Avoid the use of fluoroquinolones in patients who have experienced any of these serious adverse reactions associated with fluoroquinolones. Discontinue this medicine immediately at the first signs or symptoms of any serious adverse reactions.
Treatment with levofloxacin must be halted immediately if:
- There are first signs of hypersensitivity reactions.
- Tendinitis is suspected (the risk of tendinitis and tendon rupture is increased in the elderly, in patients using corticosteroids and in patients receiving daily dose of 1000 mg).
- The adverse reaction effects on the central nervous system (CNS) (such as mental disorder, increased intracranial pressure, CNS stimulation, which may lead to convulsions, tremor, restlessness, headache, insomnia, depression, confusion, hallucinations, nightmares, and, rarely, suicidal thoughts or acts.
- Pseudomembranous colitis is suspected (symptoms: diarrhoea, particularly if severe, persistent and/or bloody, during or after treatment with levofloxacin).
Extreme caution should be exercised when use levofloxacin for:
- Patients with myasthenia.
- Patients with G6DP deficiency.
- Patients predisposed to seizures (such as patients with pre-existing central nervous system lesions).
- Patients with known or suspected CNS disorders e.g. seizures, cerebral arteriosclerosis
- Diabetic patients receiving concomitant treatment with an oral hypoglycemic agent (e.g., glibenclamide) or with insulin. Careful monitoring of blood glucose is recommended.
- Patients with known risk factors for prolongation of the QT interval: Congenital long QT syndrome, concomitant use of class IA and III antiarrhythmic, tricyclic antidepressants, macrolides), uncorrected electrolyte imbalance (e.g. hypokalemia, hypomagnesaemia), elderly, cardiac disease (e.g. heart failure, myocardial infarction, bradycardia).
Patients should avoid direct exposure to sunlight during treatment and 48 hours following treatment.
Patients should be aware of how they react to drug before driving or operating machinery. Some undesirable effects (e.g. dizziness/vertigo, drowsiness, visual disturbances) may impair the patient’s ability to concentrate and react.