Levaquin

DRUG DESCRIPTION

LEVAQUIN® is a synthetic broad-spectrum antibacterial agent for oral and intravenous administration. Chemically, levofloxacin, a chiral fluorinated carboxyquinolone, is the pure (-)- (S)-enantiomer of the racemic drug substance ofloxacin. The chemical name is (-)-(S)-9-fluoro- 2,3-dihydro-3-methyl-10-(4-methyl-1-piperazinyl)-7-oxo-7H-pyrido[1,2,3-de]-1,4-benzoxazine-6-carboxylic acid hemihydrate.

Figure 1: The Chemical Structure of Levofloxacin

LEVAQUIN® (levofloxacin) Structural Formula Illustration

The empirical formula is C18H20FN3O4 • &frac12 H2O and the molecular weight is 370.38. Levofloxacin is a light yellowish-white to yellow-white crystal or crystalline powder. The molecule exists as a zwitterion at the pH conditions in the small intestine.

The data demonstrate that from pH 0.6 to 5.8, the solubility of levofloxacin is essentially constant (approximately 100 mg/mL). Levofloxacin is considered soluble to freely soluble in this pH range, as defined by USP nomenclature. Above pH 5.8, the solubility increases rapidly to its maximum at pH 6.7 (272 mg/mL) and is considered freely soluble in this range. Above pH 6.7, the solubility decreases and reaches a minimum value (about 50 mg/mL) at a pH of approximately 6.9.

Levofloxacin has the potential to form stable coordination compounds with many metal ions. This in vitro chelation potential has the following formation order: Al+3 > Cu+2 > Zn+2 > Mg+2 > Ca+2.

Excipients and Description of Dosage Forms

LEVAQUIN® Tablets

LEVAQUIN® Tablets are available as film-coated tablets and contain the following inactive ingredients:

  • 250 mg (as expressed in the anhydrous form): hypromellose, crospovidone, microcrystalline cellulose, magnesium stearate, polyethylene glycol, titanium dioxide, polysorbate 80 and synthetic red iron oxide.
  • 500 mg (as expressed in the anhydrous form): hypromellose, crospovidone, microcrystalline cellulose, magnesium stearate, polyethylene glycol, titanium dioxide, polysorbate 80 and synthetic red and yellow iron oxides.
  • 750 mg (as expressed in the anhydrous form): hypromellose, crospovidone, microcrystalline cellulose, magnesium stearate, polyethylene glycol, titanium dioxide, polysorbate 80.
LEVAQUIN® Oral Solution

LEVAQUIN® Oral Solution, 25 mg/mL, is a multi-use self-preserving aqueous solution of levofloxacin with pH ranging from 5.0 to 6.0. The appearance of LEVAQUIN® Oral Solution may range from clear yellow to clear greenish-yellow. This does not adversely affect product potency.

LEVAQUIN® Oral Solution contains the following inactive ingredients: sucrose, glycerin, sucralose, hydrochloric acid, purified water, propylene glycol, artificial and natural flavors, benzyl alcohol, ascorbic acid, and caramel color. It may also contain a solution of sodium hydroxide for pH adjustment.

LEVAQUIN® Injection

The appearance of LEVAQUIN® Injection may range from a clear yellow to a clear greenishyellow solution. This does not adversely affect product potency.

LEVAQUIN® Injection in Single-Use Vials is a sterile, preservative-free aqueous solution of levofloxacin in Water for Injection, with pH ranging from 3.8 to 5.8.

LEVAQUIN® Injection Premix in Single-Use Flexible Containers is a sterile, preservative-free aqueous solution of levofloxacin with pH ranging from 3.8 to 5.8. This is a dilute, nonpyrogenic, nearly isotonic premixed solution that contains levofloxacin in 5% Dextrose (D5W). Solutions of hydrochloric acid and sodium hydroxide may have been added to adjust the pH.

The flexible container is fabricated from a specially formulated non-plasticized, thermoplastic copolyester (CR3). The amount of water that can permeate from the container into the overwrap is insufficient to affect the solution significantly. Solutions in contact with the flexible container can leach out certain of the container's chemical components in very small amounts within the expiration period. The suitability of the container material has been confirmed by tests in animals according to USP biological tests for plastic containers.

What are the possible side effects of levofloxacin (Levaquin, Levaquin Leva-Pak)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using levofloxacin and call your doctor at once if you have a serious side effect such as:

  • dizziness, fainting, fast or pounding heartbeat;
  • sudden pain or swelling near your joints (especially in your arm or ankle);
  • diarrhea that is watery or bloody;
  • confusion, hallucinations, depression, unusual thoughts or...

Read All Potential Side Effects and See Pictures of Levaquin »

What are the precautions when taking levofloxacin (Levaquin)?

Before taking levofloxacin, tell your doctor or pharmacist if you are allergic to it; or to other quinolone antibiotics (such as ciprofloxacin, moxifloxacin); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: diabetes, heart problems (such as chest pain, recent heart attack), joint/tendon problems (such as tendonitis, bursitis), kidney disease, myasthenia gravis, nervous system disorder (such as peripheral neuropathy), seizure disorder, conditions that increase your risk of seizures (such as brain/head injury, brain tumors, stroke, TIA-transient ischemic...

Read All Potential Precautions of Levaquin »


Levaquin Consumer (continued)

SIDE EFFECTS: See also Warning section.

Nausea, diarrhea, headache, dizziness, lightheadedness, or trouble sleeping may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Use of this medication for prolonged or repeated periods may result in oral thrush or a new yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.

Tell your doctor right away if any of these serious side effects occur: easy bruising/bleeding, signs of a new infection (such as fever, persistent sore throat), mental/mood changes (such as nervousness, confusion, hallucinations, rare thoughts of suicide), shaking (tremor), change in the amount of urine.

This medication may rarely cause serious nerve problems that may be reversible if identified and treated early. Get medical help right away if you develop any of the following symptoms: pain/numbness/burning/tingling/weakness in any part of the body, changes in how you sense touch/pain/temperature/body position/vibration.

Get medical help right away if any of these serious side effects occur: chest pain, fainting, fast/irregular heartbeat, seizures, signs of liver problems (such as persistent nausea/vomiting, stomach/abdominal pain, unusual tiredness, yellowing eyes/skin, dark urine).

This medication may rarely make your blood sugar level rise, which can cause or worsen diabetes. Tell your doctor immediately if you develop symptoms of high blood sugar, such as increased thirst and urination. If you already have diabetes, be sure to check your blood sugars regularly. Your doctor may need to adjust your diabetes medication, exercise program, or diet.

Levofloxacin may also cause low blood sugar (hypoglycemia), especially if you have diabetes. Symptoms of low blood sugar include sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet.

This medication may rarely cause a severe intestinal condition (Clostridium difficile-associated diarrhea) due to a resistant bacteria. This condition may occur during treatment or weeks to months after treatment has stopped. Do not use anti-diarrhea products or narcotic pain medications if you have any of the following symptoms because these products may make them worse. Tell your doctor immediately if you develop: persistent diarrhea, abdominal or stomach pain/cramping, blood/mucus in your stool.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: Before taking levofloxacin, tell your doctor or pharmacist if you are allergic to it; or to other quinolone antibiotics (such as ciprofloxacin, moxifloxacin); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: diabetes, heart problems (such as chest pain, recent heart attack), joint/tendon problems (such as tendonitis, bursitis), kidney disease, myasthenia gravis, nervous system disorder (such as peripheral neuropathy), seizure disorder, conditions that increase your risk of seizures (such as brain/head injury, brain tumors, stroke, TIA-transient ischemic attack).

This drug may make you dizzy or lightheaded. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages.

Levofloxacin may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can infrequently result in serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away. The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may affect the heart rhythm. Before using levofloxacin, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).

Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using levofloxacin safely.

This medication may make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths, and sunlamps. Use a sunscreen and wear protective clothing when outdoors.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older adults may be more sensitive to the effects of the drug, such as tendon problems (especially if they are also taking corticosteroids such as prednisone or hydrocortisone), heart problems, or liver problems. Discuss the risks and benefits with your doctor.

Children may be more sensitive to the effects of the drug such as joint/tendon problems. Discuss the risks and benefits with the doctor.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

This drug passes into breast milk. Consult your doctor before breast-feeding.


Levaquin Patient Information Including Side Effects

Brand Names: Levaquin, Levaquin Leva-Pak

Generic Name: levofloxacin (oral) (Pronunciation: leev oh FLOX a sin)

  • What is levofloxacin (Levaquin)?
  • What are the possible side effects of levofloxacin (Levaquin)?
  • What is the most important information I should know about levofloxacin (Levaquin)?
  • What should I discuss with my healthcare provider before taking levofloxacin (Levaquin)?
  • How should I take levofloxacin (Levaquin)?
  • What happens if I miss a dose (Levaquin)?
  • What happens if I overdose (Levaquin)?
  • What should I avoid while taking levofloxacin (Levaquin)?
  • What other drugs will affect levofloxacin (Levaquin)?
  • Where can I get more information?

What is levofloxacin (Levaquin)?

Levofloxacin is in a group of antibiotics called fluoroquinolones (flor-o-KWIN-o-lones). Levofloxacin fights bacteria in the body.

Levofloxacin is used to treat bacterial infections of the skin, sinuses, kidneys, bladder, or prostate. Levofloxacin is also used to treat bacterial infections that cause bronchitis or pneumonia, and to treat people who have been exposed to anthrax.

Levofloxacin may also be used for other purposes not listed in this medication guide.

What are the possible side effects of levofloxacin (Levaquin)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using levofloxacin and call your doctor at once if you have a serious side effect such as:

  • dizziness, fainting, fast or pounding heartbeat;
  • sudden pain or swelling near your joints (especially in your arm or ankle);
  • diarrhea that is watery or bloody;
  • confusion, hallucinations, depression, unusual thoughts or behavior;
  • seizure (convulsions);
  • pale or yellowed skin, dark colored urine, fever, weakness;
  • urinating less than usual or not at all;
  • easy bruising or bleeding;
  • numbness, burning, pain, or tingly feeling in your hands or feet;
  • fever, sore throat, and headache with a severe blistering, peeling, and red skin rash; or
  • the first sign of any skin rash, no matter how mild.

Less serious side effects may include:

  • nausea, diarrhea, constipation;
  • feeling restless, anxious, or depressed;
  • headache, dizziness;
  • muscle pain;
  • sleep problems (insomnia or nightmares);
  • vaginal itching or discharge; or
  • mild skin itching.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may report side effects to FDA at 1-800-FDA-1088.

What is the most important information I should know about levofloxacin (Levaquin)?

You should not use this medication if you are allergic to levofloxacin or similar antibiotics such as ciprofloxacin (Cipro), moxifloxacin (Avelox), ofloxacin (Floxin), norfloxacin (Noroxin), lomefloxacin (Maxaquin), and others.

Before taking levofloxacin, tell your doctor if you have kidney or liver disease, myasthenia gravis, joint problems, seizures or epilepsy, diabetes, low levels of potassium in your blood (hypokalemia), or a personal or family history of "Long QT syndrome."

Avoid taking antacids, vitamin or mineral supplements, sucralfate (Carafate), or didanosine (Videx) powder or chewable tablets within 2 hours before or after you take levofloxacin. These other medicines can make levofloxacin much less effective when taken at the same time.

Taking levofloxacin can make your skin more sensitive to sunlight. Avoid exposure to sunlight, sun lamps, or tanning beds.

Levofloxacin may cause swelling or tearing of a tendon (the fiber that connects bones to muscles in the body), especially in the Achilles' tendon of the heel. These effects may be more likely to occur if you are over 60, if you take an oral steroid medication, or if you have had a kidney, heart, or lung transplant. Stop taking levofloxacin and call your doctor at once if you have sudden pain, swelling, tenderness, stiffness, or movement problems in any of your joints. Rest the joint until you receive medical care or instructions.

Do not share this medication with another person (especially a child), even if they have the same symptoms you have.

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