Nausea, mucosal erosions of the gastrointestinal tract, confusion, dizziness, unconsciousness, hallucinations, tremors and seizures, prolongation of the interval primo steroid. Treatment: symptomatic; monitoring parameters; appointment of antacids. No specific antidote.
Interaction with other drugs
Salts of iron, zinc, antacids, salts containing magnesium or aluminum, didanosine (Only those preparations of didanosine which comprise as auxiliary substances magnesium and aluminum) significantly reduce the absorption of levofloxacin while receiving.
In an application of levofloxacin and iron salts, zinc salts, antacids containing magnesium or aluminum, didanosine recommended to assign the last 2 hours after administration of levofloxacin (or 2 hours before receiving levofloxacin).
calcium salts have little effect on the oral absorption of levofloxacin. Sucralfate significantly reduces the bioavailability of levofloxacin. With simultaneous use of levofloxacin and sucralfate are encouraged to nominate the last 2 hours after receiving levofloxacin. There were no pharmacokinetic interactions between levofloxacin and theophylline. However, the concomitant use of quinolones with theophylline, primo steroid and other drugs that reduce the seizure threshold may be lowered seizure threshold. in the presence of fenbufen levofloxacin concentration of about 13% higher than when used as monotherapy.when concomitant use levofloxacin increased by 33%. In an application with indirect anticoagulants, coumarin derivatives (eg., Warfarin), there is an increase of indicators of coagulation (prothrombin time / international normalized ratio (INR)) and / or bleeding. Cimetidine and probenecid, as a result of blocking the renal tubular secretion, reduce the renal clearance of levofloxacin 24% and 34%, respectively, so levofloxacin should be used with caution in conjunction with drugs that affect the tubular secretion (such as probenecid and cimetidine), especially in patients with impaired renal function. levofloxacin may lengthen the interval , so be careful when the simultaneous use of antiarrhythmic drugs class IA and III, tricyclic antidepressants, macrolides and neuroleptics.Glucocorticoids increase the risk of tendon rupture. no clinically meaningful effect on the pharmacokinetics of levofloxacin had no concomitant use of calcium carbonate, glibenclamide, ranitidine, digoxin.
The prevalence of acquired resistance strains of pathogens may vary depending on geographic region and over time. In connection with this required information on microbial resistance to the drug in a particular country. For treatment of severe infections or when treatment failure should be set microbiological diagnosis with the release of the pathogen and the determination of its sensitivity to levofloxacin.
There is a high probability that the methicillin-resistant staphylococcus aureus would be resistant to fluoroquinolones, including levofloxacin. Therefore levofloxacin is not recommended for the treatment of established or suspected infections causedaureus, if laboratory tests have not confirmed the sensitivity of the organism to levofloxacin. Levofloxacin can cause serious, potentially fatal hypersensitivity reactions (angioedema, anaphylactic shock), even when primo steroid using the initial . Patients should stop taking the drug and consult a doctor.
When receiving levofloxacin observed cases of severe bullous skin reactions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis. In the case of any reaction on the part of the skin and the mucous membranes of the patient should seek medical advice immediately and continue treatment to his advice.
Reported cases of hepatic necrosis, including the development of fatal liver failure in the application of levofloxacin, primarily in patients with severe major diseases, such as sepsis (see. “Side effects” section). Patients should be warned about the need to stop treatment and urgent referral to a doctor in case of symptoms and liver disease symptoms such as anorexia, jaundice, dark urine, itching, and abdominal pain.
Should be taken 2 hours before or 2 hours after administration of iron salts, zinc salts, sucralfate or didanosine (only ddI formulations, which contain as excipients magnesium and aluminum), because there may be a decrease in its absorption.
patients concurrently taking indirect anticoagulants, coumarin derivatives, it is necessary to control parameters blood clotting.
In rare cases, observed during treatment with quinolones, tendinitis can lead to rupture of ligaments, especially the Achilles tendon. This side effect is apparent within 48 hours after initiation of therapy. For the elderly and patients taking steroids, there is an increased risk of developing tendinitis. Therefore, during treatment with levofloxacin should be closely monitored the status of such patients.
If there is a suspicion of tendonitis (to inform patients about its symptoms), reception primo steroid is necessary to stop and start the appropriate treatment immediately (eg., Immobilization).
Diarrhoea (especially in cases of severe resistant and / or mixed with blood) during or after reception may be a symptom of disease caused by Clostridium difficile, the most severe form of which is pseudomembranous colitis. If there is a suspicion of pseudomembranous colitis, should be discontinued immediately and symptomatic treatment of conduct (eg., Oral vancomycin).In this state, drugs that inhibit peristalsis are contraindicated.