Med of the Month: Levofloxacin

Dentists may prescribe Levofloxacin, a broad-spectrum fluoroquinolone antibiotic, for serious dental infections when first-line antibiotics like penicillin or amoxicillin are not effective or appropriate. However, it should be used cautiously due to risks such as tendon rupture, QT prolongation, and potential central nervous system (CNS) side effects, especially in elderly patients. Always review a patient's medication list and medical history before prescribing. Explore what you really need to know about Levofloxacin:

Generic Name: Levofloxacin

Brand Name(s): Levaquin

Pronunciation: LEE voe FLOX a sin

About this drug:

• Levofloxacin is a quinolone antibiotic used to treat many bacterial infections (e.g. infections of the skin, sinuses, kidneys, bladder, or prostate) but it will not cure a common cold, flu, or viruses.

• It is also used to treat anthrax or types of the plague.

Dentistry-related tidbits:

• Remind a patient with diabetes to check their blood sugar levels regularly as Levofloxacin may increase the risk of hypoglycemia or hyperglycemia.

• The risk of QT prolongation and cardiac arrhythmias is increased when Levofloxacin is combined with macrolide antibiotics (e.g. erythromycin), narcotics (e.g. tramadol), or the antifungal fluconazole.

• This medication may cause a tendon to rupture. Tendon problems may be more likely to occur in patients: 

  • Over 60 years old,

  • Are taking a steroid medication, or

  • Who have had a kidney, heart, or lung transplant.

• Advise the patient to call their physician or the dental office if they develop severe bloody diarrhea before taking any over-the-counter medications. This medication has an increased risk for C. difficile-associated infection. Advise the patient to call their physician or the dental office if they develop severe bloody diarrhea before taking any over-the-counter medications.

• If the patient is taking a blood thinner, speak with their physician before prescribing Levofloxacin, as the combination may result in serious bleeding.

• Combining Levofloxacin with benzodiazepines, NSAIDs, aspirin, or anticonvulsants (e.g. carbamazepine, gabapentin, pregabalin) may decrease the seizure threshold.

• Before prescribing any medication, use the Rx Check tool to prevent potential drug interactions or adverse effects.

Fun facts:

• Levofloxacin is a bactericidal antibiotic, meaning it kills bacteria by inhibiting them from copying and repairing DNA.

• Levofloxacin may make the skin burn more easily in sunlight. Advise the patient to apply sunscreen SPF 30 or greater when outdoors.

• Levofloxacin may decrease the efficacy of the hormonal contraceptive, and the patient may become pregnant. Recommend a backup non-hormonal birth control method such as condoms or a diaphragm with spermicide.

• Consuming large quantities of grapefruit products (> 1 liter) can increase the risk of QT prolongation and cardiac arrhythmias when on Levofloxacin.

• If a patient is taking zinc supplements, aluminum or magnesium antacids, or calcium or iron products, have the patient take Levofloxacin at least 2 hours before or after taking these supplements to prevent decreased Levofloxacin efficacy.

• The following are the medication’s Black Box Warnings:

  • Levofloxacin may increase the risk of tendinitis and tendon rupture in all ages. This risk is increased more in older patients, usually over 60 years of age, in patients taking corticosteroid drugs, and in patients with kidney, heart, or lung transplants.

  • Levofloxacin may increase muscle weakness in people with myasthenia gravis and should not be used in this condition.

  • There may also be an increased risk of peripheral neuropathy and central nervous system effects when taking Levofloxacin.

  • Levofloxacin should be used for patients with no other options for acute bacterial sinusitis, severe worsening of bacterial chronic bronchitis, or uncomplicated UTI.

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