Levofloxacin pdf

A short summary of this paper. Production and characterization of hypromellose phthalate nanoparticles containing levofloxacin for ophthalmic applications. Several attempts have been made to develop new drug delivery systems, which increase the residence time of the drugs in the eye and improve its bioavailability. Therapeutic soft contact lenses SCLs seem to constitute a promising alternative due to the prolonged contact with the eye.

Although drug soaked contact lenses have demonstrated to be more efficient than eyedrops, they still present limitations: maximum drug load is limited and diffusion is the only resistance to drug transport across the gel, which may lead to short release times. Designing an effective system for the treatment of ocular diseases is a challenging task, to which nanotechnologies may give a valuable contribution. The incorporation of drug-loaded nanostructures in the SCLs materials may help to control the drug release rates and to maintain drug therapeutic levels for longer periods of time.

LOF is an antibiotic which offers a broad spectrum against ocular infections and is used both in prophylaxis and treatment [1]. The NPs were produced using a supercritical atomization process developed by the research team - Supercritical Enhanced Atomization SEA [2] and were engineered in order to improve the release rate of LOF.

The morphology and size of the obtained particles were analysed by scanning electron microscopy SEM Figure 1. The release profiles of the drug were determined using a standard dissolution tester. Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate: Moderate Consider alternatives to efavirenz when coadministering with levofloxacin. Elagolix; Estradiol; Norethindrone acetate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Eliglustat: Moderate Levofloxacin should be used cautiously with other agents that may prolong the QT interval or increase the risk of torsade de pointes TdP.

Empagliflozin: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including SGLT2 inhibitors, are coadministered. Empagliflozin; Linagliptin: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including dipeptidyl peptidase-4 inhibitors, are coadministered.

Empagliflozin; Linagliptin; Metformin: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including dipeptidyl peptidase-4 inhibitors, are coadministered.

Empagliflozin; Metformin: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including metformin, are coadministered. Emtricitabine; Rilpivirine; Tenofovir alafenamide: Moderate Caution is advised when administering rilpivirine with levofloxacin.

Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate: Moderate Caution is advised when administering rilpivirine with levofloxacin.

Encorafenib: Major Avoid coadministration of encorafenib and levofloxacin due to QT prolongation. If concurrent use cannot be avoided, monitor ECGs for QT prolongation and monitor electrolytes; correct hypokalemia and hypomagnesemia prior to treatment.

Encorafenib is associated with dose-dependent prolongation of the QT interval. Levofloxacin has been associated with a risk of QT prolongation. Although extremely rare, torsade de pointes has been reported during postmarketing surveillance of levofloxacin.

Enteral Feedings: Major Because many food products contain divalent or trivalent cations, these foods may significantly decrease the absorption of orally administered levofloxacin.

Separate these foods or enteral feedings by at least 2 hours before or 2 hours after orally administered levofloxacin. Advise patients that dairy products and other high calcium- and iron-containing foods may affect the absorption of levofloxacin. Entrectinib: Major Avoid coadministration of entrectinib with levofloxacin due to the risk of QT prolongation.

Entrectinib has been associated with QT prolongation. Although extremely rare,TdP has been reported during postmarketing surveillance of levofloxacin. Eribulin: Major Levofloxacin has been associated with prolongation of the QT interval and infrequent cases of arrhythmia.

Drugs with a possible risk for QT prolongation and TdP include eribulin. If coadministration is necessary, ECG monitoring is recommended; closely monitor the patient for QT interval prolongation. Ertugliflozin: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including SGLT2 inhibitors, are coadministered. Ertugliflozin; Metformin: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including metformin, are coadministered.

Ertugliflozin; Sitagliptin: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including dipeptidyl peptidase-4 inhibitors, are coadministered. Estradiol; Levonorgestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Estradiol; Norethindrone: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Estradiol; Norgestimate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol; Norelgestromin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol; Norethindrone Acetate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Ethinyl Estradiol; Norgestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethynodiol Diacetate; Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Etonogestrel; Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Exenatide: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including incretin mimetics, are coadministered. Ezogabine: Moderate Levofloxacin should be used cautiously with other agents, such as ezogabine, that may prolong the QT interval or increase the risk of torsade de pointes TdP.

Ezogabine has been associated with QT prolongation. Fenoprofen: Moderate Use quinolones and nonsteroidal anti-inflammatory drugs NSAIDs concomitantly with caution due to potential increased risk of CNS stimulation and convulsive seizures. Ferric Maltol: Major Administer oral products that contain iron at least 2 hours before or 2 hours after orally administered levofloxacin.

Examples of compounds that may interfere with quinolone bioavailability include multivitamins that contain iron. Fingolimod: Moderate After the first fingolimod dose, overnight monitoring with continuous ECG in a medical facility is advised for patients taking QT prolonging drugs with a known risk of torsade de pointes TdP , such as levofloxacin.

Fingolimod initiation results in decreased heart rate and may prolong the QT interval. Fingolimod has not been studied in patients treated with drugs that prolong the QT interval, but drugs that prolong the QT interval have been associated with cases of TdP in patients with bradycardia.

Fludrocortisone: Moderate Quinolones have been associated with an increased risk of tendon rupture requiring surgical repair or resulting in prolonged disability; this risk is further increased in those receiving concomitant corticosteroids.

Fluocinolone; Hydroquinone; Tretinoin: Major Avoid the concomitant use of tretinoin with other drugs known to cause photosensitivity, such as levofloxacin. Fluphenazine: Minor Levofloxacin should be used cautiously with other agents, such as fluphenazine, that may prolong the QT interval or increase the risk of torsade de pointes TdP.

Fluphenazine is associated with a possible risk for QT prolongation. Theoretically, fluphenazine may increase the risk of QT prolongation if coadministered with other drugs that have a risk of QT prolongation. Flurbiprofen: Moderate Use quinolones and nonsteroidal anti-inflammatory drugs NSAIDs concomitantly with caution due to potential increased risk of CNS stimulation and convulsive seizures.

Fluvoxamine: Moderate Use fluvoxamine with caution in combination with levofloxacin. QT prolongation and torsade de pointes TdP have been reported during fluvoxamine and levofloxacin post-marketing use. Foscarnet: Major When possible, avoid concurrent use of foscarnet with other drugs known to prolong the QT interval, such as levofloxacin. Foscarnet has been associated with postmarketing reports of both QT prolongation and torsade de pointes TdP.

Quinolones have also been associated with a risk of QT prolongation and TdP. If these drugs are administered together, obtain an electrocardiogram and electrolyte concentrations before and periodically during treatment. Fostemsavir: Moderate Levofloxacin should be used cautiously with other agents that may prolong the QT interval or increase the risk of TdP. Supratherapeutic doses of fostemsavir 2, mg twice daily, four times the recommended daily dose have been shown to cause QT prolongation.

Fostemsavir causes dose-dependent QT prolongation. Gemtuzumab Ozogamicin: Moderate Use gemtuzumab ozogamicin and levofloxacin together with caution due to the potential for additive QT interval prolongation and risk of torsade de pointes TdP. If these agents are used together, obtain an ECG and serum electrolytes prior to the start of gemtuzumab and as needed during treatment.

Although QT interval prolongation has not been reported with gemtuzumab, it has been reported with other drugs that contain calicheamicin. Gilteritinib: Moderate Use caution and monitor for additive QT prolongation if concurrent use of gilteritinib and levofloxacin is necessary.

Gilteritinib has been associated with QT prolongation. Glasdegib: Major Avoid coadministration of glasdegib with levofloxacin due to the potential for additive QT prolongation.

If coadministration cannot be avoided, monitor patients for increased risk of QT prolongation with increased frequency of ECG monitoring. Glasdegib therapy may result in QT prolongation and ventricular arrhythmias including ventricular fibrillation and ventricular tachycardia. Glimepiride: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including sulfonylureas, are coadministered.

Glimepiride; Rosiglitazone: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including sulfonylureas, are coadministered. Glipizide: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including sulfonylureas, are coadministered.

Glipizide; Metformin: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including metformin, are coadministered. Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including sulfonylureas, are coadministered.

Glyburide: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including sulfonylureas, are coadministered. Glyburide; Metformin: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including metformin, are coadministered. Goserelin: Moderate Consider whether the benefits of androgen deprivation therapy outweigh the potential risks in patients receiving other QT prolonging agents, such as levofloxacin.

Granisetron: Moderate Use granisetron with caution in combination with levofloxacin. Granisetron has been associated with QT prolongation. Halobetasol; Tazarotene: Moderate Use tazarotene with caution in patients who are also taking drugs known to be photosensitizers, such as levofloxacin, due to the increased possibility of augmented phototoxicity. Halofantrine: Contraindicated Halofantrine is considered to have a well-established risk for QT prolongation and torsades de pointes and should be avoided in patients receiving drugs which may induce QT prolongation including levofloxacin.

According to the manufacturer, levofloxacin should be avoided in patients taking drugs that can result in prolongation of the QT interval, such as halogenated anesthetics.

Haloperidol: Moderate Caution is advisable when combining haloperidol concurrently with levofloxacin. Both drugs have been associated with a risk of QT prolongation and torsade de pointes TdP. Excessive doses particularly in the overdose setting or IV administration of haloperidol may be associated with a higher risk of QT prolongation.

Hetastarch; Dextrose; Electrolytes: Major Administer oral products that contain calcium at least 2 hours before or 2 hours after orally administered levofloxacin. Histrelin: Moderate Consider whether the benefits of androgen deprivation therapy outweigh the potential risks in patients receiving other QT prolonging agents. Hydrocortisone: Moderate Quinolones have been associated with an increased risk of tendon rupture requiring surgical repair or resulting in prolonged disability; this risk is further increased in those receiving concomitant corticosteroids.

Ibuprofen: Moderate Use quinolones and nonsteroidal anti-inflammatory drugs NSAIDs concomitantly with caution due to potential increased risk of CNS stimulation and convulsive seizures.

Ibuprofen; Pseudoephedrine: Moderate Use quinolones and nonsteroidal anti-inflammatory drugs NSAIDs concomitantly with caution due to potential increased risk of CNS stimulation and convulsive seizures.

Ibutilide: Major Levofloxacin has been associated with prolongation of the QT interval and infrequent cases of arrhythmia. Ibutilide administration can cause QT prolongation and torsades de pointes TdP ; proarrhythmic events should be anticipated. The potential for proarrhythmic events with ibutilide increases with the coadministration of other drugs that prolong the QT interval. Iloperidone: Major Concurrent use of iloperidone and levofloxacin should be avoided due to an increased risk for QT prolongation and torsade de pointes TdP.

Iloperidone has also been associated with QT prolongation; however, TdP has not been reported. Imipramine: Minor Levofloxacin should be used cautiously with other agents, such as tricyclic antidepressants, that may prolong the QT interval or increase the risk of torsade de pointes TdP. Incretin Mimetics: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including incretin mimetics, are coadministered.

Indomethacin: Moderate Use quinolones and nonsteroidal anti-inflammatory drugs NSAIDs concomitantly with caution due to potential increased risk of CNS stimulation and convulsive seizures. Inotuzumab Ozogamicin: Major Avoid coadministration of inotuzumab ozogamicin with levofloxacin due to the potential for additive QT prolongation and risk of torsade de pointes TdP.

If coadministration is unavoidable, obtain an ECG and serum electrolytes prior to the start of treatment, after treatment initiation, and periodically during treatment. Both inotuzumab and levofloxacin have been associated with QT prolongation. Although extremely rare, TdP has also been reported during postmarketing surveillance of levofloxacin.

Insulin Aspart: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including insulin, are coadministered. Insulin Aspart; Insulin Aspart Protamine: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including insulin, are coadministered.

Insulin Degludec: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including insulin, are coadministered. Insulin Degludec; Liraglutide: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including incretin mimetics, are coadministered.

Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including insulin, are coadministered. Insulin Detemir: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including insulin, are coadministered.

Insulin Glargine: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including insulin, are coadministered. Insulin Glargine; Lixisenatide: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including incretin mimetics, are coadministered.

Insulin Glulisine: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including insulin, are coadministered. Insulin Lispro: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including insulin, are coadministered.

Insulin Lispro; Insulin Lispro Protamine: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including insulin, are coadministered. Insulin, Inhaled: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including insulin, are coadministered.

Insulins: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including insulin, are coadministered. Iron Salts: Major Administer oral products that contain iron at least 2 hours before or 2 hours after orally administered levofloxacin.

Iron: Major Administer oral products that contain iron at least 2 hours before or 2 hours after orally administered levofloxacin. Isophane Insulin NPH : Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including insulin, are coadministered.

Itraconazole: Moderate Use itraconazole with caution in combination with levofloxacin. Itraconazole has been associated with prolongation of the QT interval. Ivosidenib: Major Avoid coadministration of ivosidenib with levofloxacin due to an increased risk of QT prolongation.

If concomitant use is unavoidable, monitor ECGs for QTc prolongation and monitor electrolytes; correct any electrolyte abnormalities as clinically appropriate.

An interruption of therapy and dose reduction of ivosidenib may be necessary if QT prolongation occurs. Prolongation of the QTc interval and ventricular arrhythmias have been reported in patients treated with ivosidenib. Although extremely rare, torsade de pointes has also been reported during postmarketing surveillance of levofloxacin.

Ketoprofen: Moderate Use quinolones and nonsteroidal anti-inflammatory drugs NSAIDs concomitantly with caution due to potential increased risk of CNS stimulation and convulsive seizures.

Ketorolac: Moderate Use quinolones and nonsteroidal anti-inflammatory drugs NSAIDs concomitantly with caution due to potential increased risk of CNS stimulation and convulsive seizures. Lansoprazole; Amoxicillin; Clarithromycin: Major Concurrent use of clarithromycin and levofloxacin should be avoided due to an increased risk for QT prolongation and torsade de pointes TdP. Lanthanum Carbonate: Major Administer lanthanum carbonate at least 2 hours before or 2 hours after orally administered levofloxacin.

When oral quinolones are given for short courses, consider eliminating the lanthanum carbonate doses that would be normally scheduled near the time of quinolone intake. Lapatinib: Moderate Monitor for evidence of QT prolongation if lapatinib is administered with levofloxacin. Lapatinib has been associated with concentration-dependent QT prolongation; ventricular arrhythmias and torsade de pointes TdP have been reported in postmarketing experience with lapatinib.

Lefamulin: Major Avoid coadministration of lefamulin with levofloxacin as concurrent use may increase the risk of QT prolongation. If coadministration cannot be avoided, monitor ECG during treatment. Lefamulin has a concentration dependent QTc prolongation effect. The pharmacodynamic interaction potential to prolong the QT interval of the electrocardiogram between lefamulin and other drugs that effect cardiac conduction is unknown.

Lente Insulin: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including insulin, are coadministered. Lenvatinib: Major Avoid coadministration of lenvatinib with levofloxacin due to the risk of QT prolongation.

Prolongation of the QT interval has been reported with lenvatinib therapy. Leuprolide: Moderate Consider whether the benefits of androgen deprivation therapy outweigh the potential risks in patients receiving other QT prolonging agents. Leuprolide; Norethindrone: Moderate Consider whether the benefits of androgen deprivation therapy outweigh the potential risks in patients receiving other QT prolonging agents.

Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Levonorgestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Levonorgestrel; Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Linagliptin: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including dipeptidyl peptidase-4 inhibitors, are coadministered.

Linagliptin; Metformin: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including dipeptidyl peptidase-4 inhibitors, are coadministered.

Liraglutide: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including incretin mimetics, are coadministered. Lixisenatide: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including incretin mimetics, are coadministered.

Lofexidine prolongs the QT interval. In addition, there are postmarketing reports of TdP. Long-acting beta-agonists: Moderate Levofloxacin should be used cautiously with long-acting beta-agonists.

Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses, when associated with hypokalemia, or when used with other drugs known to prolong the QT interval.

This risk may be more clinically significant with long-acting beta-agonists as compared to short-acting beta-agonists. Lopinavir; Ritonavir: Major Avoid coadministration of lopinavir with levofloxacin due to the potential for additive QT prolongation. If use together is necessary, obtain a baseline ECG to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances.

Lopinavir is associated with QT prolongation. Macimorelin: Major Avoid concurrent administration of macimorelin with drugs that prolong the QT interval, such as levofloxacin. Use of these drugs together may increase the risk of developing torsade de pointes-type ventricular tachycardia. Sufficient washout time of drugs that are known to prolong the QT interval prior to administration of macimorelin is recommended.

Treatment with macimorelin has been associated with an increase in the corrected QT QTc interval. Although extremely rare, torsade de pointes have been reported during postmarketing surveillance of levofloxacin.

Magnesium Citrate: Major Administer magnesium citrate at least 2 hours before or 2 hours after orally administered levofloxacin. Magnesium Hydroxide: Major Administer magnesium hydroxide at least 2 hours before or 2 hours after orally administered levofloxacin. Magnesium Salicylate: Major Administer magnesium salicylate at least 2 hours before or 2 hours after orally administered levofloxacin.

Magnesium Sulfate; Potassium Sulfate; Sodium Sulfate: Major Administer quinolones at least 2 hours before or 6 hours after administration of magnesium sulfate; potassium sulfate; sodium sulfate. The absorption of quinolones may be reduced by chelation with magnesium sulfate.

Magnesium: Major Administer oral products that contain magnesium at least 2 hours before or 2 hours after orally administered levofloxacin. Examples of compounds that may interfere with quinolone bioavailability include antacids and multivitamins that contain magnesium.

Maprotiline: Moderate Levofloxacin should be used cautiously with other agents, such as maprotiline, that may prolong the QT interval or increase the risk of torsade de pointes TdP. Maprotiline has been reported to prolong the QT interval, particularly in overdose or with higher-dose prescription therapy elevated serum concentrations. Cases of long QT syndrome and TdP tachycardia have been described with maprotiline use, but rarely occur when the drug is used alone in normal prescribed doses and in the absence of other known risk factors for QT prolongation.

Limited data are available regarding the safety of maprotiline in combination with other QT-prolonging drugs. Mefloquine: Moderate Mefloquine should be used with caution in patients receiving levofloxacin. There is evidence that the use of halofantrine after mefloquine causes a significant lengthening of the QTc interval. Mefloquine alone has not been reported to cause QT prolongation.

Meglitinides: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including meglitinides, are coadministered. Meloxicam: Moderate Use quinolones and nonsteroidal anti-inflammatory drugs NSAIDs concomitantly with caution due to potential increased risk of CNS stimulation and convulsive seizures. Mequinol; Tretinoin: Major Avoid the concomitant use of tretinoin with other drugs known to cause photosensitivity, such as levofloxacin.

Mestranol; Norethindrone: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Metformin: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including metformin, are coadministered. Metformin; Repaglinide: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including meglitinides, are coadministered.

Metformin; Rosiglitazone: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including metformin, are coadministered. Metformin; Saxagliptin: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including dipeptidyl peptidase-4 inhibitors, are coadministered. Metformin; Sitagliptin: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including dipeptidyl peptidase-4 inhibitors, are coadministered.

Methadone: Major Concurrent use of methadone and levofloxacin should be avoided due to an increased risk for QT prolongation and torsade de pointes TdP. Laboratory studies, both in vivo and in vitro, have demonstrated that methadone inhibits cardiac potassium channels and prolongs the QT interval. Most cases involve patients being treated for pain with large, multiple daily doses of methadone, although cases have been reported in patients receiving doses commonly used for maintenance treatment of opioid addiction.

Methylprednisolone: Moderate Quinolones have been associated with an increased risk of tendon rupture requiring surgical repair or resulting in prolonged disability; this risk is further increased in those receiving concomitant corticosteroids.

Midostaurin: Major The concomitant use of midostaurin and levofloxacin may lead to additive QT interval prolongation. If these drugs are used together, consider electrocardiogram monitoring. In clinical trials, QT prolongation has been reported in patients who received midostaurin as single-agent therapy or in combination with cytarabine and daunorubicin. Miglitol: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including alpha-glucosidase inhibitors, are coadministered.

Nabumetone: Moderate Use quinolones and nonsteroidal anti-inflammatory drugs NSAIDs concomitantly with caution due to potential increased risk of CNS stimulation and convulsive seizures. Naproxen; Pseudoephedrine: Moderate Use quinolones and nonsteroidal anti-inflammatory drugs NSAIDs concomitantly with caution due to potential increased risk of CNS stimulation and convulsive seizures.

Nateglinide: Moderate Monitor blood glucose carefully when systemic quinolones and antidiabetic agents, including meglitinides, are coadministered. Nilotinib: Major Avoid the concomitant use of nilotinib and levofloxacin; significant prolongation of the QT interval may occur.

Sudden death and QT prolongation have been reported in patients who received nilotinib therapy. Additionally, rare cases of torsade de pointes have been spontaneously reported during postmarketing surveillance in patients receiving levofloxacin. Nonsteroidal antiinflammatory drugs: Moderate Use quinolones and nonsteroidal anti-inflammatory drugs NSAIDs concomitantly with caution due to potential increased risk of CNS stimulation and convulsive seizures. Norethindrone Acetate; Ethinyl Estradiol; Ferrous fumarate: Major Administer oral products that contain iron at least 2 hours before or 2 hours after orally administered levofloxacin.

Norethindrone: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Norethindrone; Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Norethindrone; Ethinyl Estradiol; Ferrous fumarate: Major Administer oral products that contain iron at least 2 hours before or 2 hours after orally administered levofloxacin.

Norgestimate; Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Norgestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Nortriptyline: Minor Levofloxacin should be used cautiously with other agents, such as tricyclic antidepressants, that may prolong the QT interval or increase the risk of torsade de pointes TdP. Octreotide: Moderate Use octreotide with caution in combination with levofloxacin. Arrhythmias, sinus bradycardia, and conduction disturbances have occurred during octreotide therapy. Since bradycardia is a risk factor for development of torsade de pointes TdP , the potential occurrence of bradycardia during octreotide administration could theoretically increase the risk of TdP in patients receiving drugs that prolong the QT interval.

Olanzapine: Moderate Caution is advised when administering olanzapine with levofloxacin. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval.

Olanzapine; Fluoxetine: Moderate Caution is advised when administering olanzapine with levofloxacin. Olanzapine; Samidorphan: Moderate Caution is advised when administering olanzapine with levofloxacin. Oral Contraceptives: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Osilodrostat is associated with dose-dependent QT prolongation. Osimertinib: Major Avoid coadministration of levofloxacin with osimertinib if possible due to the risk of QT prolongation and torsade de pointes TdP.

If concomitant use is unavoidable, periodically monitor ECGs for QT prolongation and monitor electrolytes; an interruption of osimertinib therapy with dose reduction or discontinuation of therapy may be necessary if QT prolongation occurs. Concentration-dependent QTc prolongation occurred during clinical trials of osimertinib. Levofloxacin has been associated with a risk of QT prolongation; although extremely rare, TdP has been reported during postmarketing surveillance of levofloxacin.

Oxaliplatin: Major Monitor electrolytes and ECGs for QT prolongation if coadministration of levofloxacin with oxaliplatin is necessary; correct electrolyte abnormalities prior to administration of oxaliplatin. Levofloxacin has been associated with a risk of QT prolongation and, although extremely rare, torsade de pointes TdP has been reported during postmarketing surveillance of levofloxacin.

QT prolongation and ventricular arrhythmias including fatal TdP have also been reported with oxaliplatin use in postmarketing experience. Oxaprozin: Moderate Use quinolones and nonsteroidal anti-inflammatory drugs NSAIDs concomitantly with caution due to potential increased risk of CNS stimulation and convulsive seizures. Ozanimod: Major In general, do not initiate ozanimod in patients taking levofloxacin due to the risk of additive bradycardia, QT prolongation, and torsade de pointes TdP.

If treatment initiation is considered, seek advice from a cardiologist. Ozanimod initiation may result in a transient decrease in heart rate and atrioventricular conduction delays. Ozanimod has not been studied in patients taking concurrent QT prolonging drugs; however, QT prolonging drugs have been associated with TdP in patients with bradycardia. Paliperidone: Major Concurrent use of paliperidone and levofloxacin should be avoided if possible due to an increased risk for QT prolongation and torsade de pointes TdP.

If coadministration is necessary and the patient has known risk factors for cardiac disease or arrhythmias, close monitoring is essential. Levofloxacin has been associated with prolongation of the QT interval and infrequent cases of arrhythmias. Paliperidone has also been associated with QT prolongation; TdP and ventricular fibrillation have been reported in the setting of overdose. Panobinostat: Major QT prolongation has been reported with panobinostat therapy in patients with multiple myeloma in a clinical trial; use of panobinostat with other agents that prolong the QT interval is not recommended.

Obtain an electrocardiogram at baseline and periodically during treatment. Drugs with a possible risk for QT prolongation and torsade de pointes that should be used cautiously and with close monitoring with panobinostat include levofloxacin. Pasireotide: Moderate Use caution when using pasireotide in combination with other drugs, such as levofloxacin, that prolong the QT interval.

QT prolongation has occurred with pasireotide at therapeutic and supra-therapeutic doses. Pazopanib: Major Concurrent use of pazopanib and levofloxacin should be avoided due to an increased risk for QT prolongation and torsade de pointes TdP. If these drugs must be continued, closely monitor the patient for QT interval prolongation.

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