Levofloxacin

Do not co-administer intravenous levofloxacin in the same IV line with magnesium or other multivalent cations.

Do not co-administer intravenous levofloxacin in the same IV line with didanosine due to chelation with multivalent cations.

Concomitant administration may increase the risk of CNS stimulation and convulsive seizures.

Concomitant use may increase risk of tendon rupture, especially in elderly patients. Rupture can occur during or after treatment.

Antibiotic that prolongs QT interval; should be avoided with toremifene citrate or requires close monitoring.

Levofloxacin may enhance warfarin effects, elevating prothrombin time and increasing bleeding risk. Monitor prothrombin time, INR, and watch for bleeding.

Disturbances of blood glucose including hyperglycemia and hypoglycemia have been reported. Careful monitoring of blood glucose is recommended.

Absorption of levofloxacin is decreased when tablets are taken within 2 hours of these products, resulting in considerably lower systemic levels.

May interfere with gastrointestinal absorption of levofloxacin, resulting in systemic levels considerably lower than desired. Should be taken at least two hours before or after levofloxacin.

Magnesium or aluminum-containing antacids decrease levofloxacin absorption if taken within 2 hours. Separate dosing by at least 2 hours.

Concomitant use may cause blood glucose disturbances including hyperglycemia and hypoglycemia. Careful monitoring of blood glucose is recommended.

Drug known to prolong QTc interval; caution advised when used with haloperidol decanoate due to risk of QT prolongation.

Drug known to prolong QTc interval; caution advised when used with haloperidol due to risk of QT prolongation.

Metal cation may interfere with gastrointestinal absorption of levofloxacin when taken within 2 hours, resulting in lower systemic levels.

Monitor prothrombin time, INR, watch for bleeding (7.2) Antidiabetic agents Carefully monitor blood glucose ( 5.13 , 7.3) 7.1 Chelation Agents: Antacids, Sucralfate, Metal Cations, Multivitamins Levofloxacin Injection There are no data concerning an interaction of intravenous fluoroquinolones with oral antacids, sucralfate, multivitamins, didanosine, or metal cations. 7.2 Warfarin No significant effect of levofloxacin on the peak plasma concentrations, AUC, and other disposition parameters for R- and S-warfarin was detected in a clinical study involving healthy volunteers. Similarly, no apparent effect of warfarin on levofloxacin absorption and disposition was observed.

Multivitamin preparations containing zinc may interfere with levofloxacin absorption. Take at least 2 hours before or after levofloxacin.

May interfere with gastrointestinal absorption of levofloxacin, resulting in systemic levels considerably lower than desired. Should be taken at least two hours before or after levofloxacin.

Multivitamin preparations containing zinc may interfere with gastrointestinal absorption of levofloxacin, resulting in lower systemic levels. Take at least 2 hours before or after levofloxacin.

Absorption of levofloxacin is decreased when tablets are taken within 2 hours, resulting in considerably lower systemic levels.

Concomitant administration of other fluoroquinolones with theophylline has resulted in prolonged elimination half-life, elevated serum theophylline levels, and increased risk of toxicity.

Multivitamin preparations with zinc may interfere with gastrointestinal absorption of levofloxacin when taken within 2 hours, resulting in lower systemic levels.

7 DRUG INTERACTIONS Table 2: Oral drugs that can be administered concomitantly with ferric citrate Amlodipine Aspirin Atorvastatin Calcitriol Clopidogrel Digoxin Diltiazem Doxercalciferol Enalapril Fluvastatin Glimepiride Levofloxacin Losartan Metoprolol Pravastatin Propranolol Sitagliptin Warfarin Oral drugs that have to be separated from ferric citrate and meals Dosing Recommendations Doxycycline Take at least 1 hour before ferric citrate Ciprofloxacin Take at least 2 hours before or after ferric citrate Oral medications not listed in Table 2.

Consider an alternative to these antibiotics, such as ciprofloxacin, azithromycin, and levofloxacin. 7.15 Concomitant Drugs That Do Not Need Dosage Adjustment No dosage adjustment of ORKAMBI or concomitant drug is recommended when ORKAMBI is given with the following: azithromycin, aztreonam, budesonide, ceftazidime, cetirizine, ciprofloxacin, colistimethate, colistin, dornase alfa, fluticasone, ipratropium, levofloxacin, pancreatin, pancrelipase, salbutamol, salmeterol, sulfamethoxazole, trimethoprim, tiotropium, and tobramycin.