From the FDA Drug Label
Central Nervous System Effects. Seizures have been reported in people who take fluoroquinolone antibiotics including levofloxacin tablets Tell your healthcare provider if you have a history of seizures. Ask your healthcare provider whether taking levofloxacin tablets will change your risk of having a seizure. 5. 6 Central Nervous System Effects Convulsions, toxic psychoses, increased intracranial pressure (including pseudotumor cerebri) have been reported in patients receiving fluoroquinolones, including levofloxacin
The risk of seizures associated with levofloxacin therapy is a known adverse effect. Seizures have been reported in people taking fluoroquinolone antibiotics, including levofloxacin. Patients with a history of seizures or those who may be predisposed to seizures should be cautious when taking levofloxacin, and their healthcare provider should be informed. The drug should be discontinued if the patient experiences symptoms of seizures or other central nervous system effects 1, 1.
From the Research
Risk of Seizures Associated with Levofloxacin Therapy
The risk of seizures associated with levofloxacin therapy is a concern that has been investigated in several studies.
- A retrospective observational study published in 2 found that the incidence of levofloxacin-associated seizures among hospitalized patients is low, with an incidence of 1:5422 treatment days.
- The study also found that the risk of seizures did not significantly exceed that of macrolides, with an odds ratio of 1.44 (95% CI 0.59-3.5, P = 0.42).
Factors Contributing to Seizure Risk
Several factors may contribute to the risk of seizures associated with levofloxacin therapy, including:
- Electrolyte imbalances, such as hypomagnesemia and hyponatremia, as reported in 3
- Renal insufficiency, as suggested by 4, which found that renal failure can increase the sensitivity of the central nervous system to levofloxacin-induced seizures
- Concomitant treatment with agents that lower the seizure threshold, such as ganciclovir, as reported in 4
- Previous adverse reactions to fluoroquinolones, such as skin rashes, as reported in 5
Case Reports of Seizures Associated with Levofloxacin
Several case reports have described seizures associated with levofloxacin therapy, including:
- A case of generalized tonic-clonic seizure and toxic epidermal necrolysis following a single dose of levofloxacin, as reported in 5
- A case of epilepsy and rapidly progressive cognitive impairment after levofloxacin treatment, as reported in 6
Overall Risk Assessment
Overall, the risk of seizures associated with levofloxacin therapy appears to be low, but certain factors, such as electrolyte imbalances and renal insufficiency, may increase the risk.