Levoxa

Levoxa is an antibacterial drug from the quinolone category.

Indications Levoxa

It is used in adults to eliminate moderate or mild infections caused by bacteria sensitive to levofloxacin:

• chronic bronchitis in the acute stage, acute stage of sinusitis, pneumonia;
• infections affecting the urinary tract (with or without complications), such as pyelonephritis;
• infectious lesions of subcutaneous tissues and skin;
• bacterial form of chronic prostatitis.

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Release form

The drug is released in tablets, 5 pieces per blister pack. There are 2 such packs in a box.

Pharmacodynamics

Levofloxacin has a wide range of antibacterial effects.

The bactericidal effect develops by suppressing the bacterial DNA gyrase enzyme, which is a type 2 topoisomerase, with levofloxacin. As a result of such suppression, the microbe's DNA loses its ability to transition from a relaxed state to a supercoiled state. This leads to the prevention of subsequent cell division of pathogenic microorganisms.

The drug's range of activity includes gram-negative and -positive microbes, as well as non-fermenting microorganisms.

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Pharmacokinetics

Suction.

After oral administration, levofloxacin is almost completely and rapidly absorbed. Peak plasma values are recorded after 1-2 hours from the moment of administration. The bioavailability level is about 99-100%. Equilibrium values are observed for 48 hours if the dosing regimen is as follows - taking 0.5 g of the drug 1-2 times a day.

Distribution processes.

About 30-40% of Levoxa is synthesized with blood plasma protein. The average distribution volume is approximately 100 l when taking a single dose and 0.5 g of repeated doses. This allows us to conclude that the drug is widely distributed within tissues.

Passage of the active element into fluids with tissues.

Levofloxacin is found in bronchial mucosa, lung tissue, bronchial secretions, alveolar macrophages, skin (blister fluid), urine, and prostate tissue. However, the substance poorly penetrates into the cerebrospinal fluid.

Exchange processes.

Only a very small part of levofloxacin undergoes metabolic processes. Its breakdown products are the elements desmethyl-levofloxacin, and also levofloxacin N-oxide. These substances make up less than 5% of the total amount of the drug excreted in the urine.

Excretion.

After taking the drug, the substance is excreted from the blood plasma quite slowly (half-life is about 6-8 hours). Excretion occurs mainly through the kidneys (85% of the dose taken).

Linearity.

The drug has linear pharmacokinetic parameters in the range of doses of 50-1000 mg.

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Dosing and administration

The tablets should be taken once or twice a day. The portion size is determined taking into account the severity and type of infection. The duration of the course is selected taking into account the progress of the pathology, but cannot be more than 2 weeks.

It is recommended to continue taking the medication for at least 48-72 hours after the temperature has stabilized, or microbiological tests confirm the eradication of the causative microbes.

The tablets must be swallowed without chewing and washed down with water. Levox can be taken with food or at any other time.

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Use Levoxa during pregnancy

It is prohibited to prescribe Levoxa during pregnancy or lactation.

Contraindications

Main contraindications:

• the presence of intolerance to levofloxacin or other quinolones;
• epilepsy;
• the presence of side effects in the tendon area as a result of prior use of quinolones.

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Side effects Levoxa

The use of the medication may cause the appearance of certain side effects.

Infectious or invasive lesions.

Sometimes mycoses develop (and in addition, there is a proliferation of other resistant bacteria).

Lesions of the subcutaneous layer and skin surface, as well as systemic manifestations of hypersensitivity.

Occasionally, redness or itching of the skin occurs.

Systemic signs of hypersensitivity (anaphylactic and anaphylactoid) are also rarely observed - for example, bronchospasm or urticaria. In addition, severe suffocation or, extremely rarely, swelling in the mucous membrane or skin (for example, on the face or pharyngeal mucosa) may develop.

Occasionally, the development of intolerance to UV radiation and sunlight has been reported.

The appearance of a severe rash on the surface of the skin and mucous membranes (with the formation of blisters), the development of TEN, Stevens-Johnson syndrome and erythema multiforme are noted in isolated cases. Milder skin symptoms sometimes occur before the development of systemic manifestations of hypersensitivity. Such signs can develop within a few minutes or hours after taking the first portion.

Problems with the gastrointestinal tract and metabolic processes.

Diarrhea or nausea often occurs.

Occasionally, vomiting, digestive problems or abdominal pain may occur, as well as loss of appetite.

Bloody diarrhea is extremely rare – this can sometimes signal the development of an inflammatory process in the intestines (for example, pseudomembranous colitis).

A decrease in blood glucose levels (development of hypoglycemia) is occasionally recorded – this may be of great importance for people suffering from diabetes. Symptoms of hypoglycemia include increased appetite, sweating, a feeling of nervousness and trembling of the extremities.

Other quinolones have been reported to possibly induce porphyria attacks in people with the disorder. A similar effect may be seen with levofloxacin.

Disorders of the nervous system function.

Very rarely, dizziness and headaches, a feeling of numbness or drowsiness, and also sleep disorders are observed.

Occasionally, discomfort may occur, such as paresthesia in the hands, a feeling of anxiety, confusion or fear, tremors and seizures.

Hearing, smell, vision and taste disorders were observed sporadically. In addition, tactile sensitivity decreased and psychotic manifestations developed (depressive mood and hallucinations). Disturbances in motor processes (sometimes when walking), psychotic symptoms with self-destructive behavior (including suicidal thoughts and actions), and also sensory or sensorimotor polyneuropathy were observed.

Vascular disorders and disorders affecting the heart.

Occasionally, tachycardia appears or blood pressure decreases.

A collapse similar to a state of shock develops in isolated cases, blood pressure readings drop sharply, and prolongation of the QT interval is observed.

Lesions affecting connective tissue, as well as the structure of muscles and bones.

Occasionally, lesions affecting the tendons (for example, inflammatory processes) are observed, as well as pain in the muscles or joints.

Tendon rupture (for example, Achilles tendon) is extremely rare. This side effect may develop during the first 48 hours from the start of therapy and may affect the Achilles tendons on both legs. Muscle weakness may develop, which is especially important for people with severe myasthenia.

Muscle lesions (such as rhabdomyolysis) are occasionally recorded.

Disorders of the urinary and renal systems, as well as hepatobiliary disorders.

An increase in liver enzyme values (such as ALT or AST) is often observed.

Occasionally, the values of bilirubin and creatinine in the blood serum increase.

Occasionally, liver disorders (for example, inflammation) develop, as well as deterioration of renal function, up to acute renal failure - for example, due to the development of allergies (tubulointerstitial nephritis).

Lesions affecting the lymph and hematopoietic system.

Sometimes the number of certain blood cells may increase (development of eosinophilia) or the number of leukocytes may decrease (development of leukopenia).

Occasionally, a decrease in the number of certain leukocytes (development of neutropenia) or the number of platelets (development of thrombocytopenia) is observed, which may increase the tendency to bleeding or hemorrhage.

Very rarely, a significant decrease in the number of some leukocytes is observed (development of agranulocytosis), due to which severe clinical symptoms may develop (pharyngitis, prolonged or recurrent fever, and also a feeling of malaise).

A decrease in the number of red blood cells due to their destruction (development of the hemolytic form of anemia) was occasionally recorded, as well as a decrease in the number of all types of blood cells (development of pancytopenia).

Other negative signs.

Occasionally, a feeling of general weakness appears (development of asthenia).

Very rarely, a feverish condition develops, as well as allergy symptoms in the lungs (pneumonitis of allergic origin) or small blood vessels (development of vasculitis). The use of any antibacterial drugs can cause disorders associated with their effect on healthy human microflora. This can lead to a secondary infection, which will require adjuvant therapy.

Other adverse effects associated with fluoroquinolone use include:

• extrapyramidal disorders and other problems with motor coordination;
• hypersensitivity vasculitis;
• People suffering from porphyria experience attacks of this disease.

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Overdose

In case of poisoning with the drug, the function of the central nervous system is affected (symptoms include dizziness, a feeling of confusion, as well as seizures and impaired consciousness) and manifestations from the digestive organs (erosion in the mucous membranes and nausea) occur. Clinical test data have shown that overdose can result in prolongation of the QT interval.

In case of intoxication, the patient's condition should be closely monitored and ECG readings should be followed. Symptomatic measures are also taken. In case of acute poisoning, gastric lavage is performed. Antacids are used to protect the gastric mucosa. Hemodialysis procedures, including peritoneal dialysis or CAPD, do not promote the excretion of levofloxacin. The medication has no antidote.

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Interactions with other drugs

The absorption of the drug is significantly reduced when used in combination with aluminum- and magnesium-containing antacids, as well as with drugs that contain iron salts. It is necessary to maintain a minimum 2-hour interval between the use of these drugs.

The bioavailability of the drug is significantly reduced when used in combination with sucralfate. For this reason, it is necessary to observe at least a 2-hour interval between the administration of these drugs.

Although drug tests have not revealed an interaction between Levoxa and theophylline, a significant decrease in the seizure threshold may occur when quinolones are combined with NSAIDs, theophylline, and other agents that lower the seizure threshold.

Levofloxacin levels when combined with fenbufen increase by approximately 13%.

Cimetidine with probenecid have a statistically significant effect on the process of levofloxacin excretion. The level of renal clearance of the drug decreases by 34% (with probenecid) and by 24% (with cimetidine). This allows both drugs to block the excretion of Levoxa tubules.

The half-life of cyclosporine is increased by 33% when used together with levofloxacin.

Combination with vitamin K antagonists (e.g. warfarin) increases coagulation test values (PT/INR) or leads to increased bleeding severity. In this regard, individuals taking vitamin K antagonists together with Levoxa should monitor coagulation values.

It is prohibited to use the drug in combination with alcoholic beverages.

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Storage conditions

Levoxa should be kept in a dark place, protected from moisture. The temperature level should not exceed 25°C.

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Shelf life

Levoxa can be used for 3 years from the date of release of the drug.

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Application for children

The use of the medication in adolescents and children is contraindicated.

Analogues

Analogues of the drug are Levolet, Flaprox and Rotomox with Ciprofloxacin, as well as Ciprolet and Ofloxacin with Ciprofloxacin-Solopharm.

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