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Levofloxacin is authorised in the world under the following brand names: Cravit, Cravit Ophthalmic, Elequine, Floxel, Iquix, Leroxacin, Lesacin, Levaquin, Levokacin, Levox, Levoxacin, Mosardal, Nofaxin, Quixin, Reskuin, Tavanic, Volequin.

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Levofloxacin: Organs and Systems


Preclinical and clinical trial data and data from phase IV studies have suggested that levofloxacin causes prolongation of the QT interval. There were cardiovascular problems in 1 in 15 million prescriptions compared with 1-3% of patients taking sparfloxacin, who had QTC prolongation to over 500 ms. Polymorphous ventricular tachycardia with a normal QT interval has been associated with oral levofloxacin in the absence of other causes.

Among 23 patients who took levofloxacin 500 mg/day there was prolongation of the QTC interval by more than 30 ms in four patients and 60 ms in two patients.

There was absolute QT interval prolongation to over 500 ms in four patients, one of whom developed torsade de pointes.

Phlebitis can occur during parenteral administration of levofloxacin. High concentrations of levofloxacin (5 mg/ml) significantly reduced intracellular Adenosine and adenosine triphosphate content in cultured endothelial cells and reduced ADP, GTP, and GDP concentrations. These in vitro data suggest that high doses of levofloxacin are not compatible with maintenance of endothelial cell function and may explain the occurrence of phlebitis. Commercial formulations should be diluted and given into large veins.


Eosinophilic pneumonia complicated by bronchial asthma has been attributed to levofloxacin.

  • A 76-year-old woman took levofloxacin for a productive cough with non-segmental infiltration in both lung fields. She developed eosinophilia in both the peripheral blood (24%) and the sputum (10%), airflow limitation, hypoxemia, and increased airway responsiveness to methacholine. Bronchoalveolar lavage fluid showed increased total cells and a 55% increase in eosinophils, and the CD4/CD8 ratio was reduced to 0.8. Histological features included increased infiltration of eosinophils in the alveolar and interstitial compartments and goblet cell metaplasia. Levofloxacin was withdrawn, and her symptoms improved without steroid therapy. A leukocyte migration test for levofloxacin was weakly positive.

Nervous system

Levofloxacin can cause seizures. In one study convulsions occurred in two per million prescriptions.

  • A 75-year-old white woman was given oral levofloxacin (500 mg on day 1 followed by 250 mg/day) for ischemic toes. After three doses she had a seizure. One month later, she was challenged with ciprofloxacin 400 mg intravenously every 12 hours and again had a seizure.
  • A 74-year-old white woman was given oral levofloxacin 500 mg/day for bacterial pneumonia and had a seizure after five doses.

Sensory systems

Taste disturbance occurred in less than three per million prescriptions of levofloxacin.


Of 48 patients taking pyrazinamide 30 mg/kg/day plus levofloxacin 500 mg/day for 1 year, 27 discontinued therapy within 4 months owing to adverse events. Gastrointestinal intolerance was the major adverse event that resulted in early withdrawal.

Levofloxacin can cause pseudomembranous colitis due to Clostridium difficile.


In a study based on European and international data from about 130 million prescriptions, the adverse effects profile of levofloxacin was compared with that of other fluoro-quinolones; there was a low rate of hepatic abnormalities (1/1). However, two cases of severe acute liver toxicity were reported in patients who had received intravenous levofloxacin.


Two case reports have suggested that levofloxacin can cause pancreatitis.

Urinary tract

Two reports have suggested that levofloxacin can cause tubulointerstitial nephritis. A case of nephrotoxicity and purpura associated with levofloxacin has also been reported; allergic interstitial nephritis or vasculitis was believed to be the underlying pathologic process.

  • A 73-year-old white man took levofloxacin for a lower urinary tract infection for 3 days and developed palpable purpura and erythematous skin lesions over the lower limbs and trunk, with a markedly reduced urine output. Serum creatinine was 560 µmol/l (6.4 mg/dl). Levofloxacin was withdrawn, and prednisone, furose-mide, and intravenous fluids were given. The patient recovered fully over the next 4 weeks.


In a double-blind, randomized study in 30 healthy adults oral levofloxacin (500 mg/day for 5 days) had a low photosensitizing potential, as it did in preclinical animal studies and postmarketing surveillance. In preclinical studies levofloxacin was 20 times less phototoxic than sparfloxacin. Phototoxicity occurs in only 1 in 1.8 million cases.

Levofloxacin can cause a rash similar to the ampicillin rash in patients with infectious mononucleosis.

  • A 78-year-old woman developed a rash with blistering 2 days after completing a course of levofloxacin. The rash progressed to toxic epidermal necrolysis in 7 days. She was treated with intravenous fluids and wound dressings. Her condition improved and she was discharged after 22 days.


Tendinopathy has been reported with levofloxacin. Four cases of Achilles tendinitis have been reported in patients taking levofloxacin. Two were on chronic dialysis, one was a kidney transplant recipient, and one had chronic vasculitis. In all four cases, tendinitis had an acute onset with bilateral involvement and was incapacitating. In three cases the onset was early during levofloxacin treatment and in one case it began 10 days after the end of treatment. All the patients recovered completely after 3-8 weeks.

Old age, renal dysfunction, and concomitant cortico-steroid therapy are predisposing risk factors. Tendon rupture occurred in less than four per million prescriptions.


Anaphylactic and anaphylactoid reactions are rare adverse events after the administration of fluoroquinolones (about 0.46-1.2 per 100 000 patients).

  • On two occasions a 49-year-old asthmatic woman who took levofloxacin for a chest infection developed worse respiratory distress, requiring intubation. The second reaction was accompanied by a marked skin reaction.

An in vitro study in rat peritoneal mast cells showed that levofloxacin-mediated release of histamine may be closely linked to activation of pertussis toxin-sensitive G proteins.

Susceptibility Factors

The pharmacokinetics of intravenous levofloxacin have been studied in intensive care unit patients during continuous venovenous hemofiltration or hemodiafiltration. Levofloxacin clearance was substantially increased during both types of continuous renal replacement therapy. Levofloxacin 250 mg/day maintained effective plasma drug concentrations in these patients.

Dosage forms of Levofloxacin:
Levaquin i.v. 25 mg/ml vial Quixin 0.5% Solution Quixin 0.5% eye drops Levaquin 250 mg tablet
Iquix 1.5% eye drops Levaquin 500 mg tablet Levaquin 750 mg leva-pak tablet Levaquin 750 mg tablet
Levofloxacin hemihydr 100% powder Iquix 1.5% Solution 5ml Bottle Levaquin 500 mg/100 ml d5w

Synonyms of Levofloxacin:

L-Ofloxacin, Levofloxacin

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Therapeutic classes of Levofloxacin:

Anti-Bacterial Agents, Anti-Infective Agents, Urinary, Nucleic Acid Synthesis Inhibitors, Quinolones


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