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Levaquin: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on Dec 29, 2019.

1. How it works

  • Levaquin is a brand (trade) name for levofloxacin. Levofloxacin is an antibiotic which means that it kills bacteria. Levofloxacin inhibits two bacterial enzymes, topoisomerase IV and DNA gyrase, both of which are vital for the manufacture and repair of bacterial DNA and other DNA processes.
  • Levaquin belongs to a group of medicines called fluoroquinolone antibiotics.

2. Upsides

  • Levaquin may be used to treat infections of the skin, sinuses, kidneys, bladder, and prostate caused by susceptible bacteria. However, it is usually only used to treat urinary tract infections, chronic bronchitis, or sinusitis when other alternative treatment options have failed or cannot be used.
  • Levaquin may also be used to treat certain types of lung infections.
  • May be given as a preventive measure when people have been exposed to anthrax.
  • Effective against susceptible strains of a number of different gram-positive and gram-negative bacteria, for example, Staphylococcus aureus (methicillin-susceptible strains only), S. epidermidis (methicillin-susceptible isolates), S. pneumoniae (including multi-drug resistant isolates), S. pyogenes, Escherichia coli, Haemophilus influenzae, and Pseudomonas aeruginosa. Also effective against Chlamydophila pneumoniae and Mycoplasma pneumoniae.
  • Available as oral tablets, oral solution, eye drops and in an injectable form.
  • Levaquin is available as a generic under the name levofloxacin.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • A headache, insomnia, nausea, diarrhea, constipation, and abdominal pain.
  • Tendonitis and tendon rupture, peripheral neuropathy (nerve pain in fingers and toes) and central nervous system effects (side effects that affect the brain including psychosis, convulsions, hallucinations) have been associated with Levaquin and other fluoroquinolones. These side effects may be irreversible and can all occur together in some patients. May occur at any time after starting Levaquin and in any patient. If any of these very severe side effects happen, Levaquin should be discontinued immediately and all fluoroquinolones avoided in the future.
  • Risk of tendonitis and tendon rupture is increased in people over the age of 60, in those taking corticosteroids, or with a history of organ transplant. Previous tendon disorders or strenuous activity may also increase the risk. Pediatric patients are also at a higher risk of musculoskeletal disorders.
  • May disturb blood glucose levels in people with diabetes; careful monitoring of blood glucose is required.
  • Severe diarrhea associated with Clostridium difficile has been associated with most antibiotics, including Levaquin. This can occur up to two months after the administration of antibacterial agents.
  • May cause photosensitivity reactions and severe sunburn on exposed areas of skin.
  • May exacerbate muscle weakness in people with myasthenia gravis.
  • Should only be used by adults (at least 18 years old).
  • Not suitable for people with myasthenia gravis, certain heart rhythm disturbances, or pediatric patients (unless being given to prevent inhalation anthrax or plague). Dosage may need reducing in people with poor kidney function. May cause liver damage or heart rhythm disturbances.
  • May interact with antacids or preparations containing iron or zinc. Administer at least two hours before or two hours after these preparations.

Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.

4. Bottom Line

Levaquin treats a wide range of bacterial infections; however, it can cause some very severe and potentially irreversible side effects and should only be used to treat infections that have not responded to alternative treatment options.

5. Tips

  • Oral Levaquin tablets can be administered without regard to food. Take oral Levaquin solution one hour before or two hours after food.
  • Take at least two hours before or two hours after antacids or preparations containing iron or zinc.
  • Should be taken exactly as directed and for the time period indicated to reduce the risk of resistant bacteria developing, unless side effects force early discontinuation.
  • Ensure you keep hydrated while taking Levaquin to prevent crystal formation in your urine.
  • Discontinue Levaquin immediately if you experience tendon pain, swelling, inflammation or rupture and contact your healthcare provider.
  • Discontinue Levaquin immediately and contact your healthcare provider if you experience pain, tingling, or numbness in your fingers and toes; severe diarrhea; any central nervous system effects (such as paranoia, depression, hallucinations); a severe rash, jaundice (skin yellowing) or any sign of an allergic reaction.
  • Avoid excessive sun or UV light exposure, and wear sunblock when outdoors. Report any apparent sunburn to your doctor immediately.
  • Do not drive or operate machinery if Levaquin makes you feel dizzy or tired. Avoid alcohol.

6. Response and Effectiveness

  • Peak levels are reached within one to two hours but it may take up to three days before symptoms of the infection begin to resolve.
  • Take Levaquin for the entire course prescribed, unless side effects prevent you from doing so and your doctor has advised you to stop taking it.

7. Interactions

Medicines that interact with Levaquin may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Levaquin. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Levaquin include:

  • antacids containing magnesium or aluminum
  • blood-glucose-lowering agents, such as insulin or glimepiride
  • corticosteroids, such as prednisone. May enhance the risk of tendonitis or tendon rupture
  • bowel cleansing agents such as sodium picosulfate
  • lactobacillus
  • NSAIDs such as ibuprofen, diclofenac, or naproxen
  • photosensitizing agents, such as aminolevulinic acid
  • probenecid
  • QTc-prolonging agents, such as amiodarone, domperidone, methadone, ondansetron, or haloperidol
  • sucralfate
  • supplements containing calcium, iron, or zinc
  • warfarin
  • vaccinations, such as BCG, cholera, or typhoid.

Note that this list is not all-inclusive and includes only common medications that may interact with Levaquin. You should refer to the prescribing information for Levaquin for a complete list of interactions.


Levaquin (levofloxacin) [Package Insert]. Revised 07/2019. Janssen Pharmaceuticals, Inc.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Levaquin only for the indication prescribed.

Copyright 1996-2020 Revision date: December 28, 2019.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.