From the FDA Drug Label
When levofloxacin is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by levofloxacin or other antibacterial drugs in the future. Patients should be informed that levofloxacin tablets may be taken with or without food. The tablet should be taken at the same time each day. Patients should drink fluids liberally while taking levofloxacin to avoid formation of a highly concentrated urine and crystal formation in the urine Patients should be informed of the following serious adverse reactions that have been associated with levofloxacin or other fluoroquinolone use: Tendon Disorders: Patients should contact their healthcare provider if they experience pain, swelling, or inflammation of a tendon, or weakness or inability to use one of their joints; rest and refrain from exercise; and discontinue levofloxacin treatment. Exacerbation of Myasthenia Gravis: Patients should inform their physician of any history of myasthenia gravis Hypersensitivity Reactions: Patients should be informed that levofloxacin can cause hypersensitivity reactions, even following the first dose Hepatotoxicity: Severe hepatotoxicity (including acute hepatitis and fatal events) has been reported in patients taking levofloxacin Convulsions: Convulsions have been reported in patients taking fluoroquinolones, including levofloxacin. Neurologic Adverse Effects (e.g., Dizziness, Lightheadedness, Increased Intracranial Pressure): Patients should know how they react to levofloxacin before they operate an automobile or machinery or engage in other activities requiring mental alertness and coordination. Diarrhea: Diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Peripheral Neuropathies: Patients should be informed that peripheral neuropathy has been associated with levofloxacin use. Prolongation of the QT Interval: Patients should inform their physician of any personal or family history of QT prolongation or proarrhythmic conditions Musculoskeletal Disorders in Pediatric Patients: Parents should inform their child’s physician if their child has a history of joint-related problems before taking this drug Photosensitivity/Phototoxicity: Patients should be advised that photosensitivity/phototoxicity has been reported in patients receiving fluoroquinolone antibiotics. Patients should be informed that if they are diabetic and are being treated with insulin or an oral hypoglycemic agent and a hypoglycemic reaction occurs, they should discontinue levofloxacin and consult a physician Patients should be informed that concurrent administration of warfarin and levofloxacin has been associated with increases of the International Normalized Ratio (INR) or prothrombin time and clinical episodes of bleeding
Patient Education for Levaquin Use
- Take the medication exactly as directed and complete the full course of therapy.
- Levofloxacin can be taken with or without food, and patients should drink fluids liberally.
- Patients should be aware of the potential for serious adverse reactions, including:
- Tendon disorders
- Exacerbation of myasthenia gravis
- Hypersensitivity reactions
- Hepatotoxicity
- Convulsions
- Neurologic adverse effects
- Diarrhea
- Peripheral neuropathies
- Prolongation of the QT interval
- Musculoskeletal disorders in pediatric patients
- Photosensitivity/phototoxicity
- Patients with diabetes should be cautious when taking levofloxacin with insulin or oral hypoglycemic agents.
- Patients taking warfarin should be aware of the potential for increased INR or prothrombin time and clinical episodes of bleeding 1
From the Research
Patient education for Levaquin (levofloxacin) should include taking the medication exactly as prescribed, typically once daily with or without food, and completing the full course even if symptoms improve, as well as being aware of the potential for tendon rupture, particularly in those over 60, taking corticosteroids, or with organ transplants, as reported in a recent study 2. When taking Levaquin, patients should drink plenty of fluids to prevent crystalluria. They should also be warned about potential serious side effects including:
- Tendon rupture, especially in those over 60, taking corticosteroids, or with organ transplants
- Peripheral neuropathy (nerve damage)
- Central nervous system effects (confusion, hallucinations)
- Exacerbation of myasthenia gravis Patients should immediately report any:
- Tendon pain
- Weakness
- Tingling or burning sensations
- Changes in mental status Levaquin can cause photosensitivity, so patients should avoid excessive sunlight and use sun protection. They should inform their healthcare provider about all medications they take, as Levaquin has significant drug interactions, particularly with antacids, iron, and certain diabetes medications. Patients should avoid driving or operating machinery until they know how the medication affects them, as it may cause dizziness. According to a study published in 2022 2, levofloxacin showed the strongest statistical association with tendon rupture, highlighting the importance of patient education on this potential side effect. Levaquin is a broad-spectrum fluoroquinolone antibiotic that works by inhibiting bacterial DNA gyrase and topoisomerase IV, preventing bacterial DNA replication and ultimately killing the bacteria, as described in a review of its use in the treatment of bacterial infections 3.