Levoflox Drug Interactions

Fluoroquinolones are known to inhibit hepatic drug metabolism and may interfere with the clearance of drugs, such as theophylline, that are metabolized in the liver. Cations like aluminum, magnesium or iron reduced the absorption of levofloxacin and related drugs when given concomitantly.
Analgesics: Concurrent administration of fenbufen with quinolones may increase the incidence of quinolone CNS adverse effects. Adverse neurological effects have also been reported in patient receiving naproxen and chloroquine when levofloxacin is administered, abated when the antirheumatic drugs were withdrawn.
Levofloxacin also interacts with opioid analgesics; peak serum concentrations of levofloxacin by mouth pre-operatively were significantly reduced when intramuscular papaveretum was injected concomitantly. The manufacturers recommend that opioids should not be administered pre-operatively to patients receiving levofloxacin.
Antacid and metal ions: The absorption of levofloxacin and other fluoroquinolones is reduced by antacids containing aluminum or magnesium and also by calcium, iron and zinc salts. Sucralfate increases aluminum ions in the stomach and thereby reduces the absorption of levofloxacin and other fluoroquinolones, including norfloxacin and ofloxacin. In addition, concomitant administration of antacids or oral iron preparations might antagonize the antibacterial activity of fluroquinolones within the gut lumen. Dairy products with high calcium content might also interfere with the absorption of some fluoroquinolones. Enteral feeds, which contain cations, have also been found to reduce absorption of levofloxacin. A reduction of levofloxacin bioavailability has also been reported following concomitant administration of chewable tablets of didanosine which contain aluminum and magnesium ion buffering agents.
Antibacterials: The simultaneous administration of parenteral levofloxacin and azlocillin has resulted in higher and more prolonged serum concentrations of levofloxacin.
Antimigraine drugs: For a recommendation to reduce the dosage of zolmitriptan when given concurrently with levofloxacin.
Antineoplastics and immunosuppressants: Absorption of oral levofloxacin appears to reduce after cytotoxic chemotherapy. There has been a report of enhanced nephrotoxicity in a patient who received levofloxacin and ciclosporin, although a review found no correlation between concurrent treatment and alterations in pharmacokinetics or pharmacodynamics.
Antivirals: Both levofloxacin and foscarnet can cause convulsions and 2 patients developed generalized tonic-clonic seizures while receiving the drugs concurrently.
Histamine H2-antagonists: Cimetidine has been reported to reduce the clearance of pefloxacin and ranitidine given intravenously has reduced the bioavailability of oral enoxacin.
Probenecid: The urinary excretion of levofloxacin and some other fluoroquinolones is reduced by the concomitant administration or probenecid; plasma concentrations are not necessarily increased.
Xanthines: Levofloxacin and other fluoroquinolones (to a greater or lesser extent) decrease the clearance of theophylline and caffeine form the body. Seizures have occurred in patients given levofloxacin and theophylline concomitantly and in one such report serum-theophylline concentrations were normal. Fluoroquinolones can be neurotoxic in their own right.