Levofloxacin interactions to avoid

In this article:

• Levofloxacin drug interactions
• How to minimize levofloxacin interactions
• When to see a healthcare provider

In this article

• Levofloxacin drug interactions
• How to minimize levofloxacin interactions
• When to see a healthcare provider

Levofloxacin (also sold under the brand name Levaquin) is a prescription antibiotic that treats various bacterial infections, such as urinary tract infections, skin structure infections, respiratory tract infections, and others. Potential off-label uses of this drug include tuberculosis, sexually transmitted diseases (STDs), and endocarditis. It belongs to the class of medications known as fluoroquinolones. According to research and medical experts, levofloxacin—like many other medications—has several interactions with other drugs. It’s crucial to be aware of these interactions to avoid the chances of mild to severe side effects.

Levofloxacin drug interactions

Below is a list of the most common adverse drug reactions for levofloxacin:

Antacids

Antacids are medications that relieve heartburn and indigestion by reducing the amount of acid in your stomach. According to Sarah Bonza, MD, MPH, FAAFP, a family medicine physician, founder of Bonza Health, and hospitalist physician at Fairfield Medical Center in Lancaster, Ohio, antacids reduce levofloxacin absorption in the gut, making it less effective and worsening the infection you’re treating. This is particularly true for antacids that contain magnesium or aluminum. “What I advise my patients who are on mineral supplements or antacids is that they should take levofloxacin two hours before or six hours after taking them,” she says. 

Below are some antacids that should be taken with caution if you’re on levofloxacin:

• Rolaids (calcium carbonate/magnesium hydroxide)
• Mylanta (magnesium hydroxide)
• Maalox (aluminum hydroxide)

Antiarrhythmic medications

Antiarrhythmic drugs are used to treat and prevent abnormal heart rhythms (arrhythmias). Based on clinical trials, taking this heart medication with levofloxacin can have potential risks, like prolongation of the QT interval. “Levofloxacin has warnings regarding QT prolongation and therefore should not be combined with other QT-prolonging drugs,” says Bharat Pothuri, MD, a board-certified gastroenterologist and founder of GastroDoxs in Houston, Texas. A prolonged QT interval means there’s a significant delay in the heart’s ventricular recovery after a heartbeat. This can lead to long QT syndrome (LQTS), a heart condition where the electrical recovery between heartbeats is longer than normal. Levofloxacin labeling suggests avoiding this combination if at all possible, but exercise extreme caution and do diligent monitoring if they must be combined,

The following symptoms of QT prolongation include:

• Syncope (fainting)
• Seizures
• Cardiac arrest
• Sudden death

Some examples of anticoagulants that could lead to health problems if mixed with levofloxacin include:

• Multaq (dronedarone)
• Pacerone (amiodarone)
• Tikosyn (dofetilide)
• Betaspace (sotalol)
• Tambocor (flecainide)
• Rythmol SR (propafenone)

Anticoagulants

Anticoagulants, or blood thinners, are a group of medications that stop your blood from clotting too easily. Increased bleeding is a significant effect of Levaquin when used with blood thinners. “Levofloxacin can increase the anticoagulant effect of warfarin, putting them at a greater risk of mucosal bleeding,” Dr. Bonza says. “I request close monitoring of their coagulation parameters to check for bleeding while on levofloxacin.”

Below are a few of the anticoagulants that can cause adverse effects when mixed with levofloxacin:

• Coumadin, Jantoven (warfarin)
• Xarelto (rivaroxaban)
• Pradaxa (dabigatran)
• Eliquis (apixaban)
• Savaysa (edoxaban)

Corticosteroids

Corticosteroids (glucocorticoids) are a class of prescription medications that treat pain and inflammation for several medical conditions, such as lupus, rheumatoid arthritis, asthma, inflammatory bowel disease (IBD), and certain skin infections. Steroid drugs can increase the risk of tendon problems like Achilles tendon rupture and tendinitis.

“I have seen several patients on corticosteroids who had an associated side effect of tendon issues after initiating treatment with levofloxacin,” Dr. Pothuri says. “If it’s a patient who is on steroids, I’m typically more careful to initiate a medication like levofloxacin and explore alternatives as much as we can.”

Here are some popular corticosteroids that may not mix well with levofloxacin:

• Deltasone (prednisone)
• Decadron, DexPak (dexamethasone) 
• Medrol (methylprednisone)
• Cortef (hydrocortisone)

Levofloxacin food interactions 

Dr. Bonza says the antibiotic drug can interact with certain foods. “Food with dairy and calcium-fortified products interacts with the absorption of levofloxacin in the gut, rendering the antibiotic less effective,” she explains. “What I advise patients is that they should take levofloxacin with water only, and two to three hours before or six hours after intake of dairy or mineral-fortified food products.”

Foods that might not mix too well with levofloxacin include:

• Milk
• Cheese
• Yogurt
• Some fortified juices and cereals

Levofloxacin and grapefruit 

It’s best to avoid grapefruit juice while taking levofloxacin. This is because compounds in the fruit may interact with the antibiotic’s metabolism, potentially causing peak plasma concentration levels and serious side effects.

Other levofloxacin interactions

In addition to the drugs mentioned above, Dr. Pothuri says that multivitamins could also cause an interaction with levofloxacin. “I often advise my patients that even multivitamins can affect how effective your antibiotic is,” he says. “This is why I stress spacing out supplements and medications as they arise.”

Levofloxacin and caffeine 

According to Dr. Bonza, the antibiotic drug may interact with caffeinated drinks. “Levofloxacin can decrease the removal of caffeine from our body,” she explains. “As a consequence, it can lead to jitteriness, sleep issues, or anxiety in some people. I tell my patients to pause caffeine intake while on levofloxacin.”

How to minimize levofloxacin interactions

In addition to potential drug interactions, there are other instances where fluoroquinoline antibiotics like levofloxacin may be deemed unsafe to take.

These include the following conditions:

• Myasthenia gravis: This condition may worsen muscle weakness and lead to difficulty breathing or even death.
• Children: Broad-spectrum antibiotics like levofloxacin should generally be avoided in children under 18 unless they’ve been exposed to anthrax in the air or the plague.
• Allergies: Individuals with known allergies to levofloxacin or other fluoroquinolones should consider an alternative medication to avoid potential adverse reactions, such as severe allergic reactions.
• Older adults, steroid use, and transplants: The medication should be avoided or closely monitored in patients 60 years and older, those taking corticosteroids, and individuals with kidney, heart, or lung transplants.
• Pregnancy: Unless the patient has multidrug-resistant tuberculosis, alternatives like amoxicillin and cefuroxime should be considered in place of levofloxacin, given its possible effects on fetal development.

Dr. Bonza adds that those with seizure or seizure-like disorders should avoid taking levofloxacin, as the drug may worsen their conditions.

To lower your risk of side effects while taking levofloxacin, use the following tips:

• Consult your healthcare provider: If you haven’t started the medication yet, be upfront with your provider about any medical conditions, drugs, or supplements. This can help them determine whether the antibiotic is safe for you.
• Have a medication list handy: The U.S. Food and Drug Administration (FDA) offers a downloadable medication list that allows you to record your prescription and over-the-counter medications, which can be easily shared with your healthcare team or pharmacist.
• Be aware of the warning signs: Educate yourself on side effects that could signal a levofloxacin interaction, such as low blood sugar, worsening infection, and irregular heartbeat. These symptoms require immediate medical help. 

When to talk to a healthcare provider about levofloxacin interactions

Please note that this is not a complete list of all potential levofloxacin interactions. If you have any questions or concerns about your medications, supplements, or medical conditions, please share them with your healthcare provider to receive information on the proper management and monitoring of your treatment plan.