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Levaquin (Levofloxacin): Uses, Dosage & Safety Information

Levaquin (Levofloxacin)

Levaquin (Levofloxacin)
levaquin 250 mg
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Levaquin (Levofloxacin)

Levofloxacin
Levaquin is the brand name for the prescription antibiotic levofloxacin, a fluoroquinolone used to treat certain serious bacterial infections. Because of its potential for serious side effects, it is typically reserved for infections where alternative treatments are not suitable.
  • ActiveIngredient: Levofloxacin
  • DosageForm: Film-coated tablet
  • Dosage: 250 mg, 500 mg, 750 mg
  • Indications: Nosocomial and community-acquired pneumonia, skin and skin structure infections, chronic bacterial prostatitis, urinary tract infections, acute pyelonephritis, bronchitis exacerbation, sinusitis, inhalational anthrax post-exposure and plague
  • Manufacturer: Generic manufacturers; brand Levaquin no longer marketed
  • Storage: Store as directed on the dispensed container; keep out of reach of children
  • Drug Status: Prescription Only
Drug Status: Prescription Only
Description
Boxed warning
Fluoroquinolones cause disabling and potentially irreversible reactions — tendinitis and tendon rupture, peripheral neuropathy, and central nervous system effects — which can occur together in the same patient.
Levofloxacin is discontinued immediately if any of them appears, and fluoroquinolones avoided thereafter. The class may also worsen muscle weakness in myasthenia gravis.1

Levaquin was the brand name for levofloxacin, a fluoroquinolone antibacterial taken once daily. The brand is no longer on the market: a search of Drugs@FDA returns no active application under that name, and supply is now generic levofloxacin in 250 mg, 500 mg and 750 mg tablets.2 It is listed under antibiotics on iMedix.

What distinguishes levofloxacin from ciprofloxacin is the lung. It is active against Streptococcus pneumoniae, which ciprofloxacin covers poorly, and that is why its indication list opens with nosocomial and community-acquired pneumonia while ciprofloxacin’s opens with skin and bone.1

Once-daily dosing is the other practical difference. For the class warning in full and the interaction with tizanidine and mineral binders, see ciprofloxacin.

General Instructions

Once a day, at the same time. Levofloxacin is dosed once daily, unlike ciprofloxacin’s twice-daily schedule.

Separate it from antacids, iron, zinc, calcium and multivitamins with minerals by at least two hours. These bind the drug in the gut and can reduce absorption enough for treatment to fail.1

Stop and call at the first tendon pain, or with new numbness, tingling, burning, confusion or agitation. Rest the affected limb.1

Drink enough fluid and avoid strong sun. Adequate hydration reduces crystal formation in the urine, and the drug can cause exaggerated sunburn.

Side Effects
Reported Side Effects
SystemEffectWhat the label says
TendonsTendinitis and tendon ruptureBoxed warning; risk higher over 60, on corticosteroids, and after transplant
NervesPeripheral neuropathyBoxed warning; may be irreversible; discontinue at first symptom
Central nervous systemConfusion, agitation, seizures, psychosisBoxed warning; reported even after a single dose
NeuromuscularExacerbation of myasthenia gravisAvoided in patients with known myasthenia gravis
Blood sugarHypoglycaemia and hyperglycaemiaReported, particularly in diabetic patients on oral hypoglycaemics or insulin
Blood vesselsAortic aneurysm and dissectionReported with the class
GastrointestinalNausea, diarrhoeaAmong the commonest reactions

Source: 1

Emergency – stop and seek care
  • Pain, swelling or snapping in a tendon, most often behind the ankle
  • New numbness, tingling, burning or weakness in the hands or feet
  • Confusion, hallucinations, severe agitation or a seizure
  • Sudden severe pain in the chest, abdomen or back
  • Sweating, shaking or confusion suggesting low blood sugar, if you are diabetic
Uses

Levofloxacin is indicated in adults from 18 years, and in children where specified, for infections caused by designated susceptible bacteria.1

  • Nosocomial pneumonia and community-acquired pneumonia
  • Complicated and uncomplicated skin and skin structure infections
  • Chronic bacterial prostatitis
  • Complicated and uncomplicated urinary tract infections
  • Acute pyelonephritis
  • Acute bacterial exacerbation of chronic bronchitis and acute bacterial sinusitis
  • Inhalational anthrax post-exposure, and plague, in adults and children

Prostatitis is the indication levofloxacin holds and ciprofloxacin does not carry in the same form. Fluoroquinolones penetrate prostatic tissue well, and chronic bacterial prostatitis is one of the few infections where a four to six week oral course is standard.

As with the whole class, the label reserves the three mildest indications — bronchitis exacerbation, sinusitis and uncomplicated urinary infection — for patients who have no alternative treatment options.1

Safety Advice

Interactions Alcohol:

Consult your doctor
The label sets no alcohol restriction. Alcohol adds to the central nervous system effects named in the boxed warning, and in diabetic patients it compounds the risk of low blood sugar this drug can cause.

Interactions Other Medications:

Unsafe
Antacids, iron, zinc, calcium and mineral-containing multivitamins bind levofloxacin in the gut and can make treatment fail unless separated by at least two hours. Insulin and oral hypoglycaemics carry a risk of severe hypoglycaemia. Corticosteroids raise tendon rupture risk, and NSAIDs may increase seizure risk.

Special Groups Pregnancy:

Consult your doctor
The prescribing information does not set a blanket recommendation. Fluoroquinolones are generally avoided in pregnancy where alternatives exist; anthrax and plague exposure are the situations where that changes.

Special Groups Breastfeeding:

Consult your doctor
The label does not establish a breastfeeding recommendation. The decision belongs to the clinician treating the infection.

Special Groups Elderly:

Use with caution
Age over 60 is a named risk factor for tendinitis and tendon rupture, and the risk compounds with corticosteroids. Renal clearance also declines with age, and levofloxacin is cleared by the kidney.

Special Groups Children:

Use with caution
Paediatric use is restricted to specified infections, and tablets cannot be given below 30 kg because the available strengths do not divide that far. A different formulation is needed for smaller children.

Effects on Activities Driving:

Use with caution
The boxed warning covers confusion, agitation and seizures, reported even after a single dose. In diabetic patients, hypoglycaemia adds a second reason to be careful behind the wheel.

Effects on Activities Operating Machinery:

Use with caution
The same central nervous system effects apply, and tendon injury adds a concern for tasks requiring physical exertion.
Concerns

The Levaquin brand has left the market: Drugs@FDA returns no active application under that name, and levofloxacin is supplied as generic tablets, oral solution and injection.2

The concern is the same one that shaped the class labelling. Levofloxacin was for years among the most prescribed antibacterials in the United States, frequently for sinusitis and bronchitis, before regulators restricted those indications. Anyone who took it during that period and developed lasting tendon or nerve symptoms is part of why the boxed warning reads as it does.

Warnings

The class warning applies in full

Tendinitis and tendon rupture, peripheral neuropathy and central nervous system effects have occurred together and may be irreversible. The instruction is immediate discontinuation and avoidance of fluoroquinolones thereafter. Risk of tendon injury is higher over 60, on corticosteroids, and in kidney, heart or lung transplant recipients.

Blood sugar disturbance

Levofloxacin has been associated with both hypoglycaemia and hyperglycaemia, most often in diabetic patients taking oral hypoglycaemic agents or insulin. Severe hypoglycaemia, including coma, has been reported. Blood glucose is monitored where those medicines are in use.

Myasthenia gravis

The class may exacerbate muscle weakness, and levofloxacin is avoided in patients with a known history.

Aortic aneurysm and dissection

Reported with fluoroquinolones. Use in patients with a known aneurysm or risk factors is reserved for situations without an alternative.

Reserved indications and the paediatric limit

Bronchitis exacerbation, sinusitis and uncomplicated urinary infection are reserved for patients with no alternative options. Tablets cannot be given below 30 kg because the available strengths do not divide that far; another formulation is needed for smaller children.

Source: 1

Dosage
Approved Dosage
Indication / PopulationDose and FrequencyDuration / TimingClinical Notes
Adults: community-acquired pneumonia500 mg once daily, or 750 mg once daily7 to 14 days, or 5 daysThe 750 mg short course is an alternative schedule
Adults: nosocomial pneumonia750 mg once daily7 to 14 days—
Adults: chronic bacterial prostatitis500 mg once daily28 daysLong course by design
Adults: acute pyelonephritis250 mg or 750 mg once daily10 days, or 5 daysDose and duration move together
Children weighing 30 kg and abovePer the paediatric dosing tableSet by indicationTablets cannot be used below 30 kg — the strengths do not divide that far

Source: 1

Stop at the first sign of a boxed-warning reaction
Tendon pain, new numbness or tingling, confusion or agitation mean stopping the drug rather than completing the course — including in the middle of a 28-day prostatitis regimen.1
▶Clinical detailstechnical detail

Levofloxacin is the pure S-enantiomer of ofloxacin, which was a racemic mixture. The S form carries essentially all the antibacterial activity, so isolating it delivers the same effect at half the total drug load. That is why levofloxacin doses look smaller than ofloxacin doses for the same infection.

Its enhanced activity against S. pneumoniae comes from a higher affinity for topoisomerase IV, the preferred target in Gram-positive organisms, while ciprofloxacin acts chiefly on DNA gyrase and covers Gram-negatives better. The near-complete oral bioavailability means the intravenous and oral doses match one for one, as with linezolid.1

Interactions
Significant Interactions
Interacting substanceEffect and riskSeverityDocumentation
Any quinolone after hypersensitivityCross-reactivity; contraindicatedContraindicatedExcellent
Antacids, iron, zinc, calcium, sucralfate, multivitamins with mineralsChelation in the gut markedly reduces absorption; doses separated by at least two hoursMajorExcellent
Insulin and oral hypoglycaemic agentsSevere hypoglycaemia including coma has been reported; glucose monitoredMajorExcellent
CorticosteroidsRaise the risk of tendinitis and tendon rupture, particularly over 60MajorExcellent
WarfarinAnticoagulant effect may increase; prothrombin time monitoredModerateGood
Non-steroidal anti-inflammatory drugsMay increase the risk of central nervous system stimulation and seizuresModerateGood

Source: 1

Unlike ciprofloxacin, levofloxacin is not a meaningful CYP1A2 inhibitor, so the theophylline and tizanidine problems that belong to that drug do not transfer here.

FAQs
Not as a brand. Drugs@FDA returns no active application under the Levaquin name, and the medicine is supplied as generic levofloxacin in 250 mg, 500 mg and 750 mg tablets, plus oral solution and injection.
Both are fluoroquinolones with the same boxed warning, but they cover different organisms. Levofloxacin is active against Streptococcus pneumoniae and is used for pneumonia and prostatitis; ciprofloxacin covers Gram-negatives better and leads with skin, bone and abdominal infections. Levofloxacin is once daily, ciprofloxacin twice.
Some do not resolve. The boxed warning describes tendinitis, tendon rupture, peripheral neuropathy and central nervous system effects as disabling and potentially irreversible, and tendon rupture has occurred months after the course ended. Which patients recover cannot be predicted before treatment.
Yes, in both directions. Hypoglycaemia and hyperglycaemia have been reported, most often in diabetic patients taking insulin or oral hypoglycaemic agents, and severe hypoglycaemia including coma has occurred. Blood glucose is monitored when those medicines are in use.
Calcium, magnesium, aluminium, iron and zinc bind the drug in the gut and cut absorption enough for treatment to fail. Doses need separating by at least two hours from dairy, antacids, sucralfate and mineral-containing multivitamins.
At the first sign of a boxed-warning reaction: tendon pain or swelling, new numbness or tingling in the hands or feet, or confusion and agitation. The label directs stopping immediately rather than finishing the course, even mid-way through a 28-day prostatitis regimen.
Evidence and Reported Data

Evidence scope

What we know
  • Fourteen indications are defined, with dose and duration set separately for each.
  • Once-daily dosing and near-complete oral absorption allow intravenous and oral doses to match.
  • The paediatric limit is mechanical and explicit: tablets cannot be used below 30 kg.
What remains uncertain
  • How often the disabling reactions occur is not quantified in the labelling.
  • Which patients recover from tendon or nerve injury cannot be predicted in advance.
  • Why levofloxacin appears more associated with blood glucose disturbance than other fluoroquinolones is not explained by the label.

Source: 1

What has been reported to the FDA

As of the FAERS data cut of 30 July 2026, the FDA Adverse Event Reporting System held 37,010 reports naming Levaquin, of which 28,670 were classed as serious — 77% of the total.3

Most Reported Terms
Coded termReports
Pain2,813
Arthralgia2,705
Drug hypersensitivity2,685
Peripheral neuropathy2,406
Nausea2,200
Pain in extremity2,097
How to read this table

FAERS records what was reported, not what the medicine caused, and has no denominator – no count can become a rate.

Figures above are the counts held at the 30 July 2026 data cut, retrieved on 3 September 2026; they do not update between cuts.

Population note: four of the six leading terms — pain, arthralgia, peripheral neuropathy and pain in extremity — describe musculoskeletal and nerve symptoms, and together they outnumber the gastrointestinal complaints that usually dominate antibacterial reporting. This is an even closer match to the boxed warning than ciprofloxacin shows. Two cautions apply: reports cluster around drugs that attract public attention and litigation, which inflates volume without proving causation, and the brand name persists in reports long after the brand left the market.

Who was this medicine studied in?

Indications cover adults from 18 years, with paediatric use limited to specified infections and, for tablets, to children weighing 30 kg or more.1 The anthrax and plague indications rest partly on animal efficacy data, since human trials are not feasible.2

Who this is and is not appropriate for

It is not appropriate for anyone hypersensitive to a quinolone, and is avoided in myasthenia gravis. Diabetic patients on insulin or oral hypoglycaemics need glucose monitoring, since severe hypoglycaemia has been reported.1

It suits pneumonia, pyelonephritis or chronic bacterial prostatitis where its lung and prostate penetration matter. It does not suit a sinus infection that would clear on its own — and the label says so directly.

Where to go next

References

References — verified Sep 3, 2026

  1. NuCare Pharmaceuticals, Inc. Levofloxacin tablets — prescribing information. DailyMed SPL set ID 05d179f5-b200-8597-e063-6394a90a10cc, version 2, effective March 4, 2025. dailymed.nlm.nih.gov. Accessed September 3, 2026.
  2. US Food and Drug Administration. Drugs@FDA, queried for the Levaquin brand and for levofloxacin applications. No active application is returned under the Levaquin name. Accessed September 3, 2026.
  3. US Food and Drug Administration. FDA Adverse Event Reporting System, queried through openFDA for medicinalproduct LEVAQUIN. Data cut 2026-07-30 · Accessed 2026-09-03.

Three sources are listed because three are cited, covering FDA-approved labelling, FDA regulatory records and FDA post-marketing data.

Disclaimer

This page is medical information, not medical advice. Levofloxacin carries a boxed warning about disabling and potentially irreversible reactions, and several of its indications are reserved for patients with no alternative. Nothing here replaces assessment by the clinician treating you.