levofloxacin

Generic Name: levofloxacin (oral)
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 should not use this medication if you are allergic to levofloxacin or similar antibiotics such as ciprofloxacin (Cipro), gemifloxacin (Factive), moxifloxacin (Avelox), ofloxacin (Floxin), norfloxacin (Noroxin), and others.

Before taking levofloxacin, tell your doctor if you have kidney or liver disease, muscle weakness or trouble breathing, joint problems, seizures, diabetes, myasthenia gravis, a history of head injury of brain tumor, a condition called pseudotumor cerebri, low levels of potassium in your blood, a personal or family history of Long QT syndrome, or if you have ever had an allergic reaction to an antibiotic.

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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.

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 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.

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), gemifloxacin (Factive), moxifloxacin (Avelox), ofloxacin (Floxin), norfloxacin (Noroxin), and others.

To make sure you can safely take levofloxacin, tell your doctor if you have any of these other conditions:

• myasthenia gravis;

• a heart rhythm disorder, especially if you take amiodarone (Cordarone, Pacerone), dofetilide (Tikosyn), disopyramide (Norpace), ibutilide (Corvert), procainamide (Procan, Pronestyl), propafenone (Rythmol), quinidine (Quin-G), or sotalol (Betapace);

• a history of allergic reaction to an antibiotic;

• joint problems;

• kidney or liver disease;

• seizures or epilepsy;

• a history of head injury or brain tumor;

• a condition called pseudotumor cerebri (high pressure inside the skull that may cause headaches, vision loss, or other symptoms);

• diabetes;

• muscle weakness or trouble breathing;

• 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. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

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 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 exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. 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 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.

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

See also: Levofloxacin dosage (in more detail)

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. 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), or 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 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.

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; difficult 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:

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

• sudden pain, snapping or popping sound, bruising, swelling, tenderness, stiffness, or loss of movement in any of your joints;

• diarrhea that is watery or bloody;

• confusion, hallucinations, depression, tremors, feeling restless or anxious, unusual thoughts or behavior, insomnia, nightmares, seizure (convulsions);

• severe headache, ringing in your ears, nausea, vision problems, pain behind your eyes;

• pale skin, fever, weakness, easy bruising or bleeding;

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

• urinating less than usual or not at all;

• numbness, burning pain, or tingly feeling in your hands or feet;

• the first sign of any skin rash, no matter how mild; or

• severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Less serious side effects may include:

• mild diarrhea, constipation, vomiting;

• sleep problems (insomnia);

• mild headache or dizziness; or

• vaginal itching or discharge.

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: levofloxacin 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 other medicines you use, especially:

• a blood thinner such as warfarin (Coumadin, Jantoven);

• insulin or oral diabetes medication;

• theophylline (Elixophyllin, Theo-24, Theochron, Uniphyl);

• an antibiotic such as clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole), moxifloxacin (Avelox), or pentamidine (NebuPent, Pentam);

• an antidepressant such as amitriptylline (Elavil, Vanatrip, Limbitrol), clomipramine (Anafranil), or desipramine (Norpramin);

• anti-malaria medications such as chloroquine (Aralen) or mefloquine (Lariam);

• medicine to prevent or treat nausea and vomiting such as dolasetron (Anzemet), droperidol (Inapsine), or ondansetron (Zofran);

• medicines to treat psychiatric disorders, such as clozapine (FazaClo, Clozaril), haloperidol (Haldol), pimozide (Orap), ziprasidone (Geodon), and others;

• migraine headache medicine such as sumatriptan (Imitrex, Treximet);

• narcotic medication such as methadone (Methadose, Diskets, Dolophine);

• an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Arthrotec, Cambia, Cataflam, Voltaren, Flector Patch, Pennsaid, Solareze), indomethacin (Indocin), meloxicam (Mobic), and others; or

• a steroid medicine (prednisone and others).

This list is not complete and other drugs may interact with levofloxacin. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about levofloxacin.