Can Levaquin (levofloxacin) cause transaminitis?

From the Guidelines

Levaquin (levofloxacin) can cause transaminitis, although it is considered a relatively rare side effect. This is supported by the British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD) 1, which mentions liver disease as a contraindication for moxifloxacin, another quinolone antibiotic, but suggests considering levofloxacin as an alternative in patients with chronic liver disease. Key points to consider include:

• The risk of liver injury with levofloxacin is relatively low, with an estimated incidence of less than 1% of patients.
• The mechanism appears to be an idiosyncratic drug-induced liver injury, which is not dose-dependent and likely involves an immune-mediated response.
• Patients with pre-existing liver disease may be at higher risk for this side effect and should be monitored more closely, as indicated by the guidelines which advise against using moxifloxacin in patients with chronic liver disease, particularly those with Child-Pugh severity score C and transaminase levels fivefold greater than the upper limit of normal 1.
• If a patient on levofloxacin develops symptoms such as fatigue, abdominal pain, jaundice, or dark urine, liver function tests should be performed promptly.
• In most cases, the transaminitis is mild and resolves with discontinuation of the medication. Some important considerations when prescribing levofloxacin include:
• Monitoring liver function tests in patients with pre-existing liver disease.
• Being aware of the signs and symptoms of liver injury, such as fatigue, abdominal pain, jaundice, or dark urine.
• Considering alternative antibiotic classes if a patient has previously experienced liver enzyme elevations with fluoroquinolones.

From the Research

Levaquin and Transaminitis

• Levaquin, also known as levofloxacin, is a fluoroquinolone antibiotic used to treat various infections.
• There have been reports of levofloxacin-induced hepatotoxicity, including transaminitis, which is a condition characterized by elevated liver enzymes [ 2(https://www.amjcaserep.com DOI: 10.12659/AJCR.909544), 3,4 ].
• A case study published in The American Journal of Case Reports in 2018 described a young man who developed severe transaminitis after taking levofloxacin [ 2(https://www.amjcaserep.com DOI: 10.12659/AJCR.909544) ].
• Another study published in Clinical Therapeutics in 2010 reported a case of acute hepatitis associated with the use of levofloxacin in a 77-year-old man 3.
• A study published in the American Journal of Therapeutics in 2015 reported a case of levofloxacin-induced hepatotoxicity and death in a 53-year-old woman 4.

Mechanism and Risk Factors

• The exact mechanism of levofloxacin-induced hepatotoxicity is not fully understood, but it is thought to be related to the drug's ability to cause oxidative stress and mitochondrial damage 3, 4.
• Risk factors for levofloxacin-induced hepatotoxicity include pre-existing liver disease, older age, and concomitant use of other hepatotoxic medications 3, 4.

Clinical Implications

• Clinicians should be aware of the potential risk of hepatotoxicity associated with levofloxacin use and monitor patients for signs of liver injury, such as elevated liver enzymes and jaundice [ 2(https://www.amjcaserep.com DOI: 10.12659/AJCR.909544), 3,4 ].
• Patients who develop hepatotoxicity while taking levofloxacin should discontinue the medication immediately and seek medical attention [ 2(https://www.amjcaserep.com DOI: 10.12659/AJCR.909544), 3,4 ].