Levoxel Drug Interactions

Chelation Agents: Antacids, Sucralfate, Metal Cations, Multivitamins: Levofloxacin (Levoxel) Injection: There are no data concerning an interaction of intravenous fluoroquinolones with oral antacids, sucralfate, multivitamins, didanosine, or metal cations. However, no fluoroquinolone should be co-administered with any solution containing multivalent cations, e.g., magnesium, through the same intravenous line.
Warfarin: No significant effect of Levofloxacin (Levoxel) on the peak plasma concentrations, AUC, and other disposition parameters for R- and S- warfarin was detected in a clinical study involving healthy volunteers. Similarly, no apparent effect of warfarin on levofloxacin absorption and disposition was observed. However, there have been reports during the post marketing experience in patients that Levofloxacin (Levoxel) enhances the effects of warfarin. Elevations of the prothrombin time in the setting of concurrent warfarin and Levofloxacin (Levoxel) use have been associated with episodes of bleeding. Prothrombin time, International Normalized Ratio (INR), or other suitable anticoagulation tests should be closely monitored if Levofloxacin (Levoxel) is administered concomitantly with warfarin. Patients should also be monitored for evidence of bleeding.
Antidiabetic Agents: Disturbances of blood glucose, including hyperglycemia and hypoglycemia, have been reported in patients treated concomitantly with fluoroquinolones and an antidiabetic agent. Therefore, careful monitoring of blood glucose is recommended when these agents are coadministered.
Non-Steroidal Anti-Inflammatory Drugs: The concomitant administration of a non-steroidal anti-inflammatory drug with a fluoroquinolone, including Levofloxacin (Levoxel), may increase the risk of CNS stimulation and convulsive seizures.
Theophylline: No significant effect of Levofloxacin (Levoxel) on the plasma concentrations, AUC, and other disposition parameters for theophylline was detected in a clinical study involving healthy volunteers. Similarly, no apparent effect of theophylline on Levofloxacin absorption and disposition was observed. However, concomitant administration of other fluoroquinolones with theophylline has resulted in prolonged elimination half-life, elevated serum theophylline levels, and a subsequent increase in the risk of theophylline-related adverse reactions in the patient population. Therefore, theophylline levels should be closely monitored and appropriate dosage adjustments made when Levofloxacin (Levoxel) is co-administered. Adverse reactions, including seizures, may occur with or without an elevation in serum theophylline levels.
Cyclosporine: No significant effect of Levofloxacin (Levoxel) on the peak plasma concentrations, AUC, and other disposition parameters for cyclosporine was detected in a clinical study involving healthy volunteers. However, elevated serum levels of cyclosporine have been reported in the patient population when co-administered with some other fluoroquinolones. Levofloxacin Cmax and ke were slightly lower while Tmax and t½ were slightly longer in the presence of cyclosporine than those observed in other studies without concomitant medication. The differences, however, are not considered to be clinically significant. Therefore, no dosage adjustment is required for Levofloxacin (Levoxel) or cyclosporine when administered concomitantly.
Digoxin: No significant effect of Levofloxacin (Levoxel) on the peak plasma concentrations, AUC, and other disposition parameters for digoxin was detected in a clinical study involving healthy volunteers. Levofloxacin absorption and disposition kinetics were similar in the presence or absence of digoxin. Therefore, no dosage adjustment for Levofloxacin (Levoxel) or digoxin is required when administered concomitantly.
Probenecid and Cimetidine: No significant effect of probenecid or cimetidine on the Cmax of levofloxacin was observed in a clinical study involving healthy volunteers. The AUC and t½ of levofloxacin were higher while CL/F and CLR were lower during concomitant treatment of Levofloxacin (Levoxel) with probenecid or cimetidine compared to Levofloxacin (Levoxel) alone. However, these changes do not warrant dosage adjustment for Levofloxacin (Levoxel) when probenecid or cimetidine is co-administered.
Interactions with Laboratory or Diagnostic Testing: Some fluoroquinolones, including Levofloxacin (Levoxel) , may produce false-positive urine screening results for opiates using commercially available immunoassay kits. Confirmation of positive opiate screens by more specific methods may be necessary.