What is the minimum dilution of levofloxacin (Levaquin) for intravenous (IV) administration?

Minimum Dilution for Intravenous Levofloxacin Administration

Levofloxacin for intravenous administration should be diluted to a concentration of 5 mg/mL or less before infusion. 1

Standard Dilution Requirements

• The maximum safe concentration for IV levofloxacin is 5 mg/mL, as concentrations above this level have demonstrated compatibility issues with certain diluent solutions 1
• Levofloxacin 25 mg/mL injection (the commercially available concentrate) must be diluted before administration and should never be given undiluted 1
• The drug is stable and compatible at both 0.5 mg/mL and 5 mg/mL concentrations in most standard IV solutions including 0.9% sodium chloride injection and 5% dextrose injection 1

Compatible Diluents

Levofloxacin maintains stability in the following solutions at concentrations up to 5 mg/mL 1:

• 0.9% sodium chloride injection
• 5% dextrose injection
• 5% dextrose and 0.9% sodium chloride injection
• 5% dextrose and lactated Ringer's injection
• Plasma-Lyte 56 and 5% dextrose injection
• 5% dextrose and 0.45% sodium chloride with 0.15% potassium chloride injection
• 1/6 M sodium lactate injection
• Sterile water for injection

Critical Incompatibilities to Avoid

• Never dilute levofloxacin in 20% mannitol injection, as precipitation occurs at 0.5 mg/mL concentration under all storage conditions 1
• Avoid 5% sodium bicarbonate injection for dilution, particularly if any storage at cold temperatures is anticipated, as precipitation can occur with 0.5 mg/mL concentrations 1

Infusion Rate Considerations

• When administering standard doses (500-750 mg), infuse over 60 minutes to achieve optimal pharmacokinetic profiles 2, 3
• The oral and IV formulations produce nearly identical serum concentration-time profiles when the IV dose is infused over 60 minutes, reflecting the drug's excellent bioavailability 2

Common Pitfalls

• Using concentrations above 5 mg/mL risks precipitation, particularly with certain diluents or storage conditions 1
• Failing to separate administration from divalent cation-containing products (antacids with aluminum/magnesium, iron supplements) by at least 2 hours significantly decreases absorption and should be avoided even with IV administration if oral therapy follows 4, 2
• Administering undiluted concentrate can cause venous irritation and incompatibility issues 1