levofloxacin (Rx)

Brand and Other Names:Levaquin, Levofloxacin Systemic
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

premix, ready-to-use injection

  • 250mg/50mL
  • 500mg/100mL
  • 750mg/150mL

oral solution

  • 25mg/mL

tablet

  • 250mg
  • 500mg
  • 750mg

Community-Acquired Pneumonia

500 mg PO/IV once daily for 7-14 days or 750 mg PO/IV once daily for 5 days

Nosocomial Pneumonia

750 mg PO/IV once daily for 7-14 days

Acute Bacterial Sinusitis

500 mg PO/IV once daily for 10-14 days or 750 mg PO/IV once daily for 5 days

Limitations-of-use: Reserve fluoroquinolones for patients who do not have other available treatment options for acute sinusitis

Acute Bacterial Exacerbation of Chronic Bronchitis

500 mg PO/IV once daily for ≥7 days

Limitations-of-use: Reserve fluoroquinolones for patients who do not have other available treatment options for acute bacterial exacerbation of chronic bronchitis

Inhalational Anthrax

Postexposure therapy

500 mg PO once daily for 60 days, beginning as soon as possible after exposure

Skin/Skin Structure Infections

Uncomplicated: 500 mg PO/IV once daily for 7-10 days

Complicated: 750 mg PO/IV once daily for 7-14 days

Chronic Bacterial Prostatitis

500 mg PO/IV once daily for 28 days

Complicated Urinary Tract Infections & Acute Pyelonephritis

250 mg PO/IV once daily for 10 days or 750 mg PO/IV once daily for 5 days

Uncomplicated Urinary Tract Infections

250 mg PO/IV once daily for 3 days

Limitations-of-use: Reserve fluoroquinolones for patients who do not have other available treatment options for uncomplicated urinary tract infections

Plague

Indicated for treatment and prophylaxis of plague, including pneumonic and septicemic plague, caused by Yersinia pestis in adults and pediatric patients, aged 6 months or older

500 mg PO/IV once daily for 10-14 days

Acne Vulgaris (Off-label)

100 mg PO q8hr for 4 weeks

Epididymitis (Off-label)

500 mg PO qDay for 10 days

Pseudomonas aeruginosa Pulmonary Infections (Orphan)

Treatment of pulmonary infections due to Pseudomonas aeruginosa and other bacteria in patients with cystic fibrosis

Orphan indication sponsor

  • Mpex Pharmaceuticals, Inc, 11535 Sorrento Valley Road, San Diego, CA 92121

Dosage Modifications

Renal impairment (normal dosage, 750 mg/day)

  • CrCl 20-49 mL/min: 750 mg every other day
  • CrCl 10-19 mL/min or hemodialysis (HD)/peritoneal dialysis (PD): 750 mg initially, then 500 mg every other day

Renal impairment (normal dosage, 500 mg/day)

  • CrCl 20-49 mL/min: 500 mg initially, then 250 mg once daily
  • CrCl 10-19 mL/min or HD/PD: 500 mg initially, then 250 mg every other day

Renal impairment (normal dosage, 250 mg/day)

  • CrCl 20-49 mL/min: No dosage adjustment required
  • CrCl 10-19 mL/min: 250 mg every other day; no dosage adjustment required for uncomplicated urinary tract infection (UTI)
  • HD/PD: No data

Dialysis

  • Supplemental doses not required following hemodialysis or continuous ambulatory peritoneal dialysis (CAPD)

Dosing Considerations

Susceptible organisms

  • Aeromonas hydrophila, Campylobacter jejuni, Citrobacter diversus, Citrobacter freundii, Chlamydia pneumoniae, Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Legionella pneumophila, Morganella morganii, Moraxella catarrhalis, Proteus mirabilis, Providencia spp, Pseudomonas aeruginosa, Serratia spp, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Ureaplasma urealyticum
  • First-line therapy: C jejuni, C freundii, Enterobacter spp; no unanimity on others (eg, A hydrophila, L pneumophila, M morganii)

Dosage Forms & Strengths

premix, ready-to-use injection

  • 250mg/50mL
  • 500mg/100mL

oral solution

  • 25mg/mL

tablet

  • 250mg
  • 500mg

Tablets not for administration to pediatric patients with inhalational anthrax or plague who weigh <30 kg due to limitations of available strengths; alternative formulations of levofloxacin may be considered for pediatric patients who weigh <30 kg

Inhalational Anthrax

Postexposure therapy

≥6 months and <50 kg: 8 mg/kg PO q12hr for 60 days, beginning as soon as possible after exposure; individual dose not to exceed 250 mg  

≥6 months and >50 kg: 500 mg PO once daily for 60 days, beginning as soon as possible after exposure

Safety in children for treatment duration >14 days has not been established

Plague

Indicated for treatment and prophylaxis of plague, including pneumonic and septicemic plague, caused by Yersinia pestis in adults and pediatric patients, aged 6 months or older

≥6 months and <50 kg: 8 mg/kg PO/IV q12hr for 10-14 days; individual dose not to exceed 250 mg  

≥50 kg: 500 mg PO/IV once daily for 10-14 days

Acute Bacterial Rhinosinusitis (Off-label)

10-20 mg/kg/day PO qDay or divided q12hr

Community Acquired Pneumonia (Off-label)

S. pneumonia

  • 6 months - 5 years: 16-20 mg/kg/day PO qDay for 10 days
  • 5-16 years: 8-10 mg/kg/day PO qDay for 10 days; not to exceed 750 mg/da

M. pneumoniae, C. trachomatis, C. pneumoniae

  • Adolescents with skeletal maturity: 500 mg PO qDay for 10 days; not to exceed 750 mg/day
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Interactions

Interaction Checker

and levofloxacin

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              Serious - Use Alternative (56)

              • aluminum hydroxide

                aluminum hydroxide decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • aminolevulinic acid oral

                aminolevulinic acid oral, levofloxacin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.

              • aminolevulinic acid topical

                levofloxacin increases toxicity of aminolevulinic acid topical by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration of photosensitizing drugs may enhance the phototoxic reaction to photodynamic therapy with aminolevulinic acid.

              • amiodarone

                amiodarone and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

              • apomorphine

                apomorphine and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

              • arsenic trioxide

                arsenic trioxide and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

              • artemether

                artemether and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

              • BCG vaccine live

                levofloxacin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              • carbonyl iron

                carbonyl iron decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • ceritinib

                ceritinib and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

              • cholera vaccine

                levofloxacin, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

              • didanosine

                didanosine decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Applies to didanosine chewable tablets and powder for oral solution; administer 2 hr before or several hours after didanosine oral solution or chewable tablet administration.

              • disopyramide

                disopyramide and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

              • entrectinib

                levofloxacin and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

              • ferric maltol

                ferric maltol decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • ferrous fumarate

                ferrous fumarate decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • ferrous gluconate

                ferrous gluconate decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • ferrous sulfate

                ferrous sulfate decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • fexinidazole

                fexinidazole and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.

              • glasdegib

                levofloxacin and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

              • hydroxychloroquine sulfate

                hydroxychloroquine sulfate and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

              • ibutilide

                ibutilide and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

              • indapamide

                indapamide and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

              • inotuzumab

                inotuzumab and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.

              • iron dextran complex

                iron dextran complex decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • iron sucrose

                iron sucrose decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • ivosidenib

                ivosidenib and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

              • lefamulin

                lefamulin and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

              • macimorelin

                macimorelin and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

              • methyl aminolevulinate

                levofloxacin, methyl aminolevulinate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Each drug may increase the photosensitizing effect of the other.

              • mobocertinib

                mobocertinib and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

              • ondansetron

                levofloxacin and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

              • panobinostat

                levofloxacin and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

              • pentamidine

                levofloxacin and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

              • pimozide

                levofloxacin and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

              • pitolisant

                levofloxacin and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

              • polysaccharide iron

                polysaccharide iron decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • procainamide

                levofloxacin and procainamide both increase QTc interval. Avoid or Use Alternate Drug.

              • quinidine

                quinidine and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

              • ribociclib

                ribociclib increases toxicity of levofloxacin by QTc interval. Avoid or Use Alternate Drug.

              • rose hips

                rose hips decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • saquinavir

                saquinavir increases levels of levofloxacin by QTc interval. Avoid or Use Alternate Drug. Potential for increased toxicity. Increased risk of QT prolongation and cardiac arrhythmias.

              • selinexor

                selinexor, levofloxacin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • sodium bicarbonate

                sodium bicarbonate decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • sodium citrate/citric acid

                sodium citrate/citric acid decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • sotalol

                levofloxacin and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

              • strontium ranelate

                strontium ranelate decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated. Suspend strontium ranelate during antibiotic therapy.

              • toremifene

                levofloxacin and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.

              • tretinoin

                levofloxacin, tretinoin. Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased phototoxicity.

              • tretinoin topical

                levofloxacin, tretinoin topical. Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased phototoxicity.

              • trilaciclib

                trilaciclib will decrease the level or effect of levofloxacin by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of trilaciclib (OCT2, MATE1, and MATE-2K inhibitor) with substrates where minimal increased concentration in kidney or blood may lead to serious or life-threatening toxicities.

              • typhoid vaccine live

                levofloxacin decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              • umeclidinium bromide/vilanterol inhaled

                levofloxacin increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

              • vandetanib

                levofloxacin, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

              • vemurafenib

                vemurafenib and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

              • vilanterol/fluticasone furoate inhaled

                levofloxacin increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

              Monitor Closely (192)

              • acarbose

                levofloxacin increases effects of acarbose by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • albuterol

                albuterol and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • alfuzosin

                levofloxacin and alfuzosin both increase QTc interval. Use Caution/Monitor.

                alfuzosin and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • amifampridine

                levofloxacin increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

              • amitriptyline

                amitriptyline and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • amoxapine

                amoxapine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • arformoterol

                arformoterol and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • aripiprazole

                aripiprazole and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • artemether/lumefantrine

                levofloxacin and artemether/lumefantrine both increase QTc interval. Modify Therapy/Monitor Closely.

              • atomoxetine

                atomoxetine and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • bazedoxifene/conjugated estrogens

                levofloxacin will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • bedaquiline

                levofloxacin and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

              • betamethasone

                betamethasone and levofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • calcium acetate

                calcium acetate, levofloxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • calcium carbonate

                calcium carbonate, levofloxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • calcium chloride

                calcium chloride, levofloxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • calcium citrate

                calcium citrate, levofloxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • calcium gluconate

                calcium gluconate, levofloxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • celecoxib

                levofloxacin, celecoxib. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • chloroquine

                chloroquine increases toxicity of levofloxacin by QTc interval. Use Caution/Monitor.

              • chlorpromazine

                chlorpromazine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • chlorpropamide

                levofloxacin increases effects of chlorpropamide by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • citalopram

                levofloxacin and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

              • clarithromycin

                clarithromycin and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • clomipramine

                clomipramine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • clozapine

                clozapine and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • conjugated estrogens

                levofloxacin will decrease the level or effect of conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • corticotropin

                corticotropin and levofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • cortisone

                cortisone and levofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • crizotinib

                crizotinib and levofloxacin both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

              • crofelemer

                crofelemer increases levels of levofloxacin by Other (see comment). Use Caution/Monitor. Comment: Crofelemer has the potential to inhibit transporters MRP2 and OATP1A2 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

              • dasatinib

                dasatinib and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • degarelix

                degarelix and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • desipramine

                desipramine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • dexamethasone

                dexamethasone and levofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • diclofenac

                levofloxacin, diclofenac. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • dienogest/estradiol valerate

                levofloxacin will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.

              • diflunisal

                levofloxacin, diflunisal. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • digoxin

                levofloxacin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • dofetilide

                dofetilide and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • dolasetron

                dolasetron and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • doxepin

                doxepin and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • dronedarone

                dronedarone and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • droperidol

                droperidol and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • eluxadoline

                eluxadoline increases levels of levofloxacin by decreasing metabolism. Use Caution/Monitor. Eluxadoline may increase the systemic exposure of coadministered OATP1B1 substrates.

              • epinephrine

                epinephrine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • epinephrine racemic

                epinephrine racemic and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • erythromycin base

                erythromycin base and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • erythromycin ethylsuccinate

                erythromycin ethylsuccinate and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • erythromycin lactobionate

                erythromycin lactobionate and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • erythromycin stearate

                erythromycin stearate and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • escitalopram

                escitalopram increases toxicity of levofloxacin by QTc interval. Use Caution/Monitor.

              • estradiol

                levofloxacin will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • estrogens conjugated synthetic

                levofloxacin will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • estropipate

                levofloxacin will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • ethinylestradiol

                levofloxacin will decrease the level or effect of ethinylestradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • ethotoin

                levofloxacin decreases effects of ethotoin by unknown mechanism. Use Caution/Monitor. There are also case reports of quinolones increasing phenytoin levels.

              • etodolac

                levofloxacin, etodolac. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • ezogabine

                ezogabine, levofloxacin. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

              • fennel

                fennel decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • fenoprofen

                levofloxacin, fenoprofen. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • ferric citrate

                ferric citrate will decrease the level or effect of levofloxacin by drug binding in GI tract. Use Caution/Monitor. Administer at least 2 hours before or after ferric citrate

              • flecainide

                flecainide and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • fluconazole

                fluconazole and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • fludrocortisone

                fludrocortisone and levofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • fluoxetine

                fluoxetine and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • fluphenazine

                fluphenazine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • flurbiprofen

                levofloxacin, flurbiprofen. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • fluvoxamine

                fluvoxamine and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • formoterol

                formoterol and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • foscarnet

                foscarnet and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • fosphenytoin

                levofloxacin decreases effects of fosphenytoin by unknown mechanism. Use Caution/Monitor. There are also case reports of quinolones increasing phenytoin levels.

              • fostemsavir

                levofloxacin and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

              • gemtuzumab

                levofloxacin and gemtuzumab both increase QTc interval. Use Caution/Monitor.

              • glimepiride

                levofloxacin increases effects of glimepiride by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • glipizide

                levofloxacin increases effects of glipizide by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • glyburide

                levofloxacin increases effects of glyburide by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • goserelin

                goserelin increases toxicity of levofloxacin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

              • haloperidol

                haloperidol and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • histrelin

                histrelin increases toxicity of levofloxacin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

              • hydrocortisone

                hydrocortisone and levofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • hydrocortisone rectal

                hydrocortisone rectal and levofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • ibuprofen

                levofloxacin, ibuprofen. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • ibuprofen IV

                levofloxacin, ibuprofen IV. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • iloperidone

                iloperidone and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • imipramine

                imipramine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • indacaterol, inhaled

                indacaterol, inhaled, levofloxacin. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

              • indomethacin

                levofloxacin, indomethacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • insulin aspart

                levofloxacin increases effects of insulin aspart by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • insulin detemir

                levofloxacin increases effects of insulin detemir by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • insulin glargine

                levofloxacin increases effects of insulin glargine by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • insulin glulisine

                levofloxacin increases effects of insulin glulisine by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • insulin lispro

                levofloxacin increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • insulin NPH

                levofloxacin increases effects of insulin NPH by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • insulin regular human

                levofloxacin increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • ketoconazole

                ketoconazole and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • ketoprofen

                levofloxacin, ketoprofen. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • ketorolac

                levofloxacin, ketorolac. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • ketorolac intranasal

                levofloxacin, ketorolac intranasal. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • lanthanum carbonate

                lanthanum carbonate decreases levels of levofloxacin by cation binding in GI tract. Use Caution/Monitor. Administer oral quinolone antibiotics at least 1 hr before or 4 hr after lanthanum. Interaction applies only to oral quinolones.

              • lapatinib

                lapatinib and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • lenvatinib

                levofloxacin and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

              • leuprolide

                leuprolide increases toxicity of levofloxacin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

              • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

                levofloxacin will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.

              • lofepramine

                lofepramine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • lumefantrine

                levofloxacin and lumefantrine both increase QTc interval. Modify Therapy/Monitor Closely.

              • magnesium chloride

                magnesium chloride decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • magnesium citrate

                magnesium citrate decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • magnesium hydroxide

                magnesium hydroxide decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • magnesium oxide

                magnesium oxide decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • magnesium sulfate

                magnesium sulfate decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • magnesium supplement

                magnesium supplement will decrease the level or effect of levofloxacin by Other (see comment). Modify Therapy/Monitor Closely. Formation of an insoluble complex reduces absorption of the drug through intestinal tract; administer magnesium 2hr before the quinolone or 2hr after the quinolone

              • maprotiline

                maprotiline and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • meclofenamate

                levofloxacin, meclofenamate. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • mefenamic acid

                levofloxacin, mefenamic acid. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • meloxicam

                levofloxacin, meloxicam. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • mestranol

                levofloxacin will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • metformin

                levofloxacin increases effects of metformin by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • methadone

                levofloxacin and methadone both increase QTc interval. Use Caution/Monitor.

              • methylprednisolone

                methylprednisolone and levofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • mifepristone

                mifepristone, levofloxacin. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

              • miglitol

                levofloxacin increases effects of miglitol by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • mometasone inhaled

                mometasone inhaled and levofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • moxifloxacin

                levofloxacin and moxifloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • nabumetone

                levofloxacin, nabumetone. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • naproxen

                levofloxacin, naproxen. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • nateglinide

                levofloxacin increases effects of nateglinide by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • nilotinib

                levofloxacin and nilotinib both increase QTc interval. Modify Therapy/Monitor Closely.

              • nortriptyline

                nortriptyline and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • octreotide

                levofloxacin and octreotide both increase QTc interval. Modify Therapy/Monitor Closely.

              • octreotide (Antidote)

                levofloxacin and octreotide (Antidote) both increase QTc interval. Modify Therapy/Monitor Closely.

              • ofloxacin

                levofloxacin and ofloxacin both increase QTc interval. Use Caution/Monitor.

              • olodaterol inhaled

                levofloxacin and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

              • osilodrostat

                osilodrostat and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • osimertinib

                osimertinib and levofloxacin both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

              • oxaliplatin

                oxaliplatin will increase the level or effect of levofloxacin by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

              • oxaprozin

                levofloxacin, oxaprozin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • ozanimod

                ozanimod and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

              • paliperidone

                levofloxacin and paliperidone both increase QTc interval. Use Caution/Monitor.

              • paroxetine

                levofloxacin and paroxetine both increase QTc interval. Use Caution/Monitor.

              • pasireotide

                levofloxacin and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

              • perphenazine

                perphenazine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • phenytoin

                levofloxacin decreases effects of phenytoin by unknown mechanism. Use Caution/Monitor. There are also case reports of quinolones increasing phenytoin levels.

              • pioglitazone

                levofloxacin increases effects of pioglitazone by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • piroxicam

                levofloxacin, piroxicam. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • posaconazole

                levofloxacin and posaconazole both increase QTc interval. Use Caution/Monitor.

              • prednisolone

                prednisolone and levofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • prednisone

                prednisone and levofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • prochlorperazine

                prochlorperazine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • promazine

                promazine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • promethazine

                promethazine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • protriptyline

                protriptyline and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • quetiapine

                quetiapine, levofloxacin. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

              • quinine

                levofloxacin and quinine both increase QTc interval. Use Caution/Monitor.

              • ranolazine

                levofloxacin and ranolazine both increase QTc interval. Use Caution/Monitor.

              • repaglinide

                levofloxacin increases effects of repaglinide by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • rilpivirine

                rilpivirine increases toxicity of levofloxacin by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.

              • risperidone

                levofloxacin and risperidone both increase QTc interval. Use Caution/Monitor.

              • romidepsin

                levofloxacin and romidepsin both increase QTc interval. Use Caution/Monitor.

              • rosiglitazone

                levofloxacin increases effects of rosiglitazone by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • saxagliptin

                levofloxacin increases effects of saxagliptin by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • selpercatinib

                selpercatinib increases toxicity of levofloxacin by QTc interval. Use Caution/Monitor.

              • sitagliptin

                levofloxacin increases effects of sitagliptin by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • sodium picosulfate/magnesium oxide/anhydrous citric acid

                levofloxacin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

                sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of levofloxacin by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation.

              • sodium sulfate/?magnesium sulfate/potassium chloride

                sodium sulfate/?magnesium sulfate/potassium chloride decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer fluoroquinolones at least 2 hr before and no less than 6 hr after each dose to avoid chelation with magnesium. .

              • sodium sulfate/potassium sulfate/magnesium sulfate

                sodium sulfate/potassium sulfate/magnesium sulfate decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer fluoroquinolones at least 2 hr before and no less than 6 hr after each dose to avoid chelation with magnesium. .

              • sorafenib

                sorafenib and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • sucralfate

                sucralfate decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • sulfamethoxazole

                sulfamethoxazole and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • sulindac

                levofloxacin, sulindac. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • telavancin

                levofloxacin and telavancin both increase QTc interval. Use Caution/Monitor.

              • terbinafine

                levofloxacin will increase the level or effect of terbinafine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • thioridazine

                thioridazine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • tolazamide

                levofloxacin increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • tolbutamide

                levofloxacin increases effects of tolbutamide by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • tolmetin

                levofloxacin, tolmetin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • trazodone

                trazodone and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • triamcinolone acetonide injectable suspension

                triamcinolone acetonide injectable suspension and levofloxacin both increase Other (see comment). Use Caution/Monitor. Coadministration of quinolone antibiotics and corticosteroids may increase risk of tendon rupture.

              • triclabendazole

                triclabendazole and levofloxacin both increase QTc interval. Use Caution/Monitor.

              • trifluoperazine

                trifluoperazine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • trimagnesium citrate anhydrous

                trimagnesium citrate anhydrous decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Multivalent cation-containing products may reduce bioavailability of quinolones; administer quinolone at least 2 hr before or 6 hr after magnesium; use alternatives if available.

              • trimethoprim

                levofloxacin and trimethoprim both increase QTc interval. Use Caution/Monitor.

              • trimipramine

                trimipramine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

              • triptorelin

                triptorelin increases toxicity of levofloxacin by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

              • tropisetron

                levofloxacin and tropisetron both increase QTc interval. Use Caution/Monitor.

              • venlafaxine

                levofloxacin and venlafaxine both increase QTc interval. Use Caution/Monitor.

              • vildagliptin

                levofloxacin increases effects of vildagliptin by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • voclosporin

                voclosporin, levofloxacin. Either increases effects of the other by QTc interval. Use Caution/Monitor.

              • voriconazole

                levofloxacin and voriconazole both increase QTc interval. Use Caution/Monitor.

              • warfarin

                levofloxacin increases effects of warfarin by Other (see comment). Use Caution/Monitor. Comment: Decr vitamin K-producing intestinal flora may increase INR after a few days.

                levofloxacin increases effects of warfarin by unknown mechanism. Use Caution/Monitor. Ciprofloxacin, norfloxacin, & ofloxacin are most likely to interact w/warfarin; data for other quinolones is conflicting. Monitor INR closely.

              • zinc

                zinc will decrease the level or effect of levofloxacin by cation binding in GI tract. Modify Therapy/Monitor Closely. Administer oral levofloxacin 2 hr before or after administration of polyvalent cation containing products.

              • ziprasidone

                levofloxacin and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

              Minor (35)

              • aceclofenac

                levofloxacin, aceclofenac. Other (see comment). Minor/Significance Unknown. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • acemetacin

                levofloxacin, acemetacin. Other (see comment). Minor/Significance Unknown. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • alprazolam

                levofloxacin increases levels of alprazolam by decreasing metabolism. Minor/Significance Unknown.

              • azithromycin

                azithromycin and levofloxacin both increase QTc interval. Minor/Significance Unknown.

              • balsalazide

                levofloxacin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • biotin

                levofloxacin will decrease the level or effect of biotin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • chlordiazepoxide

                levofloxacin increases levels of chlordiazepoxide by decreasing metabolism. Minor/Significance Unknown.

              • choline magnesium trisalicylate

                levofloxacin, choline magnesium trisalicylate. Other (see comment). Minor/Significance Unknown. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • clonazepam

                levofloxacin increases levels of clonazepam by decreasing metabolism. Minor/Significance Unknown.

              • clorazepate

                levofloxacin increases levels of clorazepate by decreasing metabolism. Minor/Significance Unknown.

              • estazolam

                levofloxacin increases levels of estazolam by decreasing metabolism. Minor/Significance Unknown.

              • fenbufen

                levofloxacin, fenbufen. Other (see comment). Minor/Significance Unknown. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • flurazepam

                levofloxacin increases levels of flurazepam by decreasing metabolism. Minor/Significance Unknown.

              • foscarnet

                levofloxacin, foscarnet. Mechanism: unknown. Minor/Significance Unknown. Risk of tonic clonic seizure.

              • green tea

                levofloxacin increases levels of green tea by decreasing elimination. Minor/Significance Unknown. (Caffeine). Some quinolones can inhibit the hepatic clearance of caffeine. Caution is advised.

              • isotretinoin

                levofloxacin, isotretinoin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased phototoxicity.

              • itraconazole

                itraconazole and levofloxacin both increase QTc interval. Minor/Significance Unknown.

              • loprazolam

                levofloxacin increases levels of loprazolam by decreasing metabolism. Minor/Significance Unknown.

              • lorazepam

                levofloxacin increases levels of lorazepam by decreasing metabolism. Minor/Significance Unknown.

              • lormetazepam

                levofloxacin increases levels of lormetazepam by decreasing metabolism. Minor/Significance Unknown.

              • lornoxicam

                levofloxacin, lornoxicam. Other (see comment). Minor/Significance Unknown. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • midazolam

                levofloxacin increases levels of midazolam by decreasing metabolism. Minor/Significance Unknown.

              • oxazepam

                levofloxacin increases levels of oxazepam by decreasing metabolism. Minor/Significance Unknown.

              • pantothenic acid

                levofloxacin will decrease the level or effect of pantothenic acid by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • parecoxib

                levofloxacin, parecoxib. Other (see comment). Minor/Significance Unknown. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • pazopanib

                levofloxacin and pazopanib both increase QTc interval. Minor/Significance Unknown.

              • pyridoxine

                levofloxacin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • pyridoxine (Antidote)

                levofloxacin will decrease the level or effect of pyridoxine (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • quazepam

                levofloxacin increases levels of quazepam by decreasing metabolism. Minor/Significance Unknown.

              • quercetin

                quercetin decreases effects of levofloxacin by pharmacodynamic antagonism. Minor/Significance Unknown.

              • salicylates (non-asa)

                levofloxacin, salicylates (non-asa). Other (see comment). Minor/Significance Unknown. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • temazepam

                levofloxacin increases levels of temazepam by decreasing metabolism. Minor/Significance Unknown.

              • thiamine

                levofloxacin will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • tolfenamic acid

                levofloxacin, tolfenamic acid. Other (see comment). Minor/Significance Unknown. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.

              • triazolam

                levofloxacin increases levels of triazolam by decreasing metabolism. Minor/Significance Unknown.

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              Adverse Effects

              1-10%

              Nausea (7%)

              Headache (6%)

              Diarrhea (5%)

              Insomnia (4%)

              Constipation (3%)

              Dizziness (3%)

              Dyspepsia (2%)

              Rash (2%)

              Vomiting (2%)

              Chest pain (1%)

              Dyspnea (1%)

              Edema (1%)

              Fatigue (1%)

              Injection-site reaction (1%)

              Moniliasis (1%)

              Pain (1%)

              Pruritus (1%)

              Vaginitis (1%)

              <1%

              Cardiac: Cardiac arrest, palpitation, ventricular tachycardia, arrhythmia

              Nervous system: Tremor, convulsions, paresthesia, vertigo, hypertonia, hyperkinesias, abnormal gait, somnolence, syncope

              Metabolic: Hypoglycemia, hyperglycemia, hyperkalemia

              Blood/lymphatic system: Anemia, thrombocytopenia, granulocytopenia

              Musculoskeletal/connective tissue: Arthralgia, tendonitis, myalgia, skeletal pain

              Gastrointestinal (GI): Gastritis, stomatitis, pancreatitis, esophagitis, gastroenteritis, glossitis, pseudomembranous/C difficile colitis

              Hepatobiliary: Abnormal hepatic function, increased hepatic enzymes, increased alkaline phosphatase

              Psychiatric: Anxiety, agitation, confusion, depression, hallucinations, nightmares, sleep disorder, anorexia, abnormal dreaming

              Other: Immune hypersensitivity reaction, acute renal failure, urticaria, phlebitis, epistaxis

              Postmarketing Reports

              Cardiac: Prolonged QT interval, torsades de pointes, tachycardia

              Vascular disorders: Aortic aneurysm and dissection

              Musculoskeletal/connective tissue: Tendon rupture, muscle injury, rhabdomyolysis

              Skin/subcutaneous tissue: Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, photosensitivity/phototoxicity, leukocytoclastic vasculitis

              Renal and urinary disorders: Interstitial nephritis

              Vascular disorders: Vasodilation; increased risk of aortic aneurysm and dissection

              Blood/lymphatic system: Pancytopenia, aplastic anemia, leukopenia, hemolytic anemia, eosinophilia

              Hepatobiliary: Hepatic failure, hepatitis, jaundice

              Psychiatric: Psychosis, paranoia, suicidal ideation, isolated reports of suicide attempts

              Nervous system: Exacerbation of myasthenia gravis, anosmia, ageusia, parosmia, dysgeusia, peripheral neuropathy, abnormal electroencephalogram (EEG), dysphonia, isolated reports of encephalopathy, pseudotumor cerebri

              Central nervous system effects (hallucinations, anxiety, depression, insomnia, severe headaches, and confusion)

              Respiratory, thoracic and mediastinal disorders: Isolated reports of allergic pneumonitis

              Immune system disorders: Hypersensitivity reactions, sometimes fatal including: anaphylactic/anaphylactoid reactions, anaphylactic shock, angioneurotic edema, serum sickness

              Eye disorders: Uveitis, vision disturbance (including diplopia), visual acuity reduced, vision blurred, scotoma

              Otologic: Hypoacusis, tinnitus

              General disorders and administration site conditions: Multiorgan failure, pyrexia

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              Warnings

              Black Box Warnings

              Serious adverse effects and limitations-of-use

              • Both oral and injectable fluoroquinolones are associated with disabling side effects involving tendons, muscles, joints, nerves and the central nervous system
              • Fluoroquinolones have been associated with disabling and potentially irreversible serious adverse reactions that have occurred together including: tendinitis and tendon rupture, peripheral neuropathy, and CNS effects
              • Discontinue the drug immediately and avoid use of systemic fluoroquinolones in patients who experience any of these serious adverse reactions
              • These side effects can occur hours to weeks after exposure to fluoroquinolones and may potentially be permanent

              May exacerbate muscle weakness in patients with myasthenia gravis; fluoroquinolones should be avoided in patients with known history of myasthenia gravis

              Because the risk of these serious side effects generally outweighs the benefits for patients with acute bacterial sinusitis, acute exacerbation of chronic bronchitis, and uncomplicated UTIs, that fluoroquinolones should be reserved for use in patients with these conditions who have no alternative treatment options

              For some serious bacterial infections, including anthrax, plague, and bacterial pneumonia among others, the benefits of fluoroquinolones outweigh the risks and it is appropriate for them to remain available as a therapeutic option

              Contraindications

              Documented hypersensitivity

              Cautions

              Anaphylactic reactions and allergic skin reactions, serious, occasionally fatal, may occur after first dose

              Use caution in hematologic and renal toxicities

              Hepatotoxicity reported with therapy

              Peripheral neuropathy: Sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias, and weakness reported; peripheral neuropathy may occur rapidly after initiating and may potentially become permanent

              Commonly seen adverse reactions include tendinitis, tendon rupture, arthralgia, myalgia, peripheral neuropathy, and central nervous system effects (hallucinations, anxiety, depression, insomnia, severe headaches, and confusion); these reactions can occur within hours to weeks after starting therapy, including in patients of any age or without pre-existing risk factors; discontinue therapy immediately at first signs or symptoms of any serious adverse reaction; in addition, avoid use of fluoroquinolones, in patients who have experienced any serious adverse reactions associated with fluoroquinolones

              Risk of developing fluoroquinolone-associated tendinitis and tendon rupture is increased in patients over 60 years of age, in patients taking corticosteroid drugs, and in patients with kidney, heart or lung transplants; other factors that may independently increase risk of tendon rupture include strenuous physical activity, renal failure, and previous tendon disorders such as rheumatoid arthritis (see Black Box Warnings)

              Excessive sunlight may result in moderate-to-severe phototoxicity

              Fatal hypoglycemia reported in elderly patients with or without diabetes; prompt treatment when symptoms are present is essential

              May cause C difficile-associated colitis

              Prolonged use may result in fungal or bacterial superinfection

              Prolongation of QT interval and isolated cases of torsades de pointes; avoid use in patients with known QT prolongation, those with hypokalemia, and those taking other QT-prolonging drugs

              May produce false-positive urine opiate screens

              In prolonged therapy, perform periodic evaluations of organ system function (eg, renal, hepatic, hematopoietic); adjust dosage in renal impairment; superinfections may occur with prolonged or repeated antibiotic therapy

              Pediatric patients may experience increased incidence of musculoskeletal disorders (eg, arthralgia, arthritis, tendinopathy, gait abnormality)

              Acute onset of retinal detachment increased 4.5-fold with oral fluoroquinolones in a single case-controlled study - JAMA 2012;307(13):1414-1419; another study disputes these findings (relative risk, 1.29) - JAMA 2013;310(20):2184-2190

              Clostridium difficile-associated diarrhea (CDAD) has been reported; if CDAD suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued; appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated

              Prescribing antibiotics in absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to patient and increases risk of development of drug-resistant bacteria

              CNS effects

              • Fluoroquinolones have been associated with an increased risk of CNS effects, including: convulsions, increased intracranial pressure (including pseudotumor cerebri), and toxic psychosis
              • May also cause CNS events including: nervousness, agitation, insomnia, anxiety, nightmares, paranoia, dizziness, confusion, tremors, hallucinations, depression, and psychotic reactions have progressed to suicidal ideations/thoughts and self-injurious behavior such as attempted or completed suicide; reactions may occur following the first dose; advise patients to inform their healthcare provider immediately if these reactions occur, discontinue treatment, and institute appropriate care
              • Fluoroquinolone are also known to trigger seizures or lower the seizure threshold; use with caution in epileptic patients and patients with known or suspected CNS disorders that may predispose to seizures or lower the seizure threshold (eg, severe cerebral arteriosclerosis, previous history of convulsion, reduced cerebral blood flow, altered brain structure, or stroke), or in the presence of other risk factors that may predispose to seizures or lower the seizure threshold (eg, certain drug therapy, renal dysfunction)

              FDA MedWatch Safety Alert

              • Issued 12-20-2018
              • Increase in rate of aortic aneurysm and dissection reported within two months following use of fluoroquinolones, particularly in elderly patients
              • May occur with fluoroquinolones for systemic use (IV or PO)
              • Patients who have an aortic aneurysm or are at risk for an aortic aneurysm (eg, patients with peripheral atherosclerotic vascular diseases, hypertension, certain genetic conditions [eg, Marfan syndrome, Ehlers-Danlos syndrome], elderly patients)
              • Prescribe fluoroquinolones to these patients only when no other treatment options are available
              • Advise patients to seek immediate medical treatment for any symptoms associated with aortic aneurysm
              • Stop treatment immediately if a patient reports side effects suggestive of aortic aneurysm or dissection

              FDA MedWatch Safety Alert

              • Issued July 10, 2018
              • The FDA is strengthening the current warnings in the prescribing information for fluoroquinolone antibiotics to inform clinicians of significant decreases in blood glucose and certain mental health adverse effects
              • Hypoglycemia, sometimes resulting in coma, occurred more frequently in elderly patients or in diabetic patients taking oral hypoglycemic medicine or insulin
              • Alert patients regarding hypoglycemic symptoms and carefully monitor blood glucose levels; instruct patients how to treat themselves if symptoms of hypoglycemia occur
              • This safety alert affects only systemic formulations; early signs and symptoms of low blood glucose include confusion, dizziness, feeling shaky, unusual hunger, headaches, irritability, pounding heart or very fast pulse, pale skin, sweating, trembling, weakness, and/or unusual anxiety
              • Mental health side effects are to be added to or updated across all the fluoroquinolones are disturbances in attention, disorientation, agitation, nervousness, memory impairment, and delirium
              • Inform patients of the potential risk of psychiatric adverse reactions that can occur after just 1 dose
              • Immediately discontinue treatment if CNS adverse effects occur, including psychiatric adverse reactions, or blood glucose disturbances occur and switch to a nonfluoroquinolone antibiotic if possible
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              Pregnancy & Lactation

              Pregnancy

              Levofloxacin has not been shown to increase risk of major birth defects, miscarriage or adverse maternal or fetal outcomes

              Animal data

              • Oral administration to pregnant rats and rabbits during organogenesis at doses up to 9.4 times and 1.1 times the maximum recommended human dose (MRHD), respectively, did not result in teratogenicity; fetal toxicity reported in the rat study, but absent at doses up to 1.2 times maximum recommended human dose

              Lactation

              Drug is present in human milk following intravenous and oral administration; there is no information regarding effects on milk production or breastfed infant; because of potential risks of serious adverse reactions, in breastfed infants, a lactating woman may consider pumping and discarding breast milk during treatment and an additional two days (five half-lives) after last dose

              Alternatively, advise a lactating woman that breastfeeding is not recommended during treatment and for an additional two days (five half-lives) after last dose

              For inhalation anthrax (post-exposure), during an incident resulting in exposure to anthrax, risk-benefit assessment of continuing breastfeeding while the mother (and potentially the infant) is (are) on this drug may be acceptable

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              L-stereoisomer of parent compound ofloxacin; D-isomer form is inactive

              Inhibits DNA gyrase activity, which in turn promotes breakage of DNA strands

              Good monotherapy with extended coverage against Pseudomonas spp, as well as excellent activity against pneumococcus

              Absorption

              Well absorbed

              Bioavailability: 99%

              Peak serum time: 1-2 hr

              Distribution

              Cerebrospinal fluid (CSF) concentrations ~15% of serum levels; high concentrations achieved in prostate, gynecologic tissues, sinus, breast milk, saliva

              Vd: 74-112 L

              Metabolism

              Limited metabolism in humans

              Elimination

              Half-life: 6-8 hr

              Excretion: Urine (primarily as unchanged drug); after oral administration, 87% is recovered as unchanged drug in urine within 48 hr, and <4% is recovered in feces in 72 hr

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              Administration

              Oral Administration

              Administer without regard to food

              Oral solution should be taken 1 hour before or 2 hours after eating

              IV Incompatibilities

              Y-site: Acyclovir, alprostadil, furosemide, heparin, indomethacin, insulin (at 100 U/mL + 5 mg/mL levofloxacin), nitroglycerin, propofol, sodium nitroprusside

              IV Compatibilities

              Additive: Linezolid

              Y-site: Amikacin, aminophylline, ampicillin, bivalirudin, caffeine, cefotaxime, cimetidine, clindamycin, dexamethasone, dexmedetomidine, dobutamine, dopamine, epinephrine, fenoldopam, fentanyl, gentamicin, lactated hetastarch, insulin (at 1 U/mL + 5 mg/mL levofloxacin), isoproterenol, lidocaine, linezolid, lorazepam, metoclopramide, oxacillin, pancuronium, penicillin G sodium, phenobarbital, phenylephrine, sodium bicarbonate, vancomycin

              IV Preparation

              Premixed: No further preparation needed

              Single-use vials: Dilute in 50-100 mL D5W or NS or D5/NS solution for injection to 5 mg/mL; alternative solutions include sodium lactate, Plasma-Lyte, D5/lactated Ringer, D5/NS and potassium chloride

              Reconstituted solution should be clear, slightly yellow, and free of particulate matter

              Reconstituted drug is stable for 72 hours at room temperature, 14 days when refrigerated in plastic containers, and 6 months when frozen

              Thaw at room temperature or in refrigerator only

              IV Administration

              Give by IV infusion only, not bolus; rapid or bolus administration has been associated with hypotension and must be avoided

              Infuse 250-500 mg over 60 minutes or 750 mg over 90 minutes

              Avoid using IV line with solution containing multivalent cations (ie, magnesium, calcium)

              Compatible with potassium additives

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              levofloxacin ophthalmic (eye)
              -
              0.5 % drops
              levofloxacin ophthalmic (eye)
              -
              0.5 % drops
              levofloxacin ophthalmic (eye)
              -
              0.5 % drops
              levofloxacin oral
              -
              500 mg tablet
              levofloxacin oral
              -
              500 mg tablet
              levofloxacin oral
              -
              750 mg tablet
              levofloxacin oral
              -
              250 mg/10 mL solution
              levofloxacin oral
              -
              250 mg/10 mL solution
              levofloxacin oral
              -
              500 mg tablet
              levofloxacin oral
              -
              750 mg tablet
              levofloxacin oral
              -
              250 mg tablet
              levofloxacin oral
              -
              500 mg tablet
              levofloxacin oral
              -
              500 mg tablet
              levofloxacin oral
              -
              500 mg tablet
              levofloxacin oral
              -
              750 mg tablet
              levofloxacin oral
              -
              750 mg tablet
              levofloxacin oral
              -
              750 mg tablet
              levofloxacin oral
              -
              250 mg tablet
              levofloxacin oral
              -
              500 mg tablet
              levofloxacin oral
              -
              750 mg tablet
              levofloxacin oral
              -
              250 mg/10 mL solution
              levofloxacin oral
              -
              250 mg/10 mL solution
              levofloxacin oral
              -
              250 mg tablet
              levofloxacin oral
              -
              250 mg tablet
              levofloxacin oral
              -
              750 mg tablet
              levofloxacin oral
              -
              500 mg tablet
              levofloxacin oral
              -
              250 mg tablet
              levofloxacin oral
              -
              250 mg tablet
              levofloxacin oral
              -
              250 mg/10 mL solution
              levofloxacin oral
              -
              250 mg/10 mL solution
              levofloxacin oral
              -
              750 mg tablet
              levofloxacin oral
              -
              500 mg tablet
              levofloxacin oral
              -
              250 mg tablet
              levofloxacin intravenous
              -
              25 mg/mL vial
              levofloxacin intravenous
              -
              25 mg/mL vial
              levofloxacin intravenous
              -
              25 mg/mL vial
              levofloxacin intravenous
              -
              25 mg/mL vial
              levofloxacin intravenous
              -
              25 mg/mL vial
              levofloxacin intravenous
              -
              25 mg/mL vial
              levofloxacin intravenous
              -
              25 mg/mL vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Select a drug:
              Patient Education
              levofloxacin ophthalmic (eye)

              LEVOFLOXACIN DROPS - OPHTHALMIC

              (LEE-voe-FLOX-a-sin)

              COMMON BRAND NAME(S): Quixin

              USES: This medication is used to treat bacterial eye infections. Levofloxacin belongs to a class of drugs known as quinolone antibiotics. It works by stopping the growth of bacteria.This medication treats only bacterial eye infections. It will not work for other types of eye infections. Using any antibiotic when it is not needed can cause it to not work for future infections.

              HOW TO USE: This medication is applied to the eye(s) as directed by your doctor. To apply eye drops, wash hands first. To avoid contamination, do not touch the dropper tip or let it touch your eye or any other surface.Do not wear contact lenses while you are using this medicine. Sterilize contact lenses according to the manufacturer's directions, and check with your doctor before you begin using them again.Tilt your head back, look upward, and pull down the lower eyelid to make a pouch. Hold the dropper directly over your eye and place one drop into the pouch. Look downward, gently close your eyes, and place one finger at the corner of your eye (near the nose). Apply gentle pressure for 1 to 2 minutes before opening your eyes. This will prevent the medication from draining out. Try not to blink or rub your eye. Repeat these steps if your dose is for more than one drop. If directed to use this medication in both eyes, repeat these steps for your other eye. Do not rinse the dropper. Replace the dropper cap after each use.If you are using another kind of eye medication (such as drops or ointments), wait at least 5 minutes before applying other medications. Use eye drops before eye ointments to allow the drops to enter the eye.Use this medication regularly to get the most benefit from it. To help you remember, use it at the same time(s) each day. Continue to use this medication for the full time prescribed, even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a return of the infection.Tell your doctor if your condition lasts or gets worse.

              SIDE EFFECTS: Temporary blurred or decreased vision, temporary stinging/burning/pain in the eyes, feeling as if something is in the eye, fever, headache, sore throat, or sensitivity of the eyes to light may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using levofloxacin, tell your doctor or pharmacist if you are allergic to it; or to other quinolone antibiotics (such as ciprofloxacin, norfloxacin, ofloxacin); or if you have any other allergies. This product may contain inactive ingredients (such as preservatives like benzalkonium chloride), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: other eye problems.After you apply this drug, your vision may become temporarily blurred. Do not drive, use machinery, or do any activity that requires clear vision until you are sure you can perform such activities safely.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this form of levofloxacin passes into breast milk. The form taken by mouth passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

              OVERDOSE: This medicine may be harmful if swallowed. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Throw away the unused medication after treatment is completed. Do not use it later for another infection unless your doctor tells you to.

              MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from heat, light, and moisture. Do not store in the bathroom. If the solution turns brown or cloudy or contains particles, do not use it. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.