Trulev Special Precautions

General: Prescribing Levofloxacin in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria. Although Levofloxacin is more soluble than other quinolone, adequate hydration of patients receiving Levofloxacin should be maintained to prevent the formation of a highly concentrated urine.
As with the other quinolone, Levofloxacin should be used with caution in patients with known or suspected CNS disorder that may predispose to seizures or lower the seizure threshold (e.g. Severe cerebral arteriosclerosis, epilepsy) or in the presence of the risk factors that may predispose to seizure or lower the seizure threshold (e.g. Certain drug therapy, renal dysfunction). As with other quinolones, disturbances of blood glucose including symptomatic hyper/hypoglycemia, have been reported usually in diabetic patients receiving concomitant treatment with an oral hypoglycemic agent (e.g. Glyburide/glibenclamide) or with insulin. In these patients, careful monitoring of blood glucose is recommended. If a hypoglycemic reaction occurs in a patient being treated with Levofloxacin, it should be discontinued immediately and appropriate therapy should be initiated immediately. Torsades de Pointes: Some quinolone including levofloxacin have been associated with prolongation of the QT interval on the electrocardiogram and frequent cases of arrhythmia. Rare cases of torsades de pointes have been spontaneously reported during post-marketing surveillance in patients receiving quinolones including Levofloxacin. Levofloxacin should be avoided in patients with known prolongation QT interval, patient with uncorrected hypokalemia, and patients receiving class IA (quinidine, procainamide) class III (amiodarone, sotalol) anti-arrhythmic agents.
Use in Children: Quinolones including Levofloxacin cause arthropathy and osteochondrosis in juvenile animals and several species.
Use in Elderly: Elderly patients may be more susceptible to drug associated effects on the QT interval. Therefore precaution should be taken when using Levofloxacin with concomitant drugs that can result in prolongation of QT interval (e.g. Class IA, Class III) anti-arrhythmic) or in patients in risk factor for Torsade de Pointes (e.g. Known QT prolongation, uncorrected hypokalemia).