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Pronunciation

(lee voe FLOKS a sin)

U.S. Brand Names

• Iquix®
• Levaquin®
• Quixin®

Generic Available

No

Canadian Brand Names

• Levaquin®
• Novo-Levofloxacin

Pharmacologic Category

• Antibiotic, Quinolone
• Respiratory Fluoroquinolone

Pharmacologic Category Synonyms

• DNA Gyrase Inhibitor
• Fluoroquinolone
• Quinolone Antibiotic
• Topoisomerase I Inhibitor
• Fluoroquinolone, Respiratory

Use

Systemic: Treatment of mild, moderate, or severe infections caused by susceptible organisms. Includes the treatment of community-acquired pneumonia, including multidrug resistant strains of S. pneumoniae (MDRSP); nosocomial pneumonia; chronic bronchitis (acute bacterial exacerbation); acute bacterial sinusitis; urinary tract infection (uncomplicated or complicated); acute pyelonephritis; skin or skin structure infections (uncomplicated or complicated); reduce incidence or disease progression of inhalational anthrax (postexposure)

Ophthalmic: Treatment of bacterial conjunctivitis caused by susceptible organisms (Quixin™ 0.5% ophthalmic solution); treatment of corneal ulcer caused by susceptible organisms (Iquix® 1.5% ophthalmic solution)

Use: Unlabeled/Investigational

Diverticulitis, enterocolitis (Shigella spp.), epididymitis (nongonococcal), gonococcal infections, Legionnaires' disease, peritonitis, PID

Note: As of April 2007, the CDC no longer recommends the use of fluoroquinolones for the treatment of gonococcal disease.

Pregnancy Risk Factor

C

Pregnancy Implications

Reports of arthropathy (observed in immature animals and reported rarely in humans) have limited the use of fluoroquinolones in pregnancy. Teratogenic effects were not observed with levofloxacin in animal studies; however, decreased body weight and increased fetal mortality were reported. Based on limited data, quinolones are not expected to be a major human teratogen. Although quinolone antibiotics should not be used as first-line agents during pregnancy, when considering treatment for life-threatening infection and/or prolonged duration of therapy, the potential risk to the fetus must be balanced against the severity of the potential illness.

Lactation

Excretion in breast milk unknown/not recommended

Breast-Feeding Considerations

Other quinolones are known to be excreted in breast milk. Based on data from ofloxacin, excretion of levofloxacin would be expected. The manufacturer recommends to discontinue nursing or to discontinue levofloxacin.

Contraindications

Hypersensitivity to levofloxacin, any component of the formulation, or other quinolones

Warnings/Precautions

Concerns related to adverse effects:

• Altered cardiac conduction: Fluoroquinolones may prolong QT_c interval; avoid use in patients with a history of QT_c prolongation, uncorrected hypokalemia, hypomagnesemia, or concurrent administration of other medications known to prolong the QT interval (including Class Ia and Class III antiarrhythmics, cisapride, erythromycin, antipsychotics, and tricyclic antidepressants).

• CNS stimulation: Tremor, restlessness, confusion, and very rarely hallucinations or seizures may occur; use with caution in patients with known or suspected CNS disorder. Discontinue in patients who experience significant CNS adverse effects (eg, dizziness, hallucinations, suicidal ideations or actions).

• Glucose regulation: Fluoroquinolones have been associated with the development of serious, and sometimes fatal, hypoglycemia. These events have occurred most often in elderly patients with diabetes, but have also been reported in patients without a prior history of diabetes. Prompt identification and treatment of hypoglycemia is essential. Individual quinolones may differ in their potential to cause this effect. It was most evident with gatifloxacin (no longer marketed as s systemic formulation). Hyperglycemia has also been associated with the use of fluoroquinolones. Patients should be monitored closely for signs/symptoms of disordered glucose regulation.

• Hypersensitivity reactions: Severe hypersensitivity reactions, including anaphylaxis, have occurred with quinolone therapy. The spectrum of these reactions can vary widely; reactions may present as typical allergic symptoms (eg, itching, urticaria, rash, edema) after a single dose, or may manifest as severe idiosyncratic dermatologic (eg, Stevens-Johnson, toxic epidermal necrolysis), vascular (eg, vasculitis), pulmonary (eg, pneumonitis), renal (eg, nephritis), hepatic (eg, hepatic failure or necrosis), and/or hematologic (eg, anemia, cytopenias) events, usually after multiple doses. Prompt discontinuation of drug should occur if skin rash or other symptoms arise.

• Peripheral neuropathy: The use of quinolones has been linked to peripheral neuropathy (rare); discontinue if symptoms of sensory or sensorimotor neuropathy occur.

• Photosensitivity: Avoid excessive sunlight; may rarely cause moderate-to-severe phototoxicity reactions similar to other quinolones.

• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.

• Tendon inflammation/rupture: There have been reports of tendon inflammation and/or rupture with quinolone antibiotics; risk may be increased with concurrent corticosteroids, particularly in the elderly. Discontinue at first sign of tendon inflammation or pain.

Disease-related concerns:

• Myasthenia gravis: Some quinolones may exacerbate myasthenia gravis, use with caution (rare, potentially life-threatening weakness of respiratory muscles may occur).

• Renal impairment: Use with caution in patients with renal impairment.

• Seizures: Use with caution in individuals at risk of seizures (CNS disorders or concurrent therapy with medications which may lower seizure threshold). Potential for seizures, although very rare, may be increased with concomitant NSAID therapy.

Special populations:

• Elderly: Adverse effects (eg, tendon rupture, QT changes) may be increased in the elderly.

• Pediatrics: Safety and efficacy have not been established in children <1 year of age for Quixin™ and in children <6 years of age for Iquix®. Systemic use is not recommended in children <18 years of age.

Dosage form specific issues:

• Ophthalmic solution: For topical use only. Do not inject subconjunctivally or introduce into anterior chamber of the eye. Contact lenses should not be worn during treatment for bacterial conjunctivitis. Indications for ophthalmic solutions are product concentration-specific and should not be used interchangeably.

Adverse Reactions

1% to 10%:

Cardiovascular: Chest pain (1%), edema (1%)

Central nervous system: Headache (6%), insomnia (4%), dizziness (3%), fatigue (1%), pain (1%)

Dermatologic: Rash (2%), pruritus (1%)

Gastrointestinal: Nausea (7%), diarrhea (5%), constipation (3%), abdominal pain (2%), dyspepsia (2%), vomiting (2%)

Genitourinary: Vaginitis (1%)

Local: Injection site reaction (1%)

Ocular (with ophthalmic solution use): Decreased vision (transient), foreign body sensation, transient ocular burning, ocular pain or discomfort, photophobia

Respiratory: Pharyngitis (4%), dyspnea (1%)

<1%, postmarketing, and/or case reports (limited to important or life-threatening):

Systemic: Acute renal failure, agitation, agranulocytosis; allergic reaction (including anaphylaxis, angioedema, pneumonitis rash, pneumonitis, and serum sickness); anaphylactoid reaction, arrhythmia (including atrial/ventricular tachycardia/fibrillation and torsade de pointes), aplastic anemia, arthralgia, ascites, bradycardia, bronchospasm, carcinoma, cardiac failure, cholecystitis, cholelithiasis, confusion, depression, EEG abnormalities, encephalopathy, eosinophilia, erythema multiforme, GI hemorrhage, granulocytopenia, hallucination, heart block, hemolytic anemia, hemoptysis, hepatic failure (some fatal), hepatitis, hyper-/hypoglycemia, hyperkalemia, hyperkinesias, hyper-/hypotension, infection, INR increased, intestinal obstruction, intracranial hypertension, involuntary muscle contractions, jaundice, leukocytosis, leukopenia, leukorrhea, lymphadenopathy, MI, migraine, multiple organ failure, nephritis (interstitial), palpitation, pancreatitis, pancytopenia, paralysis, paresthesia, peripheral neuropathy, photosensitivity (<0.1%), pleural effusion, pneumonitis, postural hypotension, prothrombin time increased/decreased, pseudomembraneous colitis, psychosis, pulmonary edema, pulmonary embolism, purpura, QT_c prolongation, respiratory depression, rhabdomyolysis, seizure, skin disorder, somnolence, speech disorder, Stevens-Johnson syndrome, stupor, syncope, tendon rupture, tongue edema, transaminases increased, thrombocythemia, thrombocytopenia, tremor, urticaria, WBC abnormality

Ophthalmic solution: Allergic reaction, lid edema, ocular dryness, ocular itching

Drug Interactions

Corticosteroids: Concurrent use may increase the risk of tendon rupture, particularly in elderly patients (overall incidence rare).

Glyburide: Quinolones may increase the effect of glyburide; monitor

Metal cations (aluminum, calcium, iron, magnesium, and zinc) bind quinolones in the gastrointestinal tract and inhibit absorption. Concurrent administration of most antacids, oral electrolyte supplements, quinapril, sevelamer, sucralfate, some didanosine formulations (pediatric powder for oral suspension), and other highly-buffered oral drugs, should be avoided. Levofloxacin should be administered 2 hours before or 2 hours after these agents.

NSAIDs: Risk of seizures may be increased with concomitant NSAID use. Risk is considered quite low and may only be a factor with high serum levels of either agent and/or in patients with additional predisposing factors (eg, renal dysfunction, history of seizure or other neurological disorder)

Probenecid: May decrease renal secretion of levofloxacin.

QT_c-prolonging agents: Effects may be additive with levofloxacin. Avoid concurrent use with Class Ia and Class III antiarrhythmics, erythromycin, cisapride, antipsychotics (thioridazine is contraindicated), and cyclic antidepressants.

Typhoid vaccine: Antibiotics may decrease the therapeutic effect of live, attenuated Ty21a vaccine; delay vaccination for >24 hours after administration of antibacterial agents.

Warfarin and other coumarin-type anticoagulants: The hypoprothrombinemic effect of warfarin may be enhanced by some quinolone antibiotics; monitor INR.

Storage

Solution for injection:

Vial: Store at room temperature. Protect from light. Diluted solution is stable for 72 hours when stored at room temperature; stable for 14 days when stored under refrigeration. When frozen, stable for 6 months; do not refreeze. Do not thaw in microwave or by bath immersion.

Premixed: Store at ?25°C (77°F); do not freeze. Brief exposure to 40°C (104°F) does not affect product. Protect from light.

Tablet, oral solution: Store at 25°C (77°F); excursions permitted to 15°C to 25°C (59°F to 77°F).

Ophthalmic solution: Store at 15°C to 25°C (59°F to 77°F).

Reconstitution

Solution for injection: Single-use vials must be further diluted in compatible solution to a final concentration of 5 mg/mL prior to infusion.

Compatibility

Stable in D₅LR, D₅NS, D₅1/2NS with 0.15% KCl, D₅W, NS, Plasma-Lyte® 56/5% dextrose, sodium lactate (M/6); incompatible with mannitol 20%, sodium bicarbonate 5%.

Y-site administration: Compatible: Amikacin, aminophylline, ampicillin, caffeine citrate, cefotaxime, cimetidine, clindamycin, dexamethasone sodium phosphate, dobutamine, dopamine, epinephrine, fentanyl, gentamicin, isoproterenol, lidocaine, linezolid, lorazepam, metoclopramide, morphine, oxacillin, pancuronium, penicillin G sodium, phenobarbital, phenylephrine, sodium bicarbonate, vancomycin. Incompatible: Acyclovir, alprostadil, furosemide, heparin, indomethacin, nitroglycerin, sodium nitroprusside. Variable (consult detailed reference): Insulin (regular).

Mechanism of Action

As the S (-) enantiomer of the fluoroquinolone, ofloxacin, levofloxacin, inhibits DNA-gyrase in susceptible organisms thereby inhibits relaxation of supercoiled DNA and promotes breakage of DNA strands. DNA gyrase (topoisomerase II), is an essential bacterial enzyme that maintains the superhelical structure of DNA and is required for DNA replication and transcription, DNA repair, recombination, and transposition.

Pharmacodynamics/Kinetics

Absorption: Rapid and complete

Distribution: V_d: 1.25 L/kg; CSF concentrations ?15% of serum levels; high concentrations are achieved in prostate, lung, and gynecological tissues, sinus, saliva

Protein binding: 50%

Metabolism: Minimally hepatic

Bioavailability: 99%

Half-life elimination: 6-8 hours

Time to peak, serum: 1-2 hours

Excretion: Primarily urine (as unchanged drug)

Dosage

Note: Sequential therapy (intravenous to oral) may be instituted based on prescriber's discretion.

Usual dosage range:

Children ?1 year: Ophthalmic: 1-2 drops every 2-6 hours

Adults:

Ophthalmic: 1-2 drops every 2-6 hours

Oral, I.V.: 250-500 mg every 24 hours; severe or complicated infections: 750 mg every 24 hours

Indication-specific dosing:

Children ?1 year and Adults: Ophthalmic:

Conjunctivitis (0.5% ophthalmic solution):

Treatment day 1 and day 2: Instill 1-2 drops into affected eye(s) every 2 hours while awake, up to 8 times/day

Treatment day 3 through day 7: Instill 1-2 drops into affected eye(s) every 4 hours while awake, up to 4 times/day

Children ?6 years and Adults: Ophthalmic:

Corneal ulceration (1.5% ophthalmic solution): Treatment day 1 through day 3: Instill 1-2 drops into affected eye(s) every 30 minutes to 2 hours while awake and 4-6 hours after retiring.

Adults: Oral, I.V.:

Anthrax (inhalational): 500 mg every 24 hours for 60 days, beginning as soon as possible after exposure

Chronic bronchitis (acute bacterial exacerbation): 500 mg every 24 hours for at least 7 days

Diverticulitis, peritonitis (unlabeled use): 750 mg every 24 hours for 7-10 days; use adjunctive metronidazole therapy

Dysenteric enterocolitis, Shigella spp. (unlabeled use): 500 mg every 24 hours for 3-5 days

Epididymitis, nongonococcal (unlabeled use): 500 mg once daily for 10 days

Gonococcal infection (unlabeled use):

Cervicitis, urethritis: 250 mg for one dose with azithromycin or doxycycline; Note: As of April 2007, the CDC no longer recommends the use of fluoroquinolones for the treatment of uncomplicated gonococcal disease.

Disseminated infection: 250 mg I.V. once daily; 24 hours after symptoms improve may change to 500 mg orally every 24 hours to complete total therapy of 7 days; Note: As of April 2007, the CDC no longer recommends the use of fluoroquinolones for the treatment of more serious gonococcal disease, unless no other options exist and susceptibility can be confirmed via culture.

Pelvic inflammatory disease (unlabeled use): 500 mg once daily for 14 days with or without adjunctive metronidazole; Note: The CDC recommends use only if standard cephalosporin therapy is not feasible and community prevalence of quinolone-resistant gonococcal organisms is low. Culture sensitivity must be confirmed.

Pneumonia:

Community-acquired: 500 mg every 24 hours for 7-14 days or 750 mg every 24 hours for 5 days (efficacy of 5-day regimen for MDRSP not established)

Nosocomial: 750 mg every 24 hours for 7-14 days

Prostatitis (chronic bacterial): 500 mg every 24 hours for 28 days

Sinusitis (acute bacterial): 500 mg every 24 hours for 10-14 days or 750 mg every 24 hours for 5 days

Skin and skin structure infections:

Uncomplicated: 500 mg every 24 hours for 7-10 days

Complicated: 750 mg every 24 hours for 7-14 days

Traveler's diarrhea (unlabeled use): 500 mg for one dose

Urinary tract infections:

Uncomplicated: 250 mg once daily for 3 days

Complicated, including pyelonephritis: 250 mg once daily for 10 days or 750 mg once daily for 5 days

Dosing adjustment in renal impairment:

Normal renal function dosing of 750 mg/day:

Cl_cr 20-49 mL/minute: Administer 750 mg every 48 hours

Cl_cr 10-19 mL/minute: Administer 750 mg initial dose, followed by 500 mg every 48 hours

Hemodialysis/CAPD: Administer 750 mg initial dose, followed by 500 mg every 48 hours

Normal renal function dosing of 500 mg/day:

Cl_cr 20-49 mL/minute: Administer 500 mg initial dose, followed by 250 mg every 24 hours

Cl_cr 10-19 mL/minute: Administer 500 mg initial dose, followed by 250 mg every 48 hours

Hemodialysis/CAPD: Administer 500 mg initial dose, followed by 250 mg every 48 hours

Normal renal function dosing of 250 mg/day:

Cl_cr 20-49 mL/minute: No dosage adjustment required

Cl_cr 10-19 mL/minute: Administer 250 mg every 48 hours (except in uncomplicated UTI, where no dosage adjustment is required)

Hemodialysis/CAPD: No information available

CRRT: Note: Clearance dependent on filter type, flow rates, and other variables.

CVVH/CVVHD/CVVHDF: Alternative recommendations exist:

500 mg every 48 hours or

250 mg every 24 hours (Note: This regimen has been shown to be equivalent to 500 mg/day in normal renal function. Appropriateness of this regimen for target dosing equal to 750 mg/day is not known.)

Administration: Oral

Tablets may be administered without regard to meals. Oral solution should be administered 1 hour before or 2 hours after meals.

Administration: I.V.

Infuse 250-500 mg I.V. solution over 60 minutes; infuse 750 mg I.V. solution over 90 minutes. Too rapid of infusion can lead to hypotension. Avoid administration through an intravenous line with a solution containing multivalent cations (eg, magnesium, calcium).

Administration: I.V. Detail

pH: 3.8-5.8

Monitoring Parameters

Evaluation of organ system functions (renal, hepatic, ophthalmologic, and hematopoietic) is recommended periodically during therapy; the possibility of crystalluria should be assessed; WBC and signs of infection

Test Interactions

Some quinolones may produce a false-positive urine screening result for opiates using commercially-available immunoassay kits. This has been demonstrated most consistently for levofloxacin and ofloxacin, but other quinolones have shown cross-reactivity in certain assay kits. Confirmation of positive opiate screens by more specific methods should be considered.

Dietary Considerations

Tablets may be taken without regard to meals. Oral solution should be administered on an empty stomach (1 hour before or 2 hours after a meal).

Patient Education

Do not take any new prescription, OTC medications, or herbal products during therapy unless approved by prescriber. If administered by infusion, report immediately any chest or back pain; tightness in chest; difficulty swallowing; swelling of face or mouth; or redness, swelling, or pain at infusion site. Oral: Tablets may be taken without regard to meals; oral solution should be taken at least 1 hour before or 2 hours after antacids or other drug products containing calcium, iron, or zinc. Take entire prescription even if feeling better. May cause dizziness, lightheadedness, or fatigue (use caution to avoid falls, when driving or when engaging in tasks that require alertness until response to drug is known); nausea or vomiting (small frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help; if severe, request antiemetic from prescriber); or photosensitivity (avoid excessive direct sunlight, wear protective clothing, use effective sunscreen). If you have diabetes, monitor glucose levels closely; may cause hypoglycemia. Discontinue use immediately and report to prescriber if inflammation, tendon pain, or allergic reaction occurs (itching, skin rash, respiratory difficulty, facial edema, difficulty swallowing, loss of consciousness). Report chest pain or palpitations; signs of infection (unusual fever or chills, white plaques in mouth, vaginal itching or foul-smelling vaginal discharge); easy bruising or bleeding; persistent diarrhea, abdominal pain, or constipation; changes in vision or ocular pain; or other persistent adverse effects. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Breast-feeding is not recommended.

Ophthalmic: Wash hands before instilling solution. Sit or lie down to instill. Open eye, look at ceiling, and instill prescribed amount of solution. Close eye, roll eye in all directions, and apply gentle pressure to inner corner of eye. Do not let tip of applicator touch eye; do not contaminate tip of applicator (may cause eye infection, eye damage, or vision loss). Temporary stinging or blurred vision may occur. Report persistent pain, burning, vision changes, swelling, itching, or worsening of condition. Discontinue medication and contact prescriber immediately if you develop a rash or allergic reaction. Do not wear contact lenses.

Geriatric Considerations

The risk of torsade de pointes and tendon inflammation and/or rupture associated with the concomitant use of corticosteroids and quinolones is increased in the elderly population. Adjust dose for renal function.

Dental Health: Effects on Dental Treatment

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

Levofloxacin is one of the drugs confirmed to prolong the QT interval and is accepted as having a risk of causing torsade de pointes. The risk of drug-induced torsade de pointes is extremely low when a single QT interval prolonging drug is prescribed. In terms of epinephrine, it is not known what effect vasoconstrictors in the local anesthetic regimen will have in patients with a known history of congenital prolonged QT interval or in patients taking any medication that prolongs the QT interval. Until more information is obtained, it is suggested that the clinician consult with the physician prior to the use of a vasoconstrictor in suspected patients, and that the vasoconstrictor (epinephrine, levonordefrin [Neo-Cobefrin®]) be used with caution.

Infectious Diseases Comment

Treatment of asymptomatic bacteriuria: Guidelines endorsed by the Infectious Disease Society of America recommend urine culture screening and antimicrobial treatment (3-7 days) of pregnant women presenting with asymptomatic bacteriuria. These patients should also receive periodic screening for recurrence post-treatment. These recommendations were based on the results of prospective, clinical trials data showing that treatment consistently results in a reduced incidence of pyelonephritis and low birth-weight or preterm deliveries.

The guidelines also recommend screening and treatment for patients undergoing urologic procedures in which mucosal bleeding is anticipated. Patients undergoing specific procedures, such as TURP, should be screened for bacteriuria and treatment initiated shortly before the procedure. Antimicrobial therapy should be continued beyond length of procedure only if an indwelling catheter is placed.

A review of studies evaluating several other patient cohorts suggests that treatment of asymptomatic bacteriuria does not reduce the risk of adverse outcomes (eg, progression to symptomatic UTI, increased disease-related complications [eg, diabetic nephropathy], reduced survival, increased rates of reinfection) or may predispose certain patients to recurrence with resistant organisms (elderly and spinal cord injury). As such, the IDSA guidelines recommend no routine screening or antibiotic therapy in any of the following patient groups presenting with asymptomatic bacteriuria:

Premenopausal (nonpregnant) or postmenopausal women

Elderly institutionalized patients

Women with diabetes

Spinal cord injury

Short- or long-term indwelling catheters

Note: Antimicrobial therapy may be considered if catheter-associated bacteriuria persists for ?48 hours after catheter removal)

Mental Health: Effects on Mental Status

May cause agitation, anxiety, confusion, depression, dizziness, hallucinations, insomnia, nervousness, paranoia, and sedation

Mental Health: Effects on Psychiatric Treatment

May cause leukopenia; use caution with clozapine and carbamazepine; inhibits CYP1A2 isoenzyme; caution with clozapine and other psychotropics; monitor for adverse effects

Nursing: Physical Assessment/Monitoring

Assess results of culture and sensitivity tests prior to beginning therapy. Use caution in patients with known or suspected CNS disorder, current or potential for QT prolongation, renal or hepatic impairment, or diabetes. Assess other pharmacological or herbal products patient may be taking for potential interactions. See Administration for infusion specifics. Patient should be monitored closely; if an allergic reaction occurs (itching, urticaria, dyspnea or facial edema, loss of consciousness, tingling, cardiovascular collapse), drug should be discontinued immediately and prescriber notified. Evaluate results of laboratory tests, therapeutic effectiveness (resolution of infection), and adverse reactions (eg, hypersensitivity reactions [severe reactions, including anaphylaxis, have occurred with quinolone therapy], opportunistic infection, tendon rupture, persistent diarrhea [C. difficile-associated colitis can occur up to 2 months post treatment]) regularly during prolonged therapy. Teach patient proper use (according to formulation), possible side effects/appropriate interventions, and adverse symptoms to report.

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Infusion [premixed in D₅W]:

Levaquin®: 250 mg (50 mL); 500 mg (100 mL); 750 mg (150 mL)

Injection, solution [preservative free]

Levaquin®: 25 mg/mL (20 mL, 30 mL)

Solution, ophthalmic [drops]:

Iquix®: 1.5% (5 mL)

Quixin®: 0.5% (5 mL) [contains benzalkonium chloride]

Solution, oral:

Levaquin®: 25 mg/mL (480 mL) [contains benzyl alcohol]

Tablet, oral:

Levaquin®: 250 mg, 500 mg, 750 mg

Levaquin® Leva-Pak: 750 mg (5s)

Pricing: U.S. (www.drugstore.com)

Tablets (Levaquin)

250 mg (10): $104.89

500 mg (10): $121.67

750 mg (30): $676.59

Tablets (Levaquin LEVA-pak)

750 mg (5): $114.32

References

American Thoracic Society and Infectious Diseases Society of America, “Guidelines for the Management of Adults With Hospital-Acquired, Ventilator-Associated, and Healthcare-Associated Pneumonia,” Am J Respir Crit Care Med, 2005, 171(4):388-416.

Centers for Disease Control and Prevention, “Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2006: Fluoroquinolones No Longer Recommended for Treatment of Gonococcal Infections,” MMWR Recomm Rep, 2007, 56(14):332-6.

Centers for Disease Control and Prevention, "Sexually Transmitted Diseases Treatment Guidelines, 2006," MMWR, 2006, 55(RR-11): 1-94.

Ernst ME, Ernst EJ, and Klepser ME, “Levofloxacin and Trovafloxacin: The Next Generation of Fluoroquinolones?” Am J Health Syst Pharm, 1997, 54(22):2569-84.

Friedrich LV and Dougherty R, “Fatal Hypoglycemia Associated With Levofloxacin,” Pharmacotherapy, 2004, 24(12):1807-12.

Frothingham R, “Glucose Homeostasis Abnormalities Associated With Use of Gatifloxacin,” Clin Infect Dis, 2005, 41(9):1269-76.

Gavin JR 3rd, Kubin R, Choudhri S, et al, “Moxifloxacin and Glucose Homeostasis: A Pooled-Analysis of the Evidence From Clinical and Postmarketing Studies,” Drug Saf, 2004, 27(9):671-86.

Graumlich JF, Habis S, Avelino RR, et al, “Hypoglycemia in Inpatients After Gatifloxacin or Levofloxacin Therapy: Nested Case-Control Study,” Pharmacotherapy, 2005, 25(10):1296-302.

Hoogkamp-Korstanje JA, “In vitro Activities of Ciprofloxacin, Levofloxacin, Lomefloxacin, Ofloxacin, Pefloxacin, Sparfloxacin, and Trovafloxacin Against Gram-Positive and Gram-Negative Pathogens From Respiratory Tract Infections,” J Antimicrob Chemother, 1997, 40(3):427-31.

Khaliq Y and Zhanel GG, “Fluoroquinolone-Associated Tendinopathy: A Critical Review of the Literature,” Clin Infect Dis, 2003, 36(11):1404-10.

Lawrence KR, Adra M, and Keir C, “Hypoglycemia-Induced Anoxic Brain Injury Possibly Associated With Levofloxacin,” J Infect, 2006, 52(6):e177-80.

Malone RS, Fish DN, Abraham E, et al, “Pharmacokinetics of Levofloxacin and Ciprofloxacin During Continuous Renal Replacement Therapy in Critically Ill Patients,” Antimicrob Agents Chemother, 2001, 45(10):2949-54.

Martin SJ, Meyer JM, Chuck SK, et al, “Levofloxacin and Sparfloxacin: New Quinolone Antibiotics,” Ann Pharmacother, 1998, 32(3):320-36.

Mohr JF, McKinnon PS, Peymann PJ, et al, “A Retrospective, Comparative Evaluation of Dysglycemias in Hospitalized Patients Receiving Gatifloxacin, Levofloxacin, Ciprofloxacin, or Ceftriaxone,” Pharmacotherapy, 2005, 25(10):1303-9.

Nicolle LN, Bradley S, Colgan R et al, “Infectious Disease Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults,” Clinical Infectious Diseases, 2005, 40:643-54.

North DS, Fish DN, and Redington JJ, “Levofloxacin, A Second-Generation Fluoroquinolone,” Pharmacotherapy, 1998, 18(5):915-35.

Park-Wyllie LY, Juurlink DN, Kopp A, et al, “Outpatient Gatifloxacin Therapy and Dysglycemia in Older Adults,” N Engl J Med, 2006, 354(13):1352-61.

Pfaller MA and Jones RN, “Comparative Antistreptococcal Activity of Two Newer Fluoroquinolones, Levofloxacin and Sparfloxacin,” Diagn Microbiol Infect Dis, 1997, 29(3):199-201.

“Sparfloxacin and Levofloxacin,” Med Lett Drugs Ther, 1997, 39(999):41-3.

Trotman RL, Williamson JC, Shoemaker DM, et al, “Antibiotic Dosing in Critically Ill Adult Patients Receiving Continuous Renal Replacement Therapy,” Clin Infect Dis, 2005, 41(8):1159-66.

Wang S and Rizvi AA, “Levofloxacin-Induced Hypoglycemia in a Nondiabetic Patient,” Am J Med Sci, 2006, 331(6):334-5.

Zacher JL and Givone DM, “False-Positive Urine Opiate Screening Associated With Fluoroquinolone Use,” Ann Pharmacother, 2004, 38:1525-28.

International Brand Names

• Cina (MX)
• Cravit (CL, ID, JP, MY, PK, SG, TH)
• Cravit Ophthalmic (HK, ID)
• Cravox (ID)
• Elequine (MX)
• Faxlev (ID)
• Flevox (MX)
• Floxel (PH)
• Glevo (MY)
• Lefloxin (TH)
• Lefos-500 (ID)
• Leroxacin (KP)
• Lesacin (KP)
• Levaquin (AR, BR, CO, PE)
• Levo (IL)
• Levocin (ID)
• Levokacin (KP)
• Levomicin (KP)
• Levores (ID)
• Levotamin (KP)
• Levovid (ID)
• Levox (PH)
• Levoxacin (IT, KP)
• Lexa (ID)
• Lovequin (ID)
• Loxof (MY)
• Mosardal (ID)
• Nislev (ID)
• Nofaxin (KP)
• Nufalev (ID)
• Oftaquix (BG, CZ, DE, DK, EE, FI, GB, IE, PH, SE)
• Ovelquin (MX)
• Ran-Levo (MX)
• Reskuin (ID)
• Rinvox (ID)
• Tavanic (AR, AT, BB, BE, BG, BM, BS, BZ, CH, CN, CO, CR, CZ, DE, DO, EC, EE, ES, FI, FR, GB, GT, GY, HN, IE, IL, IN, JM, MX, NI, NL, PA, PE, PL, PT, PY, SE, SR, SV, TT, UY, VE)
• Voflaxin (MX)
• Volequin (ID)

Lexi-Comp.com

Last full review/revision April 2008

Content last modified April 2008