Levofloxacin and Blood Pressure
Levofloxacin does not cause hypertension and is not listed among medications known to elevate blood pressure in major hypertension guidelines.
Evidence from Hypertension Guidelines
The most authoritative source on drug-induced hypertension, the 2017 ACC/AHA Hypertension Guideline, provides a comprehensive table of medications and substances that may cause elevated blood pressure 1. Levofloxacin and fluoroquinolones are notably absent from this list, which includes:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 1
- Decongestants (phenylephrine, pseudoephedrine) 1
- Amphetamines and stimulants 1
- Certain antidepressants (MAOIs, SNRIs, TCAs) 1
- Immunosuppressants like cyclosporine 1
- Oral contraceptives 1
- Alcohol in large amounts 1
- Herbal supplements (ephedra, yohimbine) 1
The JNC 7 guidelines similarly do not identify fluoroquinolones as blood pressure-elevating agents 1.
Documented Adverse Effects of Levofloxacin
The well-established adverse effects of levofloxacin include 2, 3, 4:
- Gastrointestinal effects (nausea, bloating) in 0.5-1.8% of patients 2, 4
- Neurologic effects (dizziness, insomnia) in 0.5% of patients 2, 4
- Cutaneous reactions (rash, pruritus) in 0.2-0.4% of patients 2, 4
- Tendinitis and tendon rupture with long-term use 4
- Hypoglycemia, particularly in diabetic patients on oral hypoglycemic agents 2, 5
- QT prolongation requiring ECG monitoring 2
Rare Case Report: Intracranial Hypertension
One isolated case report documented intracranial hypertension (increased pressure within the skull, not systemic blood pressure) in a 15-year-old boy after 3 weeks of levofloxacin use 6. This resolved within one week of drug discontinuation 6. This represents elevated intracranial pressure, which is fundamentally different from systemic arterial hypertension and does not affect blood pressure readings.
Clinical Context
Levofloxacin is extensively studied with well-characterized pharmacokinetics 7, 8, 9. It is approximately 24-38% protein-bound, 80% renally eliminated unchanged, and has a half-life of 6-8 hours 7. No mechanism exists by which levofloxacin would affect systemic vascular resistance, sodium balance, or sympathetic tone—the primary pathways through which drugs elevate blood pressure 1.
Important Clinical Caveat
If a patient on levofloxacin develops elevated blood pressure, consider 1:
- Concurrent NSAIDs for pain/fever associated with the infection being treated 1
- Decongestants for upper respiratory symptoms 1
- Corticosteroids sometimes used as adjunctive therapy in severe infections 1
- The underlying infection itself causing stress response
These are far more likely culprits than levofloxacin itself.