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Tablet: To prevent the development of resistance, susceptibility to the drug should be determined before use. The duration of use should be limited to the minimum time required for treatment.
Careful Administration: Patients with severe renal disorders.
Patients with a history of convulsive disorders. (Convulsions may possibly occur).
Patients with a history of hypersensitivity to quinolone antibacterial agents.
The elderly. (See "Use in the Elderly as follows.")
Others: Animal studies have shown that Levofloxacin can produce arthropathy in juvenile dogs, young mature dogs (13 months of age) and juvenile rats.
Infusion: In cases of severest pneumococcal pneumonia Levocil may not be the optimal therapy. Hospital acquired infections due to certain pathogens (P. aeruginosa) may require combination therapy.
Infusion Time: The recommended infusion time of at least 60 minutes for Levocil 250 mg (100 ml solution for infusion) should be observed. It is known for ofloxacin, that during infusion tachycardia and a temporary decrease in blood pressure may develop. In rare cases, as a consequence of profound drop in blood pressure, circulatory collapse may occur. If there is a conspicuous drop in blood pressure during infusion of Levofloxacin (l-isomer of ofloxacin), the infusion must be halted immediately.
The risk of getting convulsions during the treatment with Levocil may be increased if in the past brain was damaged for example by a stroke or severe brain injury. Therefore inform the doctor completely about the former diseases. The patient must not be treated with Levocil if they suffer from epilepsy.
The risk of getting convulsions may also be increased by concomitant therapy with fenbufen or comparable nonsteroidal antiphlogistics or with theophylline.
Although photosensitisation (hypersensitivity to light with sunburn-like reactions) is very rare with administration of Levofloxacin, it is recommended that patients should not expose themselves unnecessarily to strong sunlight or to artificial UV rays (e.g. Sunray lamp, solarium), in order to prevent photosensitisation.
The doctor has to be immediately informed if severe, persistent and/or bloody diarrhoea occur during or after treatment with Levocil. It must be stopped immediately and an appropriate therapy must be initiated without delay. Products inhibiting the peristalsis must not be administered in these cases. Tendinitis, rarely observed with quinolones, may occasionally lead to rupture, involving Achilles tendon in particular. Elderly patients are more prone to tendinitis. The risk of tendon rupture may be increased by co-administration of corticosteroids. If tendinitis is suspected, medical advice is to be asked for immediately, treatment with Levocil must be halted, and the affected tendon must be treated approximately, e.g. Immobilization.
Patients with glucose-6 phosphate dehydrogenase deficiency (a hereditary disease) may be prone to destruction of red blood cells (hemolysis) when treated with quinolone antibacterial agents, and so Levofloxacin should be used with caution in these patients.
Some side effects of Levocil like vertigo/dizziness, drowsiness, visual disturbances may impair the ability to concentrate and react. This may constitute a risk in situations where these abilities are of special importance (e.g., Driving a car or operating machinery, working without secure hold). This especially applies to the combination with alcohol.
Use in the Elderly: Tablet: This product is mainly excreted by the kidneys. (See "Pharmacology: Pharmacokinetics under Actions.") Since the elderly often have a renal hypofunction and are in danger of continuous high blood concentration, observe dose and interval (e.g., 100 mg b.i.d.).
Infusion: For elderly patients it is to be considered, that these patients have more often a reduced renal function.
