Winaflox Drug Interactions

Chelation Agents: Antacids, Sucralfate, Didanosine, Metal Cations, Multivitamins: Concomitant administration of levofloxacin tablets with antacids containing calcium, magnesium, or aluminum, as well as sucralfate, didanosine, metal cations such as iron, and multivitamin preparations with zinc, or any products containing any of these components may interfere with the GI absorption of levofloxacin, resulting in systemic levels considerably lower than desired. These agents should be taken at least two hours before or two hours after levofloxacin therapy.
Anti-arrhythmic Agents: Levofloxacin should be avoided in patients receiving class IA (e.g., quinidine, procainamide) or class III (e.g., amiodarone, sotalol) antiarrhythmic agents because of potential pharmacologic interaction (additive effect on QT interval prolongation).
Antidepressants: Potential pharmacologic interaction with fluoxetine or imipramine (additive effect on QT interval prolongation).
Antidiabetic Agents: Disturbances of blood glucose, including hyperglycemia and hypoglycemia, have been reported in patients treated concomitantly with quinolones and antidiabetic agent. Careful monitoring of blood glucose is recommended when these agents are co-administered.
Ciclosporin and Tacrolimus: Possible pharmacokinetic interactions with ciclosporin or tacrolimus (increased AUC of the immunosuppressive agent). Although no dosage adjustment is necessary, monitoring of plasma concentrations of the immunosuppressive agent is recommended during concomitant therapy.
Corticosteroids: Risk of tendon rupture during treatment with levofloxacin may be increased in patients receiving corticosteroids, particularly in elderly patients.
Digoxin: There are no significant effects noted during concomitant therapy therefore, no dosage adjustment is required.
Fluconazole: Both levofloxacin and fluconazole can prolong the QT interval. The simultaneous use of IV levofloxacin and fluconazole resulted in an episode of torsades de pointes in patient on hemodialysis.
Non-steroidal anti-inflammatory drugs (NSAIDs): Concomitant administration of an NSAID with a quinolone including levofloxacin, may increase the risk of CNS stimulation and convulsive seizures.
Probenecid and Cimetidine: Potential pharmacokinetic interaction (increased levofloxacin AUC and t_1/2) - not considered clinically important; dosage adjustments are not required.
Theophylline: Concomitant administration of other quinolones with theophylline has resulted in prolonged elimination t_1/2 elevated serum theophylline levels, and a subsequent increase in the risk of theophylline-related adverse reactions. Closely monitor serum theophylline levels and adjust theophylline dosage accordingly; consider that adverse theophylline effects (e.g., seizures) may occur with or without elevated theophylline concentrations.
Warfarin: There have been reports of enhanced effects of warfarin when co-administered with levofloxacin. Therefore, prothrombin time, International Normalized Ratio (INR), or other suitable anticoagulation tests should be closely monitored if levofloxacin is administered concomitantly. Patient should also be monitored for evidence of bleeding.
Zidovudine: Levofloxacin absorption and disposition in HIV-infected subjects, with or without concomitant zidovudine treatment, were similar. The effect of levofloxacin on zidovudine pharmacokinetics has not been studied. No dosage adjustment for levofloxacin appears to be required when co-administered with zidovudine.