Levofloxacin

Oral soln: Should be taken on an empty stomach. Take on an empty stomach 1 hr before or 2 hr after meals. Ensure adequate fluid intake.
Tab: May be taken with or without food. Ensure adequate fluid intake.

Hypersensitivity to levofloxacin or other quinolones. Epilepsy, history of tendon disorders related to previous fluoroquinolone use.

Patient with history of prolonged QT interval, uncorrected electrolyte disorders (e.g. hypokalaemia), risk factors that predispose to seizures or lower the seizure threshold, pre-existing aortic aneurysm and/or dissection, latent or actual defects in G6PD, diabetes mellitus, history or risk factors of psychiatric disorders, history of or risk factors for tendon disorder, severe underlying diseases (e.g. sepsis), haemoptysis (inhalation). Renal impairment. Children and elderly. Pregnancy and lactation. Not recommended as treatment option for known or suspected MRSA and E. coli infection due to increased risk of resistance in some countries. Patient Counselling This drug may cause dizziness, drowsiness, visual disturbances (ophthalmic) if affected, do not drive or operate machinery. Avoid exposure to strong sunlight or to artificial UV rays (e.g. sunray lamp, solarium) during treatment and for 48 hours following discontinuation. Ophthalmic: Remove contact lenses prior to instillation of ophthalmic drops and wait at least 15 minutes before reinserting. Monitoring Parameters Monitor LFT, renal and haematopoietic function, WBC count, blood glucose level in diabetic patients, signs of infection, altered mental status, signs and symptoms of tendonitis or tendon rupture, altered glucose regulation, crystalluria, bronchospasm or haemoptysis. Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks.

Significant: CNS effects including seizures, increased intracranial pressure, lightheadedness, dizziness, tremor; psychotic reactions (e.g. hallucinations, nervousness, delirium), sensory or sensorimotor peripheral neuropathy, prolonged QT interval, blood glucose disturbances (hypo-/hyperglycaemia), phototoxicity, superinfection (prolonged use), bronchospasm, cough or productive cough, haemoptysis, fluoroquinolone-resistant P. aeruginosa (inhalation), exacerbation of myasthenia gravis, interstitial nephritis, acute renal insufficiency or failure, hypotension (rapid or bolus IV infusion). Rarely, tendinitis, tendon rupture, suicidal thoughts, self-endangering behaviour, crystalluria, cylindruria, torsades de pointes, Stevens-Johnson syndrome, toxic epidermal necrolysis, hepatic necrosis. Blood and lymphatic system disorders: Rarely, pancytopenia, agranulocytosis, haemolytic or aplastic anaemia, leukopenia, eosinophilia. Cardiac disorders: Dyspnoea, chest pain, arrhythmia. Eye disorders: Ocular burning, decreased vision and mucous strand, blurred vision, eye pain, eye irritation, eyelid oedema, eye pruritus, chemosis, photophobia, conjunctivitis, dry eye syndrome. Gastrointestinal disorders: Diarrhoea, vomiting, nausea, dyspepsia, constipation, abdominal pain. General disorders and administration site conditions: Fatigue, fever, asthenia, hyperhidrosis. Hepatobiliary disorders: Rarely, hepatitis, jaundice. Injury, poisoning and procedural complications: Infusion site reaction (e.g. pain, reddening), phlebitis. Investigations: Increased hepatic enzymes (ALT/AST, alkaline phosphatase, GGT), decreased forced expiratory volume. Metabolism and nutrition disorders: Anorexia, oedema. Musculoskeletal and connective tissue disorders: Arthralgia, myalgia. Nervous system disorders: Headache, vertigo, dysgeusia. Psychiatric disorders: Insomnia. Reproductive system and breast disorders: Vaginitis. Respiratory, thoracic and mediastinal disorders: Increased bronchial secretions, rarely, allergic pneumonitis. Skin and subcutaneous tissue disorders: Rash, pruritus. Vascular disorders: Rarely, vasculitis.
Potentially Fatal: Hypersensitivity reactions (e.g. angioedema, anaphylactic shock), Clostridium difficile-associated disease (e.g. pseudomembranous colitis), hypoglycaemic coma, severe hepatotoxicity.

Decreased absorption with Fe salts, Zn-containing multivitamins, Mg- or Al-containing antacids, didanosine. Decreased bioavailability with sucralfate. Increased risk of CNS stimulation and seizures with drugs which may affect seizure threshold (e.g. theophylline, NSAIDs). Decreased renal clearance with cimetidine and probenecid due to blockage of renal tubular secretion of levofloxacin. May increase the half-life of ciclosporin. Increased INR and/or bleeding with vitamin K antagonists (e.g. warfarin). Increased risk of severe tendon disorders with corticosteroids. Increased risk for QT interval prolongation with class IA and III antiarrhythmics, TCA, macrolides and antipsychotic agents. May result to altered blood glucose levels with antidiabetic agents (e.g. insulin, glibenclamide).

Eye Anti-Infectives & Antiseptics / Quinolones

S01AE05 - levofloxacin ; Belongs to the class of quinolone antiinfectives. Used in the treatment of eye infections.
J01MA12 - levofloxacin ; Belongs to the class of fluoroquinolones. Used in the systemic treatment of infections.