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Levofloxacin

Tavanic

RA
UR

Written by R. Author | Reviewed by Uche Ruth

Updated on June 12, 2024

Overview

Levofloxacin is a fluoroquinolone antibiotic. It can treat many types of bacterial infections, including pneumonia and urinary tract infections (UTIs). But because levofloxacin can cause serious side effects, such as tendon rupture and nerve damage, it's usually only prescribed for more serious infections or when safer options aren't available. Levofloxacin is taken by mouth, typically once daily. Some of the more common side effects of this medication include nausea, headache, and diarrhea. Levofloxacin is generic only, brand-name Levaquin is no longer available.

What is Levofloxacin used for?

Adults only

Adults and children

How Levofloxacin works

Levofloxacin is a fluoroquinolone (or "quinolone") antibiotic. It works by blocking certain enzymes (proteins) that bacteria use to grow and repair their genetic material in order to survive. By blocking this process, the antibiotic kills bacteria.

Pros and cons of Levofloxacin

pros and cons of ciprofloxacin
Pharmacist tips for Levofloxacin

  • Take levofloxacin exactly as prescribed. Make sure to finish your treatment course, even if you're feeling better. Stopping the medication earlier than prescribed can cause your infection to come back and become harder to treat.
  • If you miss a dose of levofloxacin, take it as soon as you remember if there's at least 8 hours until your next scheduled dose. If your next dose is due in less than 8 hours, don't take the missed dose. Take your next dose at your regularly scheduled time. Don't take two doses to make up for the missed dose.
  • Levofloxacin tablets can be taken with or without food. If it's upsetting your stomach, taking it with food can help. If you're taking the liquid medication, take it on an empty stomach 1 hour before or 2 hours after a meal, and at the same time every day.
  • If you develop watery or bloody diarrhea, fever, fatigue, or stomach cramps anytime during treatment or after stopping levofloxacin, get medical help right away. These could be signs of a serious type of infectious diarrhea, which needs to be treated right away.
  • Drink enough fluids while taking levofloxacin to stay well-hydrated. This helps lower your risk for kidney problems.
  • Levofloxacin can cause your skin to become sensitive to the sun. To protect your skin, make sure to wear sunscreen when going outside, wear long-sleeved clothing, and limit your time in the sun and being exposed to ultraviolet (UV) light.
  • Take levofloxacin at least 2 hours before or 2 hours after any supplements or multivitamins containing magnesium, aluminum, iron, or zinc. This timing also applies if you're taking sucralfate (Carafate). This allows your body to absorb the antibiotic better.
  • If you have diabetes, ask your healthcare team if you need to check your blood sugar more often while taking levofloxacin. This antibiotic can affect your blood sugar levels if you take certain diabetes medications, such as insulin.
  • Levofloxacin can interact with some other common medications, such as ibuprofen (Advil, Motrin), naproxen (Aleve), theophylline, and warfarin (Coumadin), among many others. Don't start any new medications while taking levofloxacin without talking to your care team first. They can make sure your medications are safe to take together.
  • Speak with your HCP about the risks and benefits of nursing while taking levofloxacin. Data shows that levofloxacin can be found in human milk. Because of the potential serious risks to the baby, the manufacturer recommends avoiding breastfeeding or considering pumping and discarding breast milk during treatment and for 2 days after the last dose for most infections. Other sources suggest avoiding breastfeeding for 4 to 6 hours after taking a levofloxacin dose might lower the risk of side effects to your baby.
  • If you're nursing during treatment with levofloxacin and your baby gets diarrhea or a diaper rash, it's possible it could be due to the antibiotic. Stop nursing and contact your healthcare team if your baby has any of these symptoms.

More tips for the oral liquid

  • Make sure to only use a medication dose cup or oral syringe from the pharmacy to measure out your dose. Don't use household spoons because they aren't accurate and might cause you to take the wrong dose.
  • Store the levofloxacin liquid at room temperature in the original bottle you received at the pharmacy.

Strengths

Tablet

  • 250mg | 7 tablets
  • 500mg | 10 tablets | 7 tablets
  • 750mg

Dosages

Your healthcare team will determine your dose of levofloxacin based different factors, such as the type of infection you have and how serious it is.

General dosing for levofloxacin tablets and oral solution:

  • Skin infections (adults): The typical dose is 500 mg or 750 mg by mouth once daily for 1 to 2 weeks.
  • Sinus infections (adults): The typical dose is 750 mg by mouth once daily for 5 days, or 500 mg once daily for 10 to 14 days.
  • Pneumonia (adults): The typical dose is 500 mg or 750 mg by mouth once daily. The length of treatment ranges from 5 days to up to 2 weeks. Dosing might differ depending on whether you got the infection in the hospital or in the community.
  • Bronchitis (adults): The typical dose is 500 mg by mouth once daily for a week.
  • Urinary tract infection (adults): The typical dose is 250 mg by mouth once daily for 3 days. The dosing for more serious infections that involve the kidneys can range from 250 mg once daily for 10 days or 750 mg once daily for 5 days.
  • Prostate infections (adults): The typical dose is 500 mg by mouth once daily for a month.
  • Anthrax
    • Adults and children (weight 50 kg or more): The typical dose is 500 mg by mouth once daily for 2 months.
    • Children (weighing 30 kg to less than 50 kg): The typical dose is 250 mg by mouth every 12 hours for 2 months.
  • Plague
    • Adults and children (weight 50 kg or more): The typical dose is 500 mg by mouth once daily for 10 to 14 days.
    • Children (weighing 30 kg to less than 50 kg): The typical dose is 250 mg by mouth every 12 hours for 10 to 14 days.

Levofloxacin is also available as an injection that's given through the veins by a healthcare professional (HCP) for people in a hospital or clinic setting. Your dose might differ if you have kidney problems.

Read Related Articles

10 Levofloxacin (Levaquin) Side Effects You Should Know About
10 Levofloxacin (Levaquin) Side Effects You Should Know About

Interactions

Levofloxacin may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Levofloxacin. Please note that only the generic name of each medication is listed below.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Aluminum Carbonate, Basic
  • Aluminum Hydroxide
  • Aluminum Phosphate
  • Aminolevulinic Acid
  • Calcium
  • Dihydroxyaluminum Aminoacetate
  • Dihydroxyaluminum Sodium Carbonate
  • Iron
  • Lanthanum Carbonate
  • Magaldrate
  • Magnesium Carbonate
  • Magnesium Hydroxide
  • Magnesium Oxide
  • Magnesium Trisilicate
  • Phenytoin

Side-effects

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Nausea (7%)
  • Headache (6%)
  • Diarrhea (5%)
  • Trouble sleeping (4%)

Other Side Effects

  • Dizziness
  • Stomach pain
  • Upset stomach
  • Constipation
  • Vomiting
  • Rash

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.

  • Achilles pain, pain or swelling at joint or muscle
  • Seizures
  • Changes in thoughts or behavior
  • Major blood vessel damage: sudden and severe chest, back, or stomach pain; shortness of breath, pain in arms or legs; weakness
  • Abnormal heart rhythm: chest pounding, chest pain, shortness of breath, feeling faint or lightheaded
  • Infectious (C. difficile-related) diarrhea: foul-smelling diarrhea, frequent bowel movements, fever
  • Kidney problems: urinating less often than usual, swelling, unexplained weight gain
  • Liver problems: swelling of your stomach, yellowing of your skin or the whites of your eyes, confusion, dark urine
  • Serious allergic and skin reactions: hives, rash, blisters, skin reddening, swelling of the lips or tongue, difficulty breathing

When do Levofloxacin possible side effects begin and end?

Time passed since treatment started:

Seek immediate medical care if you experience the side effect labelled.

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

  • Diarrhea
  • Rare
  • Agitation
  • Blisters
  • Confusion
  • Diarrhea (watery and severe) which may also be bloody
  • Feeling that others can hear your thoughts or control your behavior
  • Fever
  • Pain, inflammation, or swelling in the calves of the legs, shoulders, or hands
  • Redness and swelling of the skin
  • Seeing, hearing, or feeling things that are not there
  • Sensation of burning on the skin
  • Severe mood or mental changes
  • Stomach cramps or pain (severe)
  • Skin rash, itching, or redness
  • Trembling
  • Unusual behavior

Incidence not known

  • Black, tarry stools
  • Blurred vision
  • Burning, numbness, tingling, or painful sensations
  • Cough
  • Dark urine
  • Difficulty with breathing
  • Difficulty with chewing, talking, or swallowing
  • Drooping eyelids
  • Fainting
  • Fast or irregular heartbeat
  • General body swelling
  • Hives
  • Hoarseness
  • Joint or muscle pain
  • Muscle cramps, spasms, pain, or stiffness
  • Peeling or loosening of the skin
  • Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • Seizures
  • Severe dizziness
  • Severe tiredness
  • Tightness in the chest
  • Unsteadiness or awkwardness
  • Unusual bleeding or bruising
  • Unusual tiredness or weakness
  • Vision changes
  • Voice changes
  • Weakness in the arms, hands, legs, or feet

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

  • Change in taste
  • Constipation
  • Dizziness
  • Drowsiness
  • Headache
  • Lightheadedness
  • Nausea
  • Nervousness
  • Stomach pain or discomfort
  • Trouble sleeping
  • Vaginal itching and discharge
  • Vomiting

Incidence not known

  • Feeling of warmth or heat
  • Flushing or redness of the skin, especially on the face and neck
  • Sweating

Common Concerns

The most serious side effects of levofloxacin include risk of tendonitis and tendon rupture, nerve problems (e.g., burning or tingling in the hands and feet) , muscle weakness (e.g., myasthenia gravis), and mood-related problems (e.g., depression). Certain people might be at higher risk for some of these side effects. For example, adults ages 60 years and older and people taking corticosteroids might be more likely to experience tendon problems. The FDA gave levofloxacin and other quinolone antibiotics black box warnings, the most serious warning, because of these risks. Your healthcare team will typically only consider levofloxacin as a treatment option if you have a serious infection and there aren't any safer alternative antibiotics. Talk with your care team if you have any specific concerns about levofloxacin.
How you can reverse the side effects of levofloxacin depends on what side effects you're experiencing. You can try to manage certain side effects of levofloxacin through lifestyle changes. For example, if you feel nauseous after taking levofloxacin, then take it with food next time to see if that helps. But your healthcare team might likely ask you to stop taking levofloxacin completely if you experience more serious side effects, such as pain or swelling in the tendons. In this case, your care team might also ask you to pause certain activities, such as running or jumping, for a few months after you stop levofloxacin. This is because you're still at risk for tendon-related problems during this time. If you have a question about how to manage a specific levofloxacin side effect, talk with your care team.
Traces of levofloxacin can last in your system for up to 2 days after your last dose; it can linger around even longer if you're older than 65 years old or if you have kidney problems. This calculation is based on the medication's half-life, which is an estimation for how long it takes your body to clear the medication.
No, levofloxacin is a quinolone antibiotic, while penicillin is a beta-lactam antibiotic. Levofloxacin is unlikely to trigger an allergic reaction if you have a penicillin allergy.
You can take levofloxacin at night if directed by your provider. But there's a risk that this medication can cause trouble sleeping (insomnia) as a side effect. To lower the risk of sleep problems after starting levofloxacin, practice good sleep hygiene. For example, try to avoid drinking coffee in the afternoon or evening, or avoid looking at computer or phone screens an hour before bed. If you experience insomnia with levofloxacin, taking your dose in the morning might help.
It's best to avoid drinking alcohol while taking levofloxacin. This is because drinking alcohol can worsen certain side effects of levofloxacin, including nausea and headaches. Doing so can also raise the risk of certain serious side effects, such as liver problems and mood-related problems. Furthermore, drinking alcohol, especially regularly, can make it harder for your body to fight off an infection. Speak with your healthcare team if you need tips or resources to help avoid drinking alcohol while your body is healing from the infection.
Your healthcare team will decide how long you need to take levofloxacin based on what kind of infection you have and how serious it is. You need to take levofloxacin for 1 to 2 weeks for certain infections, like pneumonia or skin infections. Other types of infections might take a shorter or longer time to treat. Make sure to finish your treatment course as directed, even if you're feeling better before then. Otherwise, your infection might come back and become more difficult to treat.
If you are pregnant, it is crucial to inform your healthcare team before beginning levofloxacin. Discuss the potential risks and benefits of using this antibiotic during pregnancy with them. The safety of levofloxacin in pregnancy is not fully established due to limited evidence. While current studies do not show a connection between levofloxacin and pregnancy complications or harm to the fetus, further research is necessary to determine its safety. If you have any concerns, consult with your healthcare team.

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