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Antacid, Sucralfate, Metal Cations, Multivitamins: While the chelation by divalent cations is less marked than with other quinolones, concurrent administration of levofloxacin with antacids containing magnesium or aluminum, as well as sucralfate, metal cations such as iron, and multivitamin preparations with zinc may interfere with the gastrointestinal absorption of levofloxacin, resulting in systemic levels considerably lower than desired. These agents should be taken at least two hours before or two hours after levofloxacin administration.
Theophylline, Fenbufen or similar non-steroidal anti-inflammatory drugs (phenylacetic acid/propionic acid derivatives): No pharmacokinetic interactions of levofloxacin were found with theophylline in a clinical study. However there are indications of a pronounced lowering of the cerebral seizure threshold when quinolones are given concurrently with other drugs that lower the seizure threshold (e.g. theophylline) or with fenbufen or similar non-steroidal anti-inflammatory drugs.
Antidiabetic agents: Disturbances of blood glucose, including hyperglycemia and hypoglycemia, have been reported in patients treated concomitantly with quinolones and an antidiabetic agent. Therefore, careful monitoring of blood glucose is recommended when these agents are co-administered.
Anticoagulant drug (warfarin and its derivatives): Coadministration with warfarin and its derivatives has been reported that the effect of warfarin was potentiated (hepatic metabolism of warfarin may be inhibited or free warfarin may be increased by competitive displacement from the protein binding site) and therefore prothrombin time prolonged.
Class IA antiarrhythmics and Class III antiarrhythmics: Levofloxacin should be used with caution in patients receiving drug known to cause QT prolonged, Class IA antiarrhythmics (e.g. quinidine sulfate and procainamide hydrochloride) Class III antiarrhythmics (e.g. amiodarone hydrochloride and sotalol hydrochloride) and Delamanid etc. QT prolongation may occur.
