Levofloxacin Use in Severe Renal Impairment (<30 mL/min)
Levofloxacin (LEVAQUIN) can be used in patients with creatinine clearance (CrCl) <30 mL/min, but dose adjustment is recommended to avoid drug accumulation. [1] Levofloxacin should be administered with caution in renal impairment, with careful clinical observation and appropriate laboratory studies before and during therapy because elimination may be reduced. [1]
Dose Adjustment for Creatinine Clearance 20 to 49 mL/min (Includes <30 mL/min)
For adults with CrCl 20 to 49 mL/min, dosing adjustments are based on the usual (normal renal function) regimen. [1]
- Usual regimen 750 mg every 24 hours is adjusted to 750 mg every 48 hours for CrCl 20 to 49 mL/min. [1]
- Usual regimen 500 mg every 24 hours is adjusted to 500 mg every 24 hours for CrCl 20 to 49 mL/min. [1]
- Usual regimen 250 mg every 24 hours requires no dosage adjustment for CrCl 20 to 49 mL/min. [1] If treating uncomplicated UTI, no dosage adjustment is required. [1]
Dose Adjustment for Creatinine Clearance 10 to 19 mL/min
For adults with CrCl 10 to 19 mL/min, dosing adjustments are based on the usual (normal renal function) regimen. [1]
- Usual regimen 750 mg every 24 hours is adjusted to 750 mg initial dose, then 500 mg every 48 hours for CrCl 10 to 19 mL/min. [1]
- Usual regimen 500 mg every 24 hours is adjusted to 500 mg initial dose, then 250 mg every 48 hours for CrCl 10 to 19 mL/min. [1]
- Usual regimen 250 mg every 24 hours is adjusted to 250 mg every 48 hours for CrCl 10 to 19 mL/min. [1]
Dose Adjustment for Hemodialysis or CAPD
For adults receiving hemodialysis or chronic ambulatory peritoneal dialysis (CAPD), dosing adjustments are based on the usual (normal renal function) regimen. [1]
- Usual regimen 750 mg every 24 hours is adjusted to 750 mg initial dose, then 500 mg every 48 hours. [1]
- Usual regimen 500 mg every 24 hours is adjusted to 500 mg initial dose, then 250 mg every 48 hours. [1]
- Usual regimen 250 mg every 24 hours requires no dosage adjustment is available for this dosing table entry. [1]
Administration and Renal-Specific Precautions
Adequate hydration should be maintained to help prevent the formation of highly concentrated urine. [1] Crystalluria and cylindruria have been reported with quinolones, supporting hydration precautions during therapy. [1]
Drug-Interaction Precautions That Affect Levofloxacin Exposure
Oral LEVAQUIN tablets should be administered at least 2 hours before or at least 2 hours after antacids containing magnesium or aluminum, sucralfate, metal cations such as iron, and multivitamin preparations with zinc or didanosine chewable/buffered tablets (or pediatric powder for oral solution). [1] These agents can interfere with gastrointestinal absorption of levofloxacin and result in substantially lower systemic levels than desired. [1]
Monitoring During Renal Impairment Therapy
Clinical observation and appropriate laboratory studies should be performed prior to and during therapy because elimination of levofloxacin may be reduced in patients with renal impairment. [1]