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Levaquin: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on April 8, 2021.

1. How it works

  • Levaquin is a brand (trade) name for levofloxacin.
  • Levaquin (levofloxacin) works by inhibiting 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 kills bacteria.
  • 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, such as community-acquired pneumonia and nosocomial pneumonia due to methicillin-susceptible Staphylococcus aureus.
  • May be given as a preventive measure when people have been exposed to anthrax and for the treatment of plague.
  • May be used to treat chronic bacterial prostatitis due to certain organisms.
  • Effective against susceptible strains of several 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.
  • Oral tablets are available in three different strengths: 250mg, 500mg, and 750mg.
  • May be taken with or without food.
  • 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. Other serious adverse effects include allergic pneumonitis, toxic epidermal necrolysis, hepatitis, anemia, and serious hypersensitivity reactions.
  • An increased risk of aortic aneurysm and dissection has been reported in the first two months of fluoroquinolone use, particularly in elderly patients.
  • May cause polongation of teh QT interval. The risk is higher in people who already take medications known to prolong the QT interval such as azithromycin and fluconazole, or with certain antiarrhythmic agents such as quinidine or amiodarone.
  • Risk of tendinitis 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.
  • Culture and sensitivity tests should be performed to determine the susceptibility of the organism to Levaquin before using it.
  • 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. Avoid.
  • Should only be used by adults (at least 18 years old). The only indicated for pediatric patients aged 6 months and older is the prevention of inhalational anthrax and for plague. Levaquin has caused arthropathy and osteochondrosis in juvenile animal studies.
  • Ensure the person remains adequately hydrated while receiving Levaquin to prevent the formation of crystals in the urine.
  • Be careful when using Levaquin in people with kidney disease. A dosage adjustment is needed for patients with CLCR less than 50 mL/minute. Liver disease is not expected to alter the pharmacokinetics of Levaquin.
  • 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.
  • Although research in humans has not indicated an increased risk of major birth defects, miscarriage, or adverse outcomes associated with Levaquin, it should only be used during pregnancy if the benefits outweigh the risks. Breastfeeding is not recommended during treatment with Levaquin.

Note: 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. View complete list of side effects

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 exactly as directed by your doctor.
  • 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.y include tendon problems, problems with muscle weakness, low potassium, joint, kidney, or liver problems, or if you have diabetes. Tell your doctor if you are pregnant or plan to become pregnant but it is not known if Levaquin will harm a developing baby. Do not breastfeed while taking Levaquin and for 2 days after.
  • If you miss a dose and it is 8 hours or more before your next dose, then take the missed dose. If it is less than 8 hours, skip that dose and just go back to your regular dosing schedule.
  • Tell your doctor about any other medical issues you have and what medications you take.
  • Ensure you keep hydrated while taking Levaquin to prevent crystal formation in your urine. Drink plenty of fluids.
  • Discontinue Levaquin immediately if you experience tendon pain, swelling, inflammation, or rupture (a snap or pop in the tendon area) 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. Avoid sunbeds.
  • Mental health problems have been reported in people taking Levaquin. Tell your doctor if you experience any mood problems, such as depression, hear voices, or have difficulty sleeping.
  • 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 (take Levaquin 2 hours before or 2 hours after)
  • antiarrhythmics such as amiodarone or flecainide
  • antidepressants, such as amitriptyline, doxepin, or nortriptyline.
  • antipsychotics, such as clozapine, haloperidol, or thioridazine
  • blood-glucose-lowering agents, such as insulin or glimepiride
  • bowel cleansing agents such as sodium picosulfate
  • corticosteroids, such as prednisone. May enhance the risk of tendonitis or tendon rupture
  • didanosine
  • diuretics, such as furosemide or HCTZ
  • lactobacillus
  • multivitamins
  • 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
  • theophylline
  • 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.

References

Levaquin (levofloxacin) [Package Insert]. Revised 01/2021. Janssen Pharmaceuticals, Inc. https://www.drugs.com/pro/levaquin.html

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.

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

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