Contraindicated in:

• Hypersensitivity (cross-sensitivity within class may exist);

• History of myasthenia gravis (may worsen symptoms including muscle weakness and breathing problems)

  ;

• History of tendon disorders, including tendinitis or tendon rupture

  ;

• History of peripheral neuropathy

  ;
• Patients with or at risk for aortic aneurysm (use only if no alternative);
• End-stage renal disease (eGFR <15 mL/min);
• Pedi: Use only if no alternatives in children 1–17 yr due to possible arthropathy.

Use Cautiously in:

• Known or suspected CNS disorder;

• Severe renal impairment (dose ↓ if eGFR 15–29 mL/min) (IV diluent may accumulate and ↑ SCr) (↑ risk of tendon rupture in renal failure)

  ;

• Concurrent use of corticosteroids (↑ risk of tendinitis/tendon rupture)

  ;

• Kidney, heart, or lung transplant patients (↑ risk of tendinitis/tendon rupture)

  ;
• OB: Safety not established in pregnancy;
• Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
• Geri:

  ↑risk of adverse reactions in older adults

  .