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levofloxacin (Oral route)

Pronunciation

lee-voe-FLOX-a-sin

Oral route(Tablet;Solution)

Fluoroquinolones, including levofloxacin, are associated with an increased risk of tendinitis and tendon rupture in all ages. Risk further increases with age over 60 years, concomitant steroid therapy, and kidney, heart, or lung transplants. Fluoroquinolones, including levofloxacin, may exacerbate muscle weakness in persons with myasthenia gravis. Avoid in patients with known history of myasthenia gravis .

Commonly used brand name(s)

In the U.S.

  • Levaquin

Available Dosage Forms:

  • Solution
  • Tablet
  • Syrup

Therapeutic Class: Antibiotic

Chemical Class: Fluoroquinolone

Uses For levofloxacin

Levofloxacin is used to treat bacterial infections in many different parts of the body. It is also used to prevent an anthrax infection after a person has been exposed to anthrax. levofloxacin is also used to treat and prevent plague (including pneumonic and septicemic plague).

Slideshow: 2014 Update: First Time Brand-to-Generic Switches

Levofloxacin belongs to the class of medicines known as quinolone antibiotics. It works by killing bacteria or preventing their growth. However, levofloxacin will not work for colds, flu, or other virus infections.

levofloxacin is available only with your doctor's prescription.

Before Using levofloxacin

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For levofloxacin, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to levofloxacin or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Use is not recommended for infants, children, or teenagers. However, levofloxacin may be used in children 6 months of age and older to treat plague and to prevent an anthrax infection after a possible exposure.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of levofloxacin in the elderly. However, elderly patients are more likely to have age-related tendon disorders (including tendon rupture) and kidney, liver, or heart problems, which may require caution and an adjustment in the dose for patients receiving levofloxacin.

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking levofloxacin, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using levofloxacin with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Amifampridine
  • Cisapride
  • Dronedarone
  • Mesoridazine
  • Pimozide
  • Piperaquine
  • Sparfloxacin
  • Thioridazine

Using levofloxacin with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acarbose
  • Acecainide
  • Acetohexamide
  • Alfuzosin
  • Amiodarone
  • Amitriptyline
  • Amoxapine
  • Apomorphine
  • Arsenic Trioxide
  • Artemether
  • Asenapine
  • Astemizole
  • Azimilide
  • Azithromycin
  • Bedaquiline
  • Benfluorex
  • Bretylium
  • Chloroquine
  • Chlorpromazine
  • Chlorpropamide
  • Ciprofloxacin
  • Citalopram
  • Clarithromycin
  • Clomipramine
  • Clozapine
  • Crizotinib
  • Cyclobenzaprine
  • Dabrafenib
  • Dasatinib
  • Delamanid
  • Desipramine
  • Disopyramide
  • Dofetilide
  • Dolasetron
  • Domperidone
  • Droperidol
  • Erythromycin
  • Escitalopram
  • Fingolimod
  • Flecainide
  • Fluconazole
  • Fluoxetine
  • Formoterol
  • Gatifloxacin
  • Gemifloxacin
  • Gliclazide
  • Glimepiride
  • Glipizide
  • Gliquidone
  • Glyburide
  • Granisetron
  • Guar Gum
  • Halofantrine
  • Haloperidol
  • Ibutilide
  • Iloperidone
  • Imipramine
  • Insulin
  • Insulin Aspart, Recombinant
  • Insulin Glulisine
  • Insulin Lispro, Recombinant
  • Ivabradine
  • Ketoconazole
  • Lapatinib
  • Lopinavir
  • Lumefantrine
  • Mefloquine
  • Metformin
  • Methadone
  • Mifepristone
  • Miglitol
  • Moricizine
  • Moxifloxacin
  • Nilotinib
  • Norfloxacin
  • Nortriptyline
  • Octreotide
  • Ofloxacin
  • Ondansetron
  • Paliperidone
  • Pasireotide
  • Pazopanib
  • Perflutren Lipid Microsphere
  • Perphenazine
  • Posaconazole
  • Procainamide
  • Prochlorperazine
  • Promethazine
  • Propafenone
  • Protriptyline
  • Quetiapine
  • Quinidine
  • Quinine
  • Ranolazine
  • Rasagiline
  • Salmeterol
  • Saquinavir
  • Sematilide
  • Sevoflurane
  • Sodium Phosphate
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate, Monobasic
  • Solifenacin
  • Sorafenib
  • Sotalol
  • Sunitinib
  • Tedisamil
  • Telavancin
  • Telithromycin
  • Terfenadine
  • Tetrabenazine
  • Theophylline
  • Tizanidine
  • Tolazamide
  • Tolbutamide
  • Toremifene
  • Trazodone
  • Trifluoperazine
  • Trimipramine
  • Troglitazone
  • Vandetanib
  • Vardenafil
  • Vemurafenib
  • Vilanterol
  • Vinflunine
  • Voriconazole
  • Warfarin
  • Ziprasidone

Using levofloxacin with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Aluminum Carbonate, Basic
  • Aluminum Hydroxide
  • Aluminum Phosphate
  • Betamethasone
  • Calcium
  • Corticotropin
  • Cortisone
  • Cosyntropin
  • Deflazacort
  • Dexamethasone
  • Dihydroxyaluminum Aminoacetate
  • Dihydroxyaluminum Sodium Carbonate
  • Fludrocortisone
  • Fluocortolone
  • Hydrocortisone
  • Iron
  • Magaldrate
  • Magnesium Carbonate
  • Magnesium Hydroxide
  • Magnesium Oxide
  • Magnesium Trisilicate
  • Methylprednisolone
  • Paramethasone
  • Prednisolone
  • Prednisone
  • Triamcinolone

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of levofloxacin. Make sure you tell your doctor if you have any other medical problems, especially:

  • Bradycardia (slow heartbeat) or
  • Diabetes or
  • Diarrhea or
  • Heart rhythm problems (eg, prolonged QT interval), or family history of or
  • Hypokalemia (low potassium in the blood), uncorrected or
  • Liver disease (including hepatitis) or
  • Myocardial ischemia (reduced blood supply in the heart) or
  • Seizures (epilepsy), or history of—Use with caution. May make these conditions worse. .
  • Brain disease (eg, hardening of the arteries) or
  • Kidney disease, severe or
  • Organ transplant (eg, heart, kidney, or lung), history of or
  • Tendon disorder (eg, rheumatoid arthritis), history of—Use with caution. May cause side effects to become worse.
  • Myasthenia gravis (severe muscle weakness), or history of—Should not be used in patients with this condition.

Proper Use of levofloxacin

Take levofloxacin only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

levofloxacin comes with a Medication Guide. Read and follow the instructions carefully. Ask your doctor if you have any questions.

Levofloxacin oral liquid should be taken 1 hour before or 2 hours after eating. You may measure your dose with a marked measuring spoon, oral syringe, or medicine cup.

Levofloxacin tablets may be taken with meals or on an empty stomach.

levofloxacin is best taken with a full glass (8 ounces) of water. Several additional glasses of water should be taken every day, unless otherwise directed by your doctor. Drinking extra water will help to prevent some unwanted effects of levofloxacin.

levofloxacin works best when there is a constant amount in the blood. To help keep the amount constant, do not miss any doses. Also, it is best to take the doses at evenly spaced times, day and night. For example, if you are to take one dose a day, try to take it at the same time each day.

If you need to take levofloxacin for anthrax infection or plague, your doctor will want you to begin taking it as soon as possible after you are exposed to anthrax or bacteria causing the plague.

If you are taking aluminum or magnesium-containing antacids, iron supplements, multivitamins, didanosine (Videx®), sucralfate (Carafate®), or zinc, do not take them at the same time that you take levofloxacin. It is best to take these medicines at least 2 hours before or 2 hours after taking levofloxacin. These medicines may keep levofloxacin from working properly.

Keep using levofloxacin for the full treatment time, even if you feel better after the first few doses. Your infection may not clear up if you stop using the medicine too soon.

Dosing

The dose of levofloxacin will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of levofloxacin. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage forms (oral solution or tablets):
    • For treatment of an infection:
      • Adults—250 to 750 milligrams (mg) once a day.
      • Children—Use and dose must be determined by your doctor.
    • For preventing anthrax infection:
      • Adults—500 milligrams (mg) once a day.
      • Children 6 months of age and older and weighing more than 50 kilograms (kg)—500 mg once a day.
      • Children 6 months of age and older and weighing less than 50 kg—Dose is based on body weight and must be determined by your doctor. The dose is usually 8 mg per kg of body weight per dose, given two times a day. However, the dose is usually not more than 250 mg.
      • Infants younger than 6 months of age—Use and dose must be determined by your doctor.
    • For treatment and prevention of plague:
      • Adults—500 milligrams (mg) once a day.
      • Children 6 months of age and older, weighing more than 50 kilograms (kg)—500 mg once a day.
      • Children 6 months of age and older, weighing less than 50 kg—Dose is based on body weight and must be determined by your doctor. The dose is usually 8 mg per kg of body weight per dose, given two times a day. However, the dose is usually not more than 250 mg.
      • Infants younger than 6 months of age—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of levofloxacin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using levofloxacin

It is very important that your doctor check your progress while you are using levofloxacin. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. Blood and urine tests may be needed to check for unwanted effects.

If your symptoms do not improve within a few days, or if they become worse, check with your doctor.

Levofloxacin may rarely cause inflammation (tendinitis) or tearing of a tendon (the cord that attaches muscles to the bones). This can occur while you are taking the medicine or after you finish using it. The risk of having tendon problems may be increased if you are over 60 years of age, are using steroid medicines (eg, dexamethasone, prednisolone, prednisone, or Medrol®), have severe kidney problems, have a history of tendon problems (eg, rheumatoid arthritis), or have received an organ (eg, heart, kidney, or lung) transplant. Check with your doctor right away if you get sudden pain or swelling in a tendon after exercise (eg, in the ankle, back of the knee or leg, shoulder, elbow, or wrist), bruise more easily after an injury, or are unable to bear weight or move the affected area. Refrain from exercise until your doctor says otherwise.

levofloxacin may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and require immediate medical attention. Call your doctor right away if you have a rash, itching, hives, hoarseness, lightheadedness or fainting, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth after you take levofloxacin.

Serious skin reactions can occur with levofloxacin. Check with your doctor right away if you have blistering, peeling, or loose skin, red skin lesions, severe acne or skin rash, sores or ulcers on the skin, or fever or chills while you are using levofloxacin.

Levofloxacin may cause serious liver problems, including hepatitis. Check with your doctor right away if you start having nausea or vomiting, dark urine, light-colored stools, stomach pain, or yellow eyes or skin while you are using levofloxacin.

Levofloxacin may cause diarrhea, and in some cases it can be severe. It may occur 2 months or more after you stop using levofloxacin. Do not take any medicine to treat diarrhea without first checking with your doctor. Diarrhea medicines may make the diarrhea worse or make it last longer. If you have any questions about this or if mild diarrhea continues or gets worse, check with your doctor.

Tell your doctor right away if you start having numbness, tingling, or burning pain in your hands, arms, legs, or feet. These may be symptoms of a condition called peripheral neuropathy.

If you have low blood potassium or an abnormally slow heartbeat, levofloxacin may increase your risk of having a fast, slow, or irregular heartbeat, loss of consciousness, or fainting spells. If these symptoms occur, tell your doctor right away.

If you are a diabetic patient taking insulin or diabetes medicine by mouth: Levofloxacin may cause hypoglycemia (low blood sugar) in some patients. Symptoms of low blood sugar must be treated before they lead to unconsciousness (passing out). Different people may feel different symptoms of low blood sugar. If you experience symptoms of low blood sugar, stop taking levofloxacin and check with your doctor right away:

  • Symptoms of low blood sugar can include: Anxious feeling, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty with concentrating, drowsiness, excessive hunger, headache, nausea, nervousness, rapid heartbeat, shakiness, or unusual tiredness or weakness.

Some people who take levofloxacin may become more sensitive to sunlight than they are normally. Exposure to sunlight, even for brief periods of time, may cause severe sunburn or skin rash, redness, itching, or discoloration. When you begin taking levofloxacin:

  • Stay out of direct sunlight, especially between the hours of 10 AM and 3 PM, if possible.
  • Wear protective clothing, including a hat and sunglasses.
  • Apply a sun block product that has a sun protection factor (SPF) of at least 15. Some patients may require a product with a higher SPF number, especially if they have a fair complexion. If you have any questions about this, check with your doctor.
  • Do not use a sun lamp or tanning bed or booth.

If you have a severe reaction from the sun, check with your doctor.

Levofloxacin may cause some people to become dizzy, lightheaded, drowsy, or less alert than they are normally. Make sure you know how you react to levofloxacin before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert. If these reactions are especially bothersome, check with your doctor.

Before you have any medical tests, tell the medical doctor in charge that you are using levofloxacin. The results of some tests may be affected by levofloxacin.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

levofloxacin Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Diarrhea
Rare
  • Abdominal or stomach cramps or pain (severe)
  • agitation
  • blisters
  • confusion
  • diarrhea (watery and severe) which may also be bloody
  • feeling that others can hear your thoughts or control your behavior
  • fever
  • pain, inflammation, or swelling in the calves of the legs, shoulders, or hands
  • redness and swelling of the skin
  • seeing, hearing, or feeling things that are not there
  • sensation of burning on the skin
  • severe mood or mental changes
  • skin rash, itching, or redness
  • trembling
  • unusual behavior
Incidence not known
  • Black, tarry stools
  • blurred vision
  • burning, numbness, tingling, or painful sensations
  • convulsions
  • cough
  • dark-colored urine
  • difficulty with breathing
  • difficulty with chewing, talking, or swallowing
  • drooping eyelids
  • fast or irregular heartbeat
  • general body swelling
  • hives
  • hoarseness
  • joint or muscle pain
  • muscle cramps, spasms, pain, or stiffness
  • peeling or loosening of the skin
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • severe dizziness
  • severe tiredness
  • tightness in the chest
  • unsteadiness or awkwardness
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • vision changes
  • voice changes
  • weakness in the arms, hands, legs, or feet

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common
  • Abdominal or stomach pain or discomfort
  • change in taste
  • constipation
  • dizziness
  • drowsiness
  • headache
  • lightheadedness
  • nausea
  • nervousness
  • trouble sleeping
  • vaginal itching and discharge
  • vomiting
Incidence not known
  • Feeling faint
  • feeling of warmth or heat
  • flushing or redness of the skin, especially on the face and neck
  • sweating

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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