levofloxacin (Rx)

Brand and Other Names:Levaquin, Levofloxacin Systemic

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 antimicrobials#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 antimicrobials#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 antimicrobials#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 to <5 years: 8-10 mg/kg/dose PO/IV q 12 hr; not to exceed 750mg/day
  • 5-16 years: 8-10 mg/kg/dose PO qDay for 10 days; not to exceed 750 mg/day

Mycoplasma pneumonia or Chlamydia

  • 6 months to <5 years: 8- 10 mg/kg/dose IV q12hr; not to exceed 750 mg/day  
  • 5-16 years: 8- 10 mg/kg/dose IV q24 hr; not to exceed 750 mg/day
Next:

Interactions

Interaction Checker

and levofloxacin

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            Contraindicated (1)

            • fezolinetant

              levofloxacin will increase the level or effect of fezolinetant by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated. Fezolinetant AUC and peak plasma concentration are increased if coadministered with drugs that are weak, moderate, or strong CYP1A2 inhibitors

            Serious - Use Alternative (74)

            • adagrasib

              adagrasib, levofloxacin. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

            • 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.

            • amisulpride

              amisulpride and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

            • anagrelide

              anagrelide 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.

            • asenapine

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

            • asenapine transdermal

              asenapine transdermal 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.

            • buprenorphine

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

            • buprenorphine buccal

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

            • buprenorphine subdermal implant

              buprenorphine subdermal implant and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • buprenorphine, long-acting injection

              buprenorphine, long-acting injection and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • 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.

            • desflurane

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

            • 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.

            • encorafenib

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

            • entrectinib

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

            • eribulin

              eribulin and levofloxacin 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.

            • isoflurane

              isoflurane and levofloxacin both increase QTc interval. 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.

            • microbiota oral

              levofloxacin decreases effects of microbiota oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Microbiota oral contains bacterial spores. Antibacterial agents may decrease efficacy if coadministered. Complete antibiotic regimens 2-4 days before initiating microbiota oral. .

            • 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.

            • oxaliplatin

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

            • 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.

            • sevoflurane

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

            • siponimod

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

            • 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.

            • tetrabenazine

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

            • 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 (212)

            • 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.

            • buprenorphine transdermal

              buprenorphine transdermal and levofloxacin both increase QTc interval. Use Caution/Monitor.

            • 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.

            • deutetrabenazine

              deutetrabenazine and levofloxacin both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

            • 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.

            • donepezil

              donepezil 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.

            • efavirenz

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

            • eliglustat

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

            • 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

            • fingolimod

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

            • 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.

            • gadobenate

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

            • gemtuzumab

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

            • gilteritinib

              gilteritinib and levofloxacin 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.

            • granisetron

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

            • 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.

            • hydroxyzine

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

            • 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.

            • levoketoconazole

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

            • 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.

            • lithium

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

            • 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.

            • mirtazapine

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

            • 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.

            • olanzapine

              olanzapine and levofloxacin 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.

            • primaquine

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

            • 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.

            • sertraline

              sertraline and levofloxacin both increase 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.

            • sunitinib

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

            • tacrolimus

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

            • 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.

            • valbenazine

              valbenazine and levofloxacin 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.

            • vorinostat

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

            • warfarin

              levofloxacin increases effects of warfarin by unspecified interaction mechanism. Use Caution/Monitor.

            • 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 antimicrobials#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 antimicrobials#fluoroquinolones in patients who experience any of these serious adverse reactions
            • These side effects can occur hours to weeks after exposure to antimicrobials#fluoroquinolones and may potentially be permanent

            May exacerbate muscle weakness in patients with myasthenia gravis; antimicrobials#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 antimicrobials#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 antimicrobials#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 antimicrobials#fluoroquinolones, in patients who have experienced any serious adverse reactions associated with antimicrobials#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 antimicrobials#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 antimicrobials#fluoroquinolones, particularly in elderly patients
            • May occur with antimicrobials#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 antimicrobials#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 antimicrobials#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

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            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Select a drug:
            Patient Education
            levofloxacin oral

            LEVOFLOXACIN SOLUTION - ORAL

            (LEE-voe-FLOX-a-sin)

            COMMON BRAND NAME(S): Levaquin

            WARNING: Quinolone antibiotics (including levofloxacin) may cause serious and possibly permanent tendon damage (such as tendonitis, tendon rupture), nerve problems in the arms and legs (peripheral neuropathy), and nervous system problems. Get medical help right away if you have any of the following symptoms: pain/numbness/burning/tingling/weakness in your arms/hands/legs/feet, changes in how you sense touch/pain/temperature/vibration/body position, severe/lasting headache, vision changes, shaking (tremors), seizures, mental/mood changes (such as agitation, anxiety, confusion, hallucinations, depression, rare thoughts of suicide).Tendon damage may occur during or after treatment with this medication. Stop exercising, rest, and get medical help right away if you develop joint/muscle/tendon pain or swelling. Your risk for tendon problems is greater if you are over 60 years of age, if you are taking corticosteroids (such as prednisone), or if you have a kidney, heart, or lung transplant.This medication may make a certain muscle condition (myasthenia gravis) worse. Tell your doctor right away if you have new or worsening muscle weakness (such as drooping eyelids, unsteady walk) or trouble breathing.Discuss the risks and benefits with your doctor before using this medication.

            USES: Levofloxacin is used to treat a variety of bacterial infections. This medication belongs to a class of drugs known as quinolone antibiotics. It works by stopping the growth of bacteria.This antibiotic treats only bacterial infections. It will not work for viral infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.

            HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking levofloxacin and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth as directed by your doctor, usually once daily. Take this medication on an empty stomach (1 hour before or 2 hours after eating). Drink plenty of fluids while taking this medication unless otherwise directed by your doctor.Take this medication at least 2 hours before or 2 hours after taking other products that may make it work less well. Some examples include: quinapril, sucralfate, vitamins/minerals (including iron, zinc), and products that contain magnesium, aluminum, or calcium (such as antacids, didanosine solution, calcium-enriched juice). Ask your pharmacist about all the products you take.Carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.The dosage and length of treatment are based on your medical condition and response to treatment. In children, the dosage is also based on weight.For the best effect, take this antibiotic at evenly spaced times. To help you remember, take this medication at the same time every day.Continue to take this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.Tell your doctor if your condition lasts or gets worse.

            SIDE EFFECTS: See also Warning section.Nausea, diarrhea, headache, dizziness, lightheadedness, or trouble sleeping 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.Tell your doctor right away if you have any serious side effects, including: unusual bruising/bleeding, signs of kidney problems (such as change in the amount of urine), signs of liver problems (such as nausea/vomiting that doesn't stop, loss of appetite, stomach/abdominal pain, yellowing eyes/skin, dark urine).Get medical help right away if you have any very serious side effects, including: chest pain, severe dizziness, fainting, fast/irregular heartbeat, signs of a tear/break in the main blood vessel called the aorta (such as sudden/severe pain in the stomach/chest/back, shortness of breath).This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.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 taking levofloxacin, tell your doctor or pharmacist if you are allergic to it; or to other quinolone antibiotics (such as ciprofloxacin, moxifloxacin, ofloxacin); or if you have any other allergies. This product may contain inactive ingredients, 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: diabetes, joint/tendon problems (such as tendonitis, bursitis), kidney problems, mental/mood disorders (such as depression), a certain muscle condition (myasthenia gravis), nerve problems (such as peripheral neuropathy), seizure disorder, blood vessel problems (such as aneurysm or blockage of the aorta or other blood vessels, hardening of the arteries), high blood pressure, certain genetic conditions (Marfan syndrome, Ehlers-Danlos syndrome).Levofloxacin may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using levofloxacin, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using levofloxacin safely.Levofloxacin may rarely cause serious changes in blood sugar, especially if you have diabetes. Watch for symptoms of high blood sugar such as increased thirst/urination. Also watch for symptoms of low blood sugar such as sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet. It is a good habit to carry glucose tablets or gel to treat low blood sugar. If you don't have these reliable forms of glucose, rapidly raise your blood sugar by eating a quick source of sugar such as table sugar, honey, or candy, or by drinking fruit juice or non-diet soda. Tell your doctor right away about the reaction and the use of this product. To help prevent low blood sugar, eat meals on a regular schedule, and no not skip meals. Your doctor may need to switch you to another antibiotic or adjust your diabetes medications if any reaction occurs.This drug may make you dizzy or lightheaded. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.Levofloxacin may cause live bacterial vaccines (such as typhoid vaccine) to not work well. Tell your health care professional that you are using levofloxacin before having any immunizations/vaccinations.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Children may be at greater risk for joint/tendon problems while using this drug. Discuss the risks and benefits with the doctor.Older adults may be at greater risk for tendon problems (especially if they are also taking corticosteroids such as prednisone or hydrocortisone), QT prolongation, and a sudden tear/break in the main blood vessel (aorta).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This drug passes into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: See also How to Use section.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.A product that may interact with this drug is: strontium.Levofloxacin is very similar to ofloxacin. Do not use medications containing ofloxacin while using levofloxacin.This medication may interfere with certain lab tests (such as urine screening for opiates), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.

            OVERDOSE: 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. Symptoms of overdose may include: severe dizziness.

            NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor tells you to.Lab tests (such as kidney function, complete blood count, blood sugar, cultures) may be done before you start taking this medication and while you are taking it. Keep all medical and lab appointments.

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

            STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. 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 June 2022. Copyright(c) 2023 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.

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            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
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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.