
The Renal Drug Handbook suggests:
Less than 10 to 60 GFR (ml/minute)
Dose as in normal renal function
For oral administration, to be taken with a sufficient amount of liquid.
Children under 16 years
Bradycardia with pulse rate at rest < 50 beats per minute
History of angioneurotic oedema
Non-paced sinus node dysfunction
Renal impairment - glomerular filtration rate below 30ml/minute
Renal impairment - serum creatinine above 160 micromol/l
Second degree atrioventricular block
Severe cardiac failure
Severe hepatic disorder
Sinoatrial exit block
Third degree atrioventricular block
Precautions and Warnings
Children aged 16 to 18 years
First degree atrioventricular block
Glucose-galactose malabsorption syndrome
Moderate cardiac failure
Peripheral arterial circulatory disorder
Recent myocardial infarction
Renal impairment - glomerular filtration rate 30-60ml/minute
Renal impairment - serum creatinine 105-160 micromol/l
Severe ischaemic heart disease
If renal function impaired, reduce dose to lowest to maintain control
Monitor hypotensive effect in patients with moderate renal impairment
Advise ability to drive/operate machinery may be affected by side effects
Not all available products are licensed for all age groups
Gradually withdraw over 2 weeks
Stop betablocker a few days before moxonidine when withdrawing combination
Advise patient to moderate alcohol intake during treatment
When moxonidine in used in patients with first degree atrioventricular block, special care should be taken to avoid bradycardia.
Pregnancy and Lactation
Moxonidine is contraindicated during pregnancy.
Moxonidine should not be used during pregnancy unless clearly necessary.
Schaefer (2015) suggests that moxonidine should not be used during pregnancy. However, if it is used during the first trimester, a follow up sonography should be offered.
The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Moxonidine is contraindicated during breastfeeding.
Moxonidine is excreted into breast milk and therefore should not be used during breastfeeding due to lack of safety data. The manufacturers suggest that if the use of moxonidine is considered essential, then breastfeeding should be stopped.
There is one report of daily administration of 200 micrograms of moxonidine during the first postpartum days, a maximum of 2.7 microgram/L was measured in the milk of five mothers. This equated to a milk to plasma ratio of 1 to 2. If treatment has begun, then weaning is not necessary, but therapy should be changed (Schaefer, 2015).
Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Allergic skin reactions
Impaired circulation to the extremities
Pain in parotid gland
Paraesthesia in extremities
Weakness of legs
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Last Full Review Date: December 2016
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. Accessed on 15 November 2016.
Summary of Product Characteristics: Moxonidine 200 microgram film-coated tablets. Sandoz Limited. Revised March 2011.
Summary of Product Characteristics: Moxonidine 300 microgram film-coated tablets. Sandoz Limited. Revised March 2011.
Summary of Product Characteristics: Moxonidine 400 microgram film-coated tablets. Sandoz Limited. Revised March 2011.
Summary of Product Characteristics: Moxonidine 200 microgram Tablets. TEVA UK Limited. Revised December 2011.
Summary of Product Characteristics: Moxonidine 300 microgram Tablets. TEVA UK Limited. Revised December 2011.
Summary of Product Characteristics: Moxonidine 400 microgram Tablets. TEVA UK Limited. Revised December 2011.
Summary of Product Characteristics: Physiotens Tablets 200 micrograms. Mylan Products Limited. Revised October 2016.
Summary of Product Characteristics: Physiotens Tablets 300 micrograms. Mylan Products Limited. Revised October 2016.
Summary of Product Characteristics: Physiotens Tablets 400 micrograms. Mylan Products Limited. Revised October 2016.
The Renal Drug Handbook. Fourth Edition (2014) ed. Ashley, C and Dunleavy, A, Radcliffe Publishing Ltd, London.
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