An oral fourth-generation fluoroquinolone with a broad spectrum of efficacy against a number of bacterial illnesses is gemifloxacin (Factive, Grat). Acute bronchitis, community-acquired pneumonia, particularly forms of Streptococcus pneumonia that are resistant to many drugs, and gonococcal infections are all treated with it.
Gemifloxacin Uses:
It is indicated in the following conditions:
- Acute exacerbation of chronic bronchitis;
- Community-acquired pneumonia (CAP), includes pneumonia brought on by S. pneumoniae strains that are drug-resistant (MDRSP).
- Limitations of use:
- Fluoroquinolones may cause serious and potentially irreversible serious side effects e.g. tendinitis and tendon rupture, peripheral neuropathy, and CNS effects).
- It should be given to patients who have no alternative treatment options for acute bacterial exacerbation of chronic bronchitis.
-
Use: Off-Label: Adult
- Gonococcal, uncomplicated urogenital infections (For patients who has cephalosporin allergy)
Gemifloxacin Dose in Adults
Note: The United States no longer carries Factive.
Gemifloxacin Dose in adults for Susceptible infections:
- Oral: 320 mg once a day
Gemifloxacin Dose in the treatment of acute exacerbations of chronic bronchitis:
- Oral: 320 mg once a day for 5 days
Gemifloxacin Dose in the treatment of Gonococcal, uncomplicated urogenital infections:
(alternative therapy in patients with cephalosporin allergy, off-label):
- Oral: 320 mg as a single dose combined with oral azithromycin.
Gemifloxacin Dose in the treatment of community-acquired pneumonia (CAP):
- Oral: 320 milligrammes used once daily.
- Duration: Minimum 5 days; duration is based on the severity of the condition and the patient's reaction to treatment; treatment should terminate once the patient has been clinically stable and afebrile for at least 48 hours.
Use in Children:
Not indicated.
Gemifloxacin Pregnancy Category: N
- Studies on animal reproduction have shown adverse effects.
Gemifloxacin use during breastfeeding:
- It excretes from breast milk.
- Breast milk can cause non-dose-related changes in bowel flora. Be sure to monitor infants for any gastrointestinal disturbances
- Breastfeeding mothers should consider alternative antibiotics. However, it can be used in situations where other agents are not possible.
- Gemifloxacin should be used during breastfeeding based on the benefits for the mother as well as the risk to infants.
Gemifloxacin Dose in Kidney Disease:
Note: Renal function may be estimated using the Cockcroft-Gault formula for dosage adjustment purposes.
- CrCl >40 mL/minute:
- No dose adjustment required.
- CrCl ≤40 mL/minute:
- 160 mg once a day
- Hemodialysis:
- Dialyzable (20% - 30%): 160 mg once daily (Dose should be given after hemodialysis on dialysis days).
- CAPD:
- 160 mg once a day
Dose in Liver disease:
No dosage adjustment is necessary.
Side Effects of Gemifloxacin:
-
Central Nervous System:
- Headache
- Dizziness
-
Dermatologic:
- Skin Rash
-
Gastrointestinal:
- Diarrhea
- Nausea
- Abdominal Pain
- Vomiting
-
Hematologic:
- Increased Platelets
-
Hepatic:
- Increased Serum Alanine Aminotransferase
- Increased Serum Aspartate Aminotransferase
Less common side effects of Gemifloxacin:
-
Central Nervous System:
- Agitation
- Anxiety
- Confusion
- Delirium
- Depression
- Disorientation
- Disturbance In Attention
- Hallucination
- Memory Impairment
- Paranoia
- Pseudotumor Cerebri
- Restlessness
- Seizure
- Suicidal Ideation
- Suicidal Tendencies
- Toxic Psychosis
Contraindications to Gemifloxacin:
Hypersensitivity
Warnings and precautions
-
Modified cardiac conduction
- Fluoroquinolones are associated with a longer QT interval
- Patients who have a history or are at high risk of developing it should avoid it
- Extension of QT
- Torsades de pointes
- Hypokalemia and hypomagnesemia are two examples of uncorrected electrolyte problems.
- Cardiac disease
- Concurrent administration of antipsychotics and tricyclic antidepressants, including Class Ia, Class III, erythromycin and cisapride.
-
Regulation of Glucose
- Fluoroquinolone may cause severe hyperglycemia or hypoglycemia, especially in patients who are on insulin or sulfonylureas.
- Monitoring for signs and symptoms of disordered sugar regulation
-
Hypersensitivity reactions
- There are many reactions that can occur, from the common allergic symptoms (itching and urticaria), to severe idiosyncratic reactions (Stevens Johnson, toxic epidermal necrlysis), to life-threatening anaphylaxis reactions
- In some cases, there might be organ involvement.
- Vessel: vasculitis
- Lungs: pneumonitis
- Renal: nephritis
- Necrosis or hepatic failure of the liver
- Hematologic: Cytopenias and anemia
- CVS: Hypotension, Shock, angioedema
- If you experience any symptoms or signs of an allergic reaction, stop using the drug immediately.
-
Phototoxicity:
- Fluoroquinolones can cause phototoxicity reactions ranging from moderate to severe. These reactions may manifest as sunburn symptoms.
- If you develop photosensitivity, discontinue using the product.
-
Warning: Serious adverse reactions
- Fluoroquinolone, including gatifloxacin, can cause serious adverse reactions that could be irreversible.
- In the following situations, it is important to immediately stop any therapy:
-
CNS effects
- Fluoroquinolones may cause seizures, lightheadedness, tremors, and increased intracranial pressure.
- Patients with CNS disorders or other risk factors for seizures should be treated cautiously.
- If you experience a reaction, stop immediately.
-
Peripheral neuropathy:
- Peripheral neuropathy can occur shortly after therapy is initiated. It is irreversible
- If you experience symptoms of sensorimotor or sensory neuropathy, stop using the drug immediately.
- Patients with a history of peripheral neuropathy should avoid it.
-
Psychiatric reactions
- Hallucinations, toxic psychosis, and paranoia can all be brought on by fluoroquinolones.
- Additionally, they may result in agitation, restlessness, delirium, attention deficit disorder, insomnia, anxiety, memory loss, disorientation, sadness, or suicidal thoughts or deeds.
-
Tendinitis/tendon rupture:
- Fluoroquinolones have been linked to tendinitis and tendon rupture at all ages.
- Patients over 60 years old and patients who have received solid organ transplants may be at greater risk. However, this has also been observed in patients with no risk factors.
- The Achilles tendon is the most commonly affected, and it may rupture. Other tendon may also be affected, either unilaterally or bilaterally.
- Following the start of drug use, tendon involvement may start hours or days later and last for several months.
-
Superinfection
- The prolonged use of this medication can lead to fungal and bacterial superinfections, such as Clostridioides difficile -associated diarrhea (CDAD), pseudomembranous colitis.
-
Cardiovascular disease
- Avoid severe bradycardia and acute MI.
-
Myasthenia gravis: [US Boxed Warning]:
- Myasthenia Gravis can cause muscle weakness; it is best to avoid myasthenia gravis patients.
- There have been cases of severe exacerbations that progressed to ventilatory support and death.
-
Renal impairment
- If CrCl is less than 40 mL/minute dose adjustment required.
- Tendon rupture can be triggered by impaired renal function.
-
Rheumatoid arthritis:
- Patients with rheumatoid arthritis are advised to be cautious as there is a greater risk of tendon rupture.
Gemifloxacin: Drug Interaction
|
Risk Factor C (Monitor therapy) |
|
|
Aminolevulinic Acid (Topical) |
Aminolevulinic Acid's photosensitizing impact may be enhanced by photosensitizing agents (Topical). |
|
BCG Vaccine (Immunization) |
Antibiotics may reduce the BCG vaccine's therapeutic effect (Immunization). |
|
Blood Glucose Lowering Agents |
Blood Glucose Lowering Agents' hypoglycemic effects may be strengthened by quinolones. Blood Glucose Lowering Agents' therapeutic impact may be lessened by quinolones. In particular, the use of quinolones may result in a loss of blood sugar control if an agent is being used to treat diabetes. |
|
Corticosteroids (Systemic) |
Quinolones' harmful or poisonous effects could be increased. Particularly, there may be an increased risk of tendonitis and tendon rupture. |
|
Haloperidol |
May increase the action of quinolone antibiotics that prolong QTc (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors. |
|
Heroin |
Quinolones may intensify Heroin's harmful or toxic effects. |
|
Lactobacillus and Estriol |
The therapeutic effects of Lactobacillus and Estriol may be reduced by antibiotics. |
|
Mycophenolate |
Quinolones may lower the level of mycophenolate in the blood. Quinolones in particular may lower levels of mycophenolate's active metabolite. |
|
Nonsteroidal Anti-Inflammatory Agents |
Quinolones' neuroexcitatory and/or seizure-potentiating effects might be enhanced. Quinolones' serum concentration may rise in response to non-steroidal anti-inflammatory drugs. |
|
Ondansetron |
May increase the action of quinolone antibiotics that prolong QTc (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors. |
|
Pentamidine (Systemic) |
May increase the action of quinolone antibiotics that prolong QTc (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors. |
|
Porfimer |
The photosensitizing effect of Porfimer may be strengthened by photosensitizing agents. |
|
Probenecid |
Gemifloxacin serum concentration can rise. |
|
QT-prolonging Antidepressants (Moderate Risk) |
The QTc-prolonging action of QT-prolonging antidepressants may be enhanced by QT-prolonging Quinolone Antibiotics (Moderate Risk) (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors. |
|
QT-prolonging Antipsychotics (Moderate Risk) |
QT-prolonging Antibiotics with quinolones (moderate risk) may increase the QTc-prolonging effects of antipsychotics (Moderate Risk). Management: When these medications are combined, keep an eye out for QTc interval prolongation and cardiac arrhythmias. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors. Examples include pimozide. |
|
QT-prolonging Class IC Antiarrhythmics (Moderate Risk) |
QT-prolonging QT-prolonging Class IC Antiarrhythmics' QTc-prolonging effect may be enhanced by quinolone antibiotics (Moderate Risk) (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors. |
|
QT-prolonging Kinase Inhibitors (Moderate Risk) |
The QTc-prolonging impact of QT-prolonging Kinase Inhibitors may be enhanced by QT-prolonging Quinolone Antibiotics (Moderate Risk) (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors. |
|
QT-prolonging Miscellaneous Agents (Moderate Risk) |
May increase the action of quinolone antibiotics that prolong QTc (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors. Domperidone is an exception. |
|
QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) |
Quinolone antibiotics with a moderate risk of QT prolongation may increase the QTc-prolonging effects of moderate CYP3A4 inhibitors (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors. |
|
QT-prolonging Quinolone Antibiotics (Moderate Risk) |
May increase the action of other quinolone antibiotics that prolong QTc (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors. |
|
QT-prolonging Strong CYP3A4 Inhibitors |
(QT-prolonging Strong QT-prolonging CYP3A4 Inhibitors may have a greater QTc-prolonging impact when used with quinolone antibiotics (Moderate Risk) (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors. |
|
Moderate Risk) |
Varenicline's serum levels may rise in response to quinolones. Management: Keep an eye out for any increased varenicline side effects when levofloxacin or other quinolone antibiotics are also being taken, especially in patients who have severe renal impairment. Different international standards exist for product labelling. Look up the relevant labelling. |
|
Varenicline |
Verteporfin's photosensitizing effect may be strengthened by photosensitizing agents. |
|
Verteporfin |
Quinolones might make Vitamin K antagonists' anticoagulant effects even more potent. |
|
Risk Factor D (Consider therapy modification) |
|
|
Antacids |
Quinolones' absorption might be decreased. a problem only when quinolones are taken orally. To lessen the effects of this combination, avoid giving quinolones and antacids at the same time. Optimal dosage separation recommendations differ depending on the particular quinolone. Bicarbonate of sodium is an exception. |
|
Calcium Salts |
Quinolones' absorption might be decreased. only when both drugs are administered orally. Examples include calcium chloride. |
|
Delamanid |
May increase the action of quinolone antibiotics that prolong QTc (Moderate Risk). Delamanid's ability to prolong QTc may be enhanced by QT-prolonging quinolone antibiotics (moderate risk). Management: If at all feasible, avoid using delamanid and quinolone antibiotics concurrently. Electrocardiograms should be frequently checked throughout the entire delamanid treatment period if coadministration is thought to be unavoidable. |
|
Didanosine |
Didanosine's serum levels may be reduced by quinolones. Didanosine may lower the level of quinolones in the serum. Treatment: Give oral quinolones at least two hours prior to or six hours following didanosine. Check for diminished quinolone therapeutic effects, especially if dosages cannot be separated as advised. Didanosine with an unbuffered enteric coating is exempt from this rule. |
|
Domperidone |
The QTc-prolonging action of Domperidone may be strengthened by QT-prolonging Agents (Moderate Risk). Management: Take into account different pharmacological combinations. If combined, keep an eye out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors. |
|
Iron Salts |
Quinolones' serum concentration can drop. Treatment: Give oral quinolones at least several hours before (four hours for moxi- and sparfloxacin, two hours for others) or after (six hours for cipro/dela-, four hours for lome-, three hours for gemi-, and two hours for levo-, nor-, oflox-, pefloxacin, or nalidixic acid) taking oral iron salts. Iron Carboxymaltose, Iron Gluconate, Iron Hydroxide Polymaltose Complex, Iron Pyrophosphate Citrate, Ferumoxytol, Iron Dextran Complex, Iron Isomaltoside, and Iron Sucrose are exceptions. |
|
Magnesium Salts |
Quinolones' serum concentration can drop. Treatment: Give oral quinolones before or after oral magnesium salts, depending on the drug (8 h for moxi, 6 h for cipro/dela, 4 h for lome/pe, 3 h for gemi, and 2 h for levo, nor, or ofloxacin or nalidixic acid). |
|
Methadone |
Gemifloxacin may increase Methadone's ability to prolong QTc. Management: Take into account different pharmacological combinations. If combined, keep an eye out for cardiac arrhythmias and a prolonged QTc interval. Patients who have other QTc prolongation risk factors may be at even greater risk. |
|
Multivitamins/Minerals (with ADEK, Folate, Iron) |
Quinolones' serum concentration can drop. Particularly, oral quinolone antibiotics may be less effectively absorbed when used with polyvalent cations found in multivitamin supplements. Treatment: By taking the oral quinolone at least two hours before or six hours after taking the dose of a multivitamin containing polyvalent cations, interactions can be reduced (i.e., calcium, iron, magnesium, selenium, zinc). |
|
Multivitamins/Minerals (with AE, No Iron) |
Quinolones' serum concentration can drop. Particularly, elements in the multivitamin/mineral supplement may hinder quinolone medicines' absorption. Treatment: By taking the oral quinolone at least two hours before or six hours after taking the dose of a multivitamin containing polyvalent cations, interactions can be reduced (i.e., calcium, iron, magnesium, selenium, zinc). |
|
QT-prolonging Kinase Inhibitors (Highest Risk) |
The QTc-prolonging effects of gemifloxacin might be improved. Management: Take into account different pharmacological combinations. If combined, keep an eye out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors. |
|
QT-prolonging Miscellaneous Agents (Highest Risk) |
Gemifloxacin may increase the effect of QT-prolonging additional agents on QTc (Highest Risk). Management: Take into account different pharmacological combinations. If combined, keep an eye out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors. Delamanian is an exception. |
|
Quinapril |
Quinolones' serum concentration can drop. Treatment: To lessen the possibility of an interaction, provide oral quinolones and quinapril at least two hours apart. If both of these medicines are administered at the same time, keep an eye out for any quinolone efficacy reduction. |
|
Sevelamer |
Quinolones' absorption might be decreased. Treatment: Oral quinolones should be taken at least two hours before or six hours after sevelamer. |
|
Sodium Picosulfate |
Antibiotics may reduce Sodium Picosulfate's therapeutic impact. Management: If a patient previously used or is currently using an antibiotic, think about utilising an alternative product for bowel cleansing prior to a colonoscopy. |
|
Sucralfate |
Quinolones' serum concentration can drop. Treatment: Give oral quinolones at least two hours prior to or six hours following the dosage of sucralfate. Greater dose spacing may further reduce the possibility of a harmful interaction. |
|
Typhoid Vaccine |
The Typhoid Vaccine's therapeutic benefits may be reduced by antibiotics. The only strain impacted is the live attenuated Ty21a strain. Treatment: Patients receiving systemic antibacterial drugs should refrain from receiving the live attenuated typhoid vaccination (Ty21a). It is recommended to wait at least 3 days following the last dose of antibacterial medication before administering this vaccine. |
|
Zinc Salts |
Quinolones' serum concentration can drop. Treatment: Oral quinolones should be administered at least a few hours before or after oral zinc salts (8 h for moxi, 6 h for cipro/dela, 4 h for lome, 3 h for gemi, and 2 h for levo, nor, pe, or ofloxacin or nalidixic acid). ZnCl2 is an exception. |
|
Risk Factor X (Avoid combination) |
|
|
Aminolevulinic Acid (Systemic) |
Aminolevulinic Acid's photosensitizing impact may be enhanced by photosensitizing agents (Systemic). |
|
Amiodarone |
Amiodarone's ability to prolong QTc may be enhanced by gemifloxacin. |
|
BCG (Intravesical) |
Antibiotics may lessen BCG's therapeutic effects (Intravesical). |
|
Cholera Vaccine |
The therapeutic benefit of the cholera vaccine may be reduced by antibiotic use. Management: Cholera vaccine should not be administered to individuals taking systemic antibiotics or within 14 days after taking oral or parenteral antibiotics. |
|
Nadifloxacin |
Quinolones' harmful or poisonous effects could be increased. |
|
Pimozide |
Could make QT-prolonging agents' effect on QTc longer (Moderate Risk). |
|
QT-prolonging Class IA Antiarrhythmics (Highest Risk) |
Gemifloxacin may increase the effect of class IA antiarrhythmics that prolong QTc (Highest Risk). |
|
QT-prolonging Class III Antiarrhythmics (Highest Risk) |
Gemifloxacin may increase the effect of Class III antiarrhythmics that prolong QTc (Highest Risk). |
|
Strontium Ranelate |
Quinolones' serum concentration can drop. Management: It is advised that strontium ranelate medication be stopped during quinolone therapy in order to reduce any potential effects of strontium ranelate on quinolone antibiotic concentrations. |
Monitoring parameters:
- WBC
- Signs and symptoms of infection
- Renal functions
- Blood sugar level
- Feature of tendinitis
How to administer Gemifloxacin?
- Oral: Can be taken with or without food.
- It should not be administered with calcium-fortified juices and dairy products like milk and yogurt, however, meals containing these dairy products can be taken.
- Multivitamins or other products that contain iron, zinc, or magnesium should not be taken before 3 hours or 2 hours after gemifloxacin.
Mechanism of action of Gemifloxacin:
- It inhibits DNA gyrase and topoisomerase IV.
- Topoisomerase IV, also known as DNA gyrase, is vital for bacterial survival because it is responsible to maintain the superhelical DNA structure.
- For DNA replication, transcription, DNA repair, and transposition, the DNA gyrase is necessary. It is a drug that kills bacteria.
Absorption:
- Well absorbed from the GI tract
Protein binding:
- ~60% to 70%
Metabolism:
- Hepatic (minor); forms metabolites (CYP isoenzymes are not involved)
Bioavailability:
- ~71%
Half-life elimination:
- 7 hours (range 4-12 hours)
Time to peak, plasma:
- 0.5 - 2 hours
Excretion:
- Feces (61%);
- urine (36%)
International Brand Names of Gemifloxacin:
- Factive
- Factive-5
- Furfact
- Gemone
- Spektrel
- Weptonal
Gemifloxacin Brand Names in Pakistan:
Gemifloxacin 320 mg Tablets in Pakistan |
|
| Actigem | Ferozsons Laboratoies Ltd. |
| Agemix | Alliance Pharmaceuticals (Pvt) Ltd. |
| Arigem | Aries Pharmaceuticals (Pvt) Ltd |
| Arja | Unimark Pharmaceuticals |
| Bactigen | Pharmethics |
| Bio-Gem | Medera Pharmaceuticals (Pvt) Ltd. |
| Dugram | Pharmix Laboratories (Private) Limited. |
| Factiflox | Envoy Pharma |
| Factim | Hansel Pharmacueutical Pvt (Ltd) |
| Floxigem | Agp (Private) Ltd. |
| G-Active | Azron Pharmaceuticals (Pvt) Ltd |
| G-Cim | Semos Pharmaceuticals (Pvt) Ltd. |
| Gamibro | Albro Pharma |
| Gamiflet | Pulse Pharmaceuticals |
| Ganiflo | Medisearch Pharmacal(Pvt) Ltd |
| Gemacin | Nexpharm |
| Geman | Amson Vaccines & Pharma (Pvt) Ltd. |
| Gemap | Maple Pharmaceuticals (Pvt) Ltd |
| Gemcid | Crest Pharmaceuticals |
| Gemex | Raazee Theraputics (Pvt) Ltd. |
| Gemgen | Biogen Pharma |
| Gemglow | Searle Pakistan (Pvt.) Ltd. |
| Gemi | Shawan Pharmaceuticals |
| Gemi-Med | Mediate Pharmaceuticals (Pvt) Ltd |
| Gemibac | Gray`S Pharmaceuticals |
| Gemicin | Bryon Pharmaceuticals (Pvt) Ltd. |
| Gemicon | S.J. & G. Fazul Ellahie (Pvt) Ltd. |
| Gemiflox | Platinum Pharmaceuticals (Pvt.) Ltd. |
| Gemiflox | Platinum Pharmaceuticals (Pvt.) Ltd. |
| Gemiloc | Danas Pharmaceuticals (Pvt) Ltd |
| Gemilox | Shrooq Pharmaceuticals |
| Geminex | Nexus Pharma (Pvt) Ltd |
| Gemisaf | Saaaf Pharmaceuticals |
| Gemiver | Florence Farmaceuticals (Pvt) Ltd |
| Gemiwood | W.Woodward Pakistan (Pvt) Ltd. |
| Gemix | Medizan Labs (Pvt) Ltd |
| Gemixa | Bosch Pharmaceuticals (Pvt) Ltd. |
| Gemizak | Schazoo Zaka |
| Gemlin | Xenon Pharmaceuticals (Pvt) Ltd. |
| Gemlon | Paramount Pharmaceuticals |
| Gemo | Pharmatec Pakistan (Pvt) Ltd. |
| Gemox | Genome Pharmaceuticals (Pvt) Ltd |
| Gemoxin | Fassgen Pharmaceuticals |
| Gems | Medicure Laboratories |
| Gemwel | Welmark Pharmaceuticals |
| Genflox | High - Q International |
| Gesimz | Simz Pharmaceuticals |
| Getec | Sante (Pvt) Limited |
| Gexin | Valor Pharmaceuticals |
| Gezlin | Shaigan Pharmaceuticals (Pvt) Ltd |
| Gimlox | Panacea Pharmaceuticals |
| Grat | Genix Pharma (Pvt) Ltd |
| Jamicid | Himont Chemical (Pvt) Ltd. |
| Jayquin | Akson Pharmaceuticals (Pvt) Ltd. |
| Lagem | Kurative Pak (Pvt) Ltd |
| Lebgal | Cirin Pharmaceuticals (Pvt) Ltd. |
| Mccure | Alfalah Pharma (Pvt) Ltd. |
| Milox | English Pharmaceuticals Industries |
| Precious | Everest Pharmaceuticals |
| Qflox | The Schazoo Laboratories Ltd. |
| Qupric | Navegal Laboratories |
| Renova | Sami Pharmaceuticals (Pvt) Ltd. |
| Siflogem | Siza International (Pvt) Ltd. |
| Zemi | Macter International (Pvt) Ltd. |
| Zeorax | Noa Hemis Pharmaceuticals |
Gemifloxacin 320 mg Capsules in Pakistan |
|
| Glamix | Wns Field Pharmaceuticals |
 Injection.webp)