Levobest Drug Interactions

Antidiabetic agents: Disturbances of blood glucose, including hyperglycemia and hypoglycemia, have been reported in patients treated concomitantly with quinolones and an antidiabetic agent. Careful monitoring of blood glucose is recommended when these agents are co-administered.
Antidepressants (e.g., fluoxetine, imipramine): Potential pharmacologic interaction with these antidepressants.
Chelation Agents (e.g., antacids, sucralfate, metal cations, multivitamins): Concomitant administration of levofloxacin tablets with antacids containing calcium, magnesium, or aluminum, as well as sucralfate, metal cations such as iron, multivitamin preparations with zinc, or any products containing any of these components may interfere with the gastrointestinal absorption of levofloxacin due to the chelation of levofloxacin by multivalent cations, resulting in systemic levels considerably lower than desired. These agents should be taken at least two hours before or two hours after levofloxacin therapy.
Ciclosporin: Elevated serum levels of ciclosporin have been reported when concomitantly used with other quinolones. Levofloxacin peak concentration and elimination rate were slightly lower, while the time at which the peak concentration is achieved and t_1/2 were slightly longer in the presence of ciclosporin, than those observed in patients without concomitant drug. The differences, however, are not considered to be clinically significant. No dosage adjustment is required for levofloxacin or ciclosporin when administered concomitantly.
Corticosteroids: Concomitant use of corticosteroids increases the risk of severe tendon disorders (e.g., tendinitis, tendon rupture), particularly in elderly patients older than 60 years old.
Digoxin: There are no significant effects noted during concomitant therapy, therefore, no dosage adjustment is required.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Concomitant administration of an NSAID with a quinolone, including levofloxacin, may increase the risk of CNS stimulation and convulsive seizures.
Probenecid and Cimetidine: Potential pharmacokinetic interaction (increased levofloxacin AUC and t_1/2) - not considered clinically important; dosage adjustments are not required.
Sucralfate: The bioavailability of levofloxacin is significantly reduced when concomitantly used with sucralfate. If the patient is to receive both sucralfate and levofloxacin, it is best to administer sucralfate two hours after levofloxacin administration.
Tacrolimus: Possible pharmacokinetic interactions with tacrolimus (increased AUC of the immunosuppressive agent). Dosage adjustment is not required.
Theophylline: Concomitant administration of other quinolones with theophylline has resulted in prolonged elimination t_1/2, elevated serum theophylline levels, and a subsequent increase in the risk of theophylline-related adverse reactions. Therefore, theophylline levels should be closely monitored, and appropriate dosage adjustments made when levofloxacin is concomitantly used.
Warfarin: There have been reports of enhanced effects of warfarin when co-administered with levofloxacin. Therefore, prothrombin time, International Normalization Ratio (INR), or other suitable anticoagulation tests should be closely monitored if levofloxacin is administered concomitantly. Patients should also be monitored for evidence of bleeding.
Zidovudine: Levofloxacin absorption and disposition in HIV-infected individuals, with or without concomitant zidovudine treatment, were similar. The effect of levofloxacin on zidovudine pharmacokinetics has not been studied. No dosage adjustment for levofloxacin is required when concomitantly used with zidovudine.
Interference with Laboratory Tests: Some fluoroquinolones, including levofloxacin, may give false-positive urine screening results for opiates using commercially available immunoassay kits. Confirmation of positive opiate screen by more specific methods may be necessary.
Levofloxacin may inhibit the growth of Mycobacterium tuberculosis, and therefore, may give false-negative results in the bacteriological diagnosis of tuberculosis.