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levofloxacin

Pronunciation

Generic Name: levofloxacin (oral) (LEE voe FLOX a sin)
Brand Name: Levaquin, Levaquin Leva-Pak

What is levofloxacin?

Levofloxacin is in a group of antibiotics called fluoroquinolones (flor-o-KWIN-o-lones). Levofloxacin fights bacteria in the body.

Levofloxacin is used to treat bacterial infections of the skin, sinuses, kidneys, bladder, or prostate. Levofloxacin is also used to treat bacterial infections that cause bronchitis or pneumonia, and to treat people who have been exposed to anthrax or plague.

Levofloxacin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about levofloxacin?

You may not be able to use levofloxacin if you have a muscle disorder. Tell your doctor if you have a history of myasthenia gravis.

Levofloxacin may cause swelling or tearing of a tendon (the fiber that connects bones to muscles in the body), especially in the Achilles' tendon of the heel. This effect may be more likely to occur if you are over 60, if you take steroid medication, or if you have had a kidney, heart, or lung transplant.

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Stop taking levofloxacin and call your doctor at once if you have sudden pain, swelling, bruising, tenderness, stiffness, or movement problems in any of your joints. Rest the joint until you receive medical care or instructions.

What should I discuss with my healthcare provider before taking levofloxacin?

You should not use this medication if you are allergic to levofloxacin or other fluoroquinolones (ciprofloxacin, gemifloxacin, moxifloxacin, ofloxacin, norfloxacin, and others).

You may not be able to use levofloxacin if you have a muscle disorder. Tell your doctor if you have a history of myasthenia gravis.

To make sure levofloxacin is safe for you, tell your doctor if you have:

  • a heart rhythm disorder, especially if you take medication to treat it;

  • a personal or family history of Long QT syndrome;

  • tendon problems, arthritis or other joint problems (especially in children);

  • a muscle or nerve disorder;

  • bone problems;

  • liver or kidney disease;

  • seizures or epilepsy;

  • a history of head injury or brain tumor;

  • a history of allergic reaction to an antibiotic;

  • diabetes (especially if you use insulin or take oral diabetes medication);

  • low levels of potassium in your blood (hypokalemia); or

  • if you use a blood thinner (warfarin, Coumadin) and have "INR" or prothrombin time tests.

Levofloxacin may cause swelling or tearing of a tendon (the fiber that connects bones to muscles in the body), especially in the Achilles' tendon of the heel. This can happen during treatment or up to several months after you stop taking levofloxacin. Tendon problems may be more likely to occur if you are over 60, if you take steroid medication, or if you have had a kidney, heart, or lung transplant.

FDA pregnancy category C. It is not known whether levofloxacin will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

It is not known whether levofloxacin passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

How should I take levofloxacin?

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Take levofloxacin at the same time each day with a full glass of water (8 ounces). Drink several extra glasses of fluid each day while you are taking levofloxacin. You may take levofloxacin tablets with or without food.

Take levofloxacin oral solution (liquid) on an empty stomach 1 hour before or 2 hours after meals. Measure liquid medicine with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Use this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Levofloxacin will not treat a viral infection such as the common cold or flu.

This medication can cause you to have a false positive drug screening test. If you provide a urine sample for drug screening, tell the laboratory staff that you are taking levofloxacin.

Do not share this medication with another person (especially a child), even if they have the same symptoms you have.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking levofloxacin?

You may be taking certain other medicines that should not be taken at the same time as levofloxacin. Avoid taking the following medicines within 2 hours before or after you take levofloxacin. These other medicines can make levofloxacin much less effective when taken at the same time:

  • antacids that contain magnesium or aluminum (such as Maalox, Mylanta, or Rolaids), or the ulcer medicine sucralfate (Carafate);

  • didanosine (Videx) powder or chewable tablets; or

  • vitamin or mineral supplements that contain aluminum, iron, magnesium, or zinc.

Avoid exposure to sunlight or tanning beds. Levofloxacin can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Call your doctor if you have severe burning, redness, itching, rash, or swelling after being in the sun.

This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking levofloxacin and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Levofloxacin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives, or the first sign of a skin rash; rapid heart rate, difficult breathing; swelling of your face, lips, tongue, or throat.

Levofloxacin may cause swelling or tearing of (rupture) a tendon. Levofloxacin can also have serious effects on your nerves, and may cause permanent nerve damage. Stop taking this medicine and call your doctor at once if you have:

  • signs of tendon rupture--sudden pain, swelling, bruising, tenderness, stiffness, movement problems, or a snapping or popping sound in any of your joints (rest the joint until you receive medical care or instructions); or

  • nerve symptoms--numbness, tingling, burning pain, or being more sensitive to temperature, light touch, or the sense of your body position.

Stop using levofloxacin and call your doctor at once if you have:

  • headache with chest pain and severe dizziness, fainting, fast or pounding heartbeats;

  • nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

  • muscle weakness or trouble breathing;

  • diarrhea that is watery or bloody;

  • sudden weakness or ill feeling, fever, chills, sore throat, mouth sores, easy bruising or bleeding;

  • depression, confusion, hallucinations, paranoia, tremors, feeling restless or anxious, unusual thoughts or behavior, insomnia, nightmares;

  • severe eye redness, small white or yellow patches on the surface of your eye;

  • seizure (convulsions); or

  • increased pressure inside the skull-- severe headaches, ringing in your ears, dizziness, nausea, vision problems, pain behind your eyes.

Common side effects may include:

  • constipation, mild diarrhea;

  • mild dizziness; or

  • mild headache.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Levofloxacin dosing information

Usual Adult Dose for Nosocomial Pneumonia:

750 mg orally or IV every 24 hours for 7 to 14 days

Initial empiric treatment with broad-spectrum coverage according to the hospital's and/or ICU's antibiogram is recommended if multidrug-resistant organisms are suspected.

Duration: If the causative organism is not Pseudomonas aeruginosa, the duration of treatment should be as short as clinically possible (e.g., as little as 7 days) to reduce the risk of superinfections with resistant organisms.

Usual Adult Dose for Pneumonia:

Community-acquired pneumonia:
Due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae (including multi-drug resistant S pneumoniae [MDRSP]), Haemophilus influenzae, H parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae: 500 mg orally or IV every 24 hours for 7 to 14 days

Due to S pneumoniae (excluding MDRSP), H influenzae, H parainfluenzae, M pneumoniae, or C pneumoniae: 750 mg orally or IV every 24 hours for 5 days

Usual Adult Dose for Sinusitis:

Acute bacterial sinusitis: 500 mg orally or IV every 24 hours for 10 to 14 days or 750 mg orally or IV every 24 hours for 5 days

Usual Adult Dose for Bronchitis:

Acute bacterial exacerbation of chronic bronchitis: 500 mg orally or IV once a day for 7 days

Usual Adult Dose for Skin or Soft Tissue Infection:

Uncomplicated: 500 mg orally or IV once a day for 7 to 10 days
Complicated: 750 mg orally or IV once a day for 7 to 14 days

Usual Adult Dose for Prostatitis:

Chronic bacterial prostatitis: 500 mg orally or IV every 24 hours for 28 days

Usual Adult Dose for Urinary Tract Infection:

Complicated:
Due to Enterococcus faecalis, Enterobacter cloacae, E coli, K pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa: 250 mg orally or IV once a day for 10 days
Due to E coli, K pneumoniae, or P mirabilis: 750 mg orally or IV once a day for 5 days

Uncomplicated: 250 mg orally or IV once a day for 3 days

Usual Adult Dose for Pyelonephritis:

Acute:
Due to Escherichia coli: 250 mg orally or IV once a day for 10 days
Due to E coli (including cases with concurrent bacteremia): 750 mg orally or IV once a day for 5 days

Usual Adult Dose for Cystitis:

250 mg orally or IV once a day for 3 days

Usual Adult Dose for Anthrax Prophylaxis:

Prophylaxis postexposure to inhalational Bacillus anthracis: 500 mg orally or IV once a day for 60 days after exposure

Usual Adult Dose for Plague:

For treatment of plague (including pneumonic and septicemic plague) and prophylaxis for plague: 500 mg orally or IV once a day for 10 to 14 days

Drug administration should begin as soon as possible after suspected or confirmed exposure to Yersinia pestis. Higher doses (750 mg orally or IV once a day) can be used for treatment of plague if clinically indicated.

Usual Adult Dose for Plague Prophylaxis:

For treatment of plague (including pneumonic and septicemic plague) and prophylaxis for plague: 500 mg orally or IV once a day for 10 to 14 days

Drug administration should begin as soon as possible after suspected or confirmed exposure to Yersinia pestis. Higher doses (750 mg orally or IV once a day) can be used for treatment of plague if clinically indicated.

Usual Adult Dose for Inhalation Bacillus anthracis:

(Not approved by FDA)

Mass casualty treatment: 500 mg orally or IV once a day for 60 days

The Working Group on Civilian Biodefense has suggested that, based on in vitro studies, levofloxacin could be used for treatment of inhalational anthrax if ciprofloxacin and doxycycline are not available. One or two additional antibiotics with activity against the causative organism (e.g., rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, imipenem, clindamycin, or clarithromycin) should be added.

Usual Adult Dose for Tuberculosis -- Active:

(Not approved by FDA)

500 to 1000 mg orally or IV once a day

This regimen has been recommended by the Centers for Disease Control and Prevention (CDC), the Infectious Diseases Society of America, and American Thoracic Society.

May be given in combination with at least 3 other active drugs for treatment of multi-drug resistant TB, or when the patient is intolerant of first-line agents. AFB smear and culture should be monitored monthly.

Duration: Treatment for TB should generally continue for 18 to 24 months, or for 12 to 18 months after culture results are negative.

Usual Adult Dose for Nongonococcal Urethritis:

(Not approved by FDA)

CDC recommendations: 500 mg orally once a day for 7 days

Levofloxacin therapy is recommended as an alternative regimen. Single-dose azithromycin is a preferred regimen.

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Chlamydia Infection:

(Not approved by FDA)

CDC recommendations: 500 mg orally once a day for 7 days

Levofloxacin therapy is recommended as an alternative regimen. Single-dose azithromycin is a preferred regimen.

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Pelvic Inflammatory Disease:

(Not approved by FDA)

CDC recommendations:
Mild to moderately severe acute PID: 500 mg orally once a day for 14 days

Due to high rates of resistance, the CDC does not recommend fluoroquinolones for treatment of gonococcal infections in the United States. As a result, regimens that include a quinolone are not recommended for the treatment of PID. If parenteral cephalosporin therapy is not possible, oral levofloxacin (with or without oral metronidazole) can be considered if community prevalence and individual risk for gonorrhea are low. Prior to therapy, diagnostic tests for gonorrhea must be performed. If test results are positive for quinolone-resistant Neisseria gonorrhoeae and cephalosporin therapy is not possible, single-dose azithromycin should be added to this quinolone-based PID regimen.

If patients do not respond to oral therapy within 72 hours, they should be reevaluated and parenteral therapy should be initiated.

Usual Adult Dose for Epididymitis -- Sexually Transmitted:

(Not approved by FDA)

CDC recommendations: 500 mg orally once a day for 10 days

The patient's sexual partner(s) should also be evaluated/treated.

All patients should receive ceftriaxone plus doxycycline for initial (empiric) treatment. Additional therapy can include levofloxacin if testing determines acute epididymitis is not caused by gonorrhea or if the infection is most likely caused by enteric organisms.

Due to high rates of resistance, the CDC does not recommend fluoroquinolones for treatment of gonococcal infections in the United States. Ceftriaxone is the first-line agent recommended for the treatment of gonococcal infections in the United States. Antimicrobial susceptibility patterns should be monitored.

Usual Pediatric Dose for Anthrax Prophylaxis:

Prophylaxis postexposure to inhalational B anthracis:
6 months or older:
Less than 50 kg: 8 mg/kg orally or IV every 12 hours for 60 days; not to exceed 250 mg per dose
50 kg or more: 500 mg orally or IV every 24 hours for 60 days

Usual Pediatric Dose for Plague:

For treatment of plague (including pneumonic and septicemic plague) and prophylaxis for plague:
6 months or older:
Less than 50 kg: 8 mg/kg orally or IV every 12 hours for 10 to 14 days; not to exceed 250 mg per dose
50 kg or more: 500 mg orally or IV every 24 hours for 10 to 14 days

Drug administration should begin as soon as possible after suspected or confirmed exposure to Yersinia pestis.

Usual Pediatric Dose for Plague Prophylaxis:

For treatment of plague (including pneumonic and septicemic plague) and prophylaxis for plague:
6 months or older:
Less than 50 kg: 8 mg/kg orally or IV every 12 hours for 10 to 14 days; not to exceed 250 mg per dose
50 kg or more: 500 mg orally or IV every 24 hours for 10 to 14 days

Drug administration should begin as soon as possible after suspected or confirmed exposure to Yersinia pestis.

What other drugs will affect levofloxacin?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with levofloxacin, especially:

  • a diuretic or "water pill";

  • theophylline;

  • heart rhythm medication--amiodarone, disopyramide, dofetilide, dronedarone, procainamide, quinidine, sotalol, and others;

  • medicine to treat depression or mental illness--amitriptylline, clomipramine, desipramine, iloperidone, imipramine, nortriptyline, and others; or

  • NSAIDs (nonsteroidal anti-inflammatory drugs)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

This list is not complete. Other drugs may interact with levofloxacin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about levofloxacin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 10.03. Revision Date: 2014-08-28, 3:32:21 PM.

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