Levaquin, Iquix, Quixin
Classifications: antibiotic; quinolone; Therapeutic: antibiotic
Pregnancy Category: C
250 mg, 500 mg, 750 mg tablets; 25 mg/mL solution; 25 mg/mL injection; 0.5%, 1.5% ophthalmic solution
A broad-spectrum fluoroquinolone antibiotic that inhibits topoisomerase IV and DNA-gyrase, an enzyme necessary for bacterial
replication, transcription, repair, and recombination.
Effective against many aerobic gram-positive and aerobic gram-negative organisms.
Treatment of maxillary sinusitis, acute exacerbations of bacterial bronchitis, community-acquired pneumonia, uncomplicated
skin/skin structure infections, UTI, acute pyelonephritis caused by susceptible bacteria; acute bacterial sinusitis; chronic
bacterial prostatitis; bacterial conjunctivitis.
Hypersensitivity to levofloxacin and quinolone antibiotics; tendon pain, inflammation or rupture; syphilis; viral infections;
phototoxicity; suicidal ideation; psychotic manifestations; manifestations of peripheral neuropathy; hypoglycemic reaction
to drug; QT prolongation, hypokalemia; concurrent administration of class IA (e.g., quinidine, procainamide) or class III
(e.g., amiodarone, sotalol) antiarrhythmic agents; pregnancy (category C); lactation. Safety and efficacy in children <18
y are not established.
History of suicidal ideation; psychosis; anxiety, confusion, depression; known or suspected CNS disorders predisposed to
seizure activity (e.g., severe cerebral atherosclerosis), risk factors associated with potential seizures (e.g., some drug
therapy, renal insufficiency), dehydration, renal impairment (Clcr <50 mL/min); colitis; cardiac arrhythmias; diabetes; patients receiving theophylline or caffeine; older adults.
Route & Dosage
Adult: PO 500 mg q24h x 10 d IV 500 mg infused over 60 min q24h x 714 d
Adult: PO/IV 750 mg q24h x 5 d
Adult: PO/IV 250 mg q24h x 14 d
Complicated UTI, Pyelonephritis
Adult: PO/IV 250 mg q24h x 10 d
Acute Bacterial Sinusitis
Adult: PO/IV 750 mg q.d. x 5 d
Chronic Bacterial Prostatitis
Adult: PO/IV 500 mg q24h x 28 d
Skin & Skin Structure Infections
Adult: PO 750 mg q24h x 14 d
For initial dose of 500 mg, adjust as follows: Clcr 2050 mL/min: 250 mg q24h; <20 mL/min: 250 mg q48h
For initial dose of 750 mg, adjust as follows: Clcr 2050 mL/min: 750 mg q48h; 1019 mL/min: 500 mg q48h; <20 mL/min: 250 mg q48h
Adult: Ophthalmic Days 12, 12 drops in affected eye(s) q2h while awake (max: 8 times/d), days 37, 12 drops in affected
eye(s) q4h while awake (max: 4 times/d)
- Do not give oral drug within 2 h of drugs containing aluminum or magnesium (antacids), iron, zinc, or sucralfate.
PREPARE: Intermittent: Withdraw the desired dose from 500 or 750 mg (25 mg/mL) single-use vial. Add to enough D5W, NS, D5/NS, D5/RL, or other compatible
solutions to produce a concentration of 5 mg/mL [e.g., 500 mg (or 20 mL) added to 80 mL]. Discard any unused drug remaining
in the vial.
ADMINISTER: Intermittent: Infuse 500 mg or less over 60 min. Infuse 750 mg over at least 90 min. Do NOT give a bolus dose or infuse too rapidly.
INCOMPATIBILITIES Y-site: Do not add any drugs to levofloxacin solution or infuse simultaneously through the same line (manufacturer recommendation).
Azithromycin, furosemide, heparin, indomethacin, insulin, nitroglycerin, nitroprusside, propofol.
- Store tablets in a tightly closed container. IV solution is stable for 72 h at 25° C (77° F).
Adverse Effects (≥1%)CNS:
, dizziness. GI:
Nausea, diarrhea, constipation
, vomiting, abdominal pain, dyspepsia. Skin:
Rash, pruritus. Special Senses:
Decreased vision, foreign body sensation, transient ocular burning, ocular pain, photophobia. Urogenital: Vaginitis
. Body as a Whole:
Injection site pain or inflammation, chest or back pain, fever, pharyngitis. Other:
Diagnostic Test Interference
May cause false positive on opiate screening tests.
-containing antacids, sucralfate, iron, zinc
may decrease levofloxacin absorption; nsaid
s may increase risk of CNS reactions, including seizures; may cause hyper- or hypoglycemia
in patients on oral hypoglycemic agents
Rapidly from GI tract. Peak:
PO 12 h. Distribution:
Penetrates lung tissue, 2438% protein bound. Metabolism:
Minimally in the liver. Elimination:
Primarily unchanged in urine. Half-Life:
Assessment & Drug Effects
- Lab tests: Do C&S test prior to beginning therapy and periodically.
- Withhold therapy and report to physician immediately any of the following: Skin rash or other signs of a hypersensitivity
reaction (see Appendix F); CNS symptoms such as seizures, restlessness, confusion, hallucinations, depression; skin eruption
following sun exposure; symptoms of colitis such as persistent diarrhea; joint pain, inflammation, or rupture of a tendon;
hypoglycemic reaction in diabetic on an oral hypoglycemic agent.
Patient & Family Education
- Learn important indications for discontinuing drug and immediately notifying physician.
- If tendon pain occurs, discontinue the drug and notify the physician.
- Consume fluids liberally while taking levofloxacin.
- Allow a minimum of 2 h between drug dosage and taking any of the following: Aluminum or magnesium antacids, iron supplements,
multivitamins with zinc, or sucralfate.
- Avoid exposure to excess sunlight or artificial UV light.
- Avoid NSAIDs while taking levofloxacin, if possible.