Consumer Drug Information

levofloxacin

Generic Name: levofloxacin (oral) (leev oh FLOX a sin)
Brand Names: 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.

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

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

You should not use this medication if you are allergic to levofloxacin or similar antibiotics such as ciprofloxacin (Cipro), moxifloxacin (Avelox), ofloxacin (Floxin), norfloxacin (Noroxin), lomefloxacin (Maxaquin), and others.

Before taking levofloxacin, tell your doctor if you have kidney or liver disease, myasthenia gravis, joint problems, seizures or epilepsy, diabetes, low levels of potassium in your blood (hypokalemia), or a personal or family history of "Long QT syndrome."

Avoid taking antacids, vitamin or mineral supplements, sucralfate (Carafate), or didanosine (Videx) powder or chewable tablets within 2 hours before or after you take levofloxacin. These other medicines can make levofloxacin much less effective when taken at the same time.

Taking levofloxacin can make your skin more sensitive to sunlight. Avoid exposure to sunlight, sun lamps, or tanning beds.

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. These effects may be more likely to occur if you are over 60, if you take an oral steroid medication, or if you have had a kidney, heart, or lung transplant. Stop taking levofloxacin and call your doctor at once if you have sudden pain, swelling, tenderness, stiffness, or movement problems in any of your joints. Rest the joint until you receive medical care or instructions. Do not share this medication with another person (especially a child), even if they have the same symptoms you have.

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 such as ciprofloxacin (Cipro), moxifloxacin (Avelox), ofloxacin (Floxin), norfloxacin (Noroxin), lomefloxacin (Maxaquin), and others.

Before taking levofloxacin, tell your doctor if you have a heart rhythm disorder, especially if you are being treated with one of these medications: quinidine (Cardioquin, Quinidex, Quinaglute), disopyramide (Norpace), bretylium (Bretylol), procainamide (Pronestyl, Procan SR), amiodarone (Cordarone, Pacerone), or sotalol (Betapace).

If you have certain conditions, you may need a dose adjustment or special tests to safely use this medication. Before you take levofloxacin, tell your doctor if you have:

a history of allergic reaction to an antibiotic;
myasthenia gravis;
joint problems;
kidney or liver disease;
seizures or epilepsy;
diabetes;
low levels of potassium in your blood (hypokalemia); or
a personal or family history of "Long QT syndrome."

FDA pregnancy category C: It is not known whether levofloxacin is harmful to an unborn baby. Do not use ciprofloxacin without telling your doctor if you are pregnant. Tell your doctor if you become pregnant during treatment. Levofloxacin can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. 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. These effects may be more likely to occur if you are over 60, if you take an oral steroid medication, or if you have had a kidney, heart, or lung transplant. Stop taking levofloxacin and call your doctor at once if you have sudden pain, swelling, tenderness, stiffness, or movement problems in any of your joints. Rest the joint until you receive medical care or instructions. Do not share this medication with another person (especially a child), even if they have the same symptoms you have.

How should I take levofloxacin?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Take levofloxacin 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 cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Take this medication for as many days as it has been prescribed for you even if you begin to feel better. Your symptoms may improve before the infection is completely cleared. Levofloxacin will not treat a viral infection such as the common cold or flu.

This medicine can cause you to have unusual results with certain medical tests. Tell any doctor who treats you that you are using levofloxacin.

Store this medication at room temperature away from moisture and heat. Do not allow the liquid medicine to freeze.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have taken too much of this medicine. Overdose symptoms may include loss of balance or coordination, drooping eyelids, weakness, decreased activity, trouble breathing, sweating, tremors, or seizure (convulsions).

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);
the ulcer medicine sucralfate (Carafate);
didanosine (Videx) powder or chewable tablets; or
vitamin or mineral supplements that contain iron or zinc.

Avoid exposure to sunlight, sunlamps, or tanning beds. Levofloxacin can make your skin more sensitive to sunlight, and a sunburn may result. Wear protective clothing and use a sunscreen (SPF-15 or higher) if you must be out in the sun. Call your doctor if you have severe burning, redness, itching, rash, or swelling after being in the sun.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

Levofloxacin can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Levofloxacin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using levofloxacin and call your doctor at once if you have a serious side effect such as:

dizziness, fainting, fast or pounding heartbeat;
sudden pain or swelling near your joints (especially in your arm or ankle);
diarrhea that is watery or bloody;
confusion, hallucinations, depression, unusual thoughts or behavior;
seizure (convulsions);
pale or yellowed skin, dark colored urine, fever, weakness;
urinating less than usual or not at all;
easy bruising or bleeding;
numbness, burning, pain, or tingly feeling in your hands or feet;
fever, sore throat, and headache with a severe blistering, peeling, and red skin rash; or
the first sign of any skin rash, no matter how mild.

Less serious side effects may include:

nausea, diarrhea, constipation;
feeling restless, anxious, or depressed;
headache, dizziness;
muscle pain;
sleep problems (insomnia or nightmares);
vaginal itching or discharge; or
mild skin itching.

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.

Levofloxacin Dosing Information

Usual Adult Dose for Anthrax Prophylaxis:

500 mg orally or IV once daily for 60 days after exposure

Usual Adult Dose for Inhalation Bacillus anthracis:

Mass casualty treatment: 500 mg orally or IV once daily 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 Bronchitis:

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

Usual Adult Dose for Chlamydia Infection:

500 mg orally once daily for 7 days

Single-dose azithromycin is the preferred agent.

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

Usual Adult Dose for Cystitis:

250 mg orally or IV once a day for approximately 3 days

Usual Adult Dose for Epididymitis -- Sexually Transmitted:

500 mg orally once daily for 10 days

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

Levofloxacin is recommended for nongonococcal epididymitis in patients over 35 years old, for infections due to enteric organisms, or as an alternate agent for nongonococcal infections in patients with hypersensitivity to ceftriaxone or doxycycline.

Due to high rates of resistance, the Centers for Disease Control and Prevention (CDC) do not recommend fluoroquinolones for treatment of gonococcal infections in the United States or for infections acquired in Asia, the Pacific Islands, England, and Wales. Ceftriaxone is recommended as first-line treatment of gonococcal infections in the United States or acquired in these areas. Antimicrobial susceptibility patterns should be monitored. The CDC recommend fluoroquinolones as alternative therapy only when gonococcal culture proves susceptibility.

Usual Adult Dose for Gonococcal Infection -- Disseminated:

250 mg intravenously every 24 hours; may convert to 500 mg/day orally 24 to 48 hours after clinical improvement for a total course of at least 1 week

Due to high rates of resistance, the CDC do not recommend fluoroquinolones for treatment of gonococcal infections in the United States or for infections acquired in Asia, the Pacific Islands, England, and Wales. Antimicrobial susceptibility patterns should be monitored. The CDC recommend fluoroquinolones as alternative therapy only when culture proves susceptibility.

The CDC currently recommend initial hospitalization and injectable antimicrobials (i.e., ceftriaxone, cefotaxime, ceftizoxime) for the treatment of disseminated gonococcal infection. Twenty-four to forty-eight hours after improvement begins, the patient can be switched to oral cefixime or cefpodoxime for a total course of at least 1 week.

Doxycycline therapy for 7 days (if not pregnant) or single dose azithromycin is also recommended to treat possible concurrent chlamydial infection.

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

Usual Adult Dose for Gonococcal Infection -- Uncomplicated:

Uncomplicated urethral/cervical gonococcal infections: 250 mg orally once

Due to high rates of resistance, the CDC do not recommend fluoroquinolones for treatment of gonococcal infections in the United States or for infections acquired in Asia, the Pacific Islands, England, and Wales. Ceftriaxone or oral cefixime are recommended as first-line treatment of gonorrhea in the United States or acquired in these areas. Antimicrobial susceptibility patterns should be monitored. The CDC recommend fluoroquinolones as alternative therapy only when culture proves susceptibility.

Doxycycline therapy for 7 days (if not pregnant) or single-dose azithromycin is also recommended to treat possible concurrent chlamydial infection.

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

Usual Adult Dose for Nongonococcal Urethritis:

500 mg orally once daily for 7 days

Single-dose azithromycin is the preferred agent.

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

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 Pelvic Inflammatory Disease:

500 mg IV or orally every 24 hours in combination with metronidazole, if anaerobes are present or suspected

Parenteral therapy should be continued for at least 24 hours after clinical improvement. Oral therapy should then be substituted for a total course of at least 14 days.

If patients who are started on oral therapy do not improve within 72 hours, they should be reevaluated and parenteral therapy initiated.

Due to high rates of resistance, the CDC do not recommend fluoroquinolones for treatment of gonococcal infections in the United States or for infections acquired in Asia, the Pacific Islands, England, and Wales. A parenteral cephalosporin is recommended as first-line treatment of gonococcal infections in the United States or acquired in these areas. Antimicrobial susceptibility patterns should be monitored. The CDC recommend fluoroquinolones as alternative therapy only when gonococcal culture proves susceptibility.

Usual Adult Dose for Pneumonia:

Community-acquired pneumonia: 500 mg orally or IV every 24 hours for 7 to 14 days or 750 mg orally or IV every 24 hours for 5 days

The 750 mg, 5-day regimen is not approved by the FDA for the treatment of community-acquired pneumonia due to multi-drug resistant Streptococcus pneumoniae.

Usual Adult Dose for Prostatitis:

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

Usual Adult Dose for Pyelonephritis:

250 mg orally or IV once a day for 10 days or 750 mg orally or IV once a day for 5 days

Usual Adult Dose for Sinusitis:

500 mg orally once a day for 10 to 14 days or 750 mg orally every 24 hours for 5 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 Tuberculosis -- Active:

500 to 1000 mg orally or IV once daily

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 Urinary Tract Infection:

Complicated: 250 mg orally or IV once a day for 10 days or 750 mg orally or IV once a day for 5 days

The 750 mg, 5-day regimen is not approved by the FDA for the treatment of mild to moderate complicated infections due to Enterococcus faecalis, Enterobacter cloacae, or Pseudomonas aeruginosa.

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

Usual Pediatric Dose for Anthrax Prophylaxis:

Prophylaxis postexposure to inhalational Bacillus 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

What other drugs will affect levofloxacin?

Before taking levofloxacin, tell your doctor if you are also using any of the following drugs:

a blood thinner such as warfarin (Coumadin);
insulin or diabetes medication you take by mouth, such as glyburide (Micronase, Diabeta, Glynase);
a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Motrin, Advil, Nuprin, others), etodolac (Lodine), diclofenac (Cataflam, Voltaren), indomethacin (Indocin), nabumetone (Relafen), meloxicam (Mobic), naproxen (Aleve, Naprosyn, Anaprox), piroxicam (Feldene), and others; or
an oral steroid medication such as betamethasone (Celestone), dexamethasone (Decadron, Dexpak), methylprednisolone (Medrol), prednisolone (Orapred), prednisone (Meticorten, Sterapred), and others.

This list is not complete and there may be other drugs that can interact with levofloxacin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

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 medicine only for the indication prescribed.
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.