Version May 2024
Bacterial conjunctivitis: Ophthalmic: 0.5% solution:
Treatment day 1 and day 2: Instill 1 to 2 drops into affected eye(s) every 2 hours while awake, up to 8 times daily.
Treatment day 3 through day 7: Instill 1 to 2 drops into affected eye(s) every 4 hours while awake, up to 4 times daily.
Corneal ulcer: Ophthalmic: 1.5% solution:
Treatment day 1 through day 3: Instill 1 to 2 drops into affected eye(s) every 30 minutes to 2 hours while awake and ~ 4 to 6 hours after going to bed for the night.
Treatment day 4 through completion of therapy: Instill 1 to 2 drops into affected eye(s) every 1 to 4 hours while awake.
There are no dosage adjustments provided in the manufacturer’s labeling. However, dosage adjustment unlikely due to low systemic absorption.
There are no dosage adjustments provided in the manufacturer’s labeling. However, dosage adjustment unlikely due to low systemic absorption.
Refer to adult dosing.
(For additional information see "Levofloxacin (ophthalmic): Pediatric drug information")
Bacterial conjunctivitis: Children and Adolescents: Ophthalmic: 0.5% solution:
Day 1 and 2: Instill 1 to 2 drops into affected eye(s) every 2 hours while awake, up to 8 times/day
Day 3 to 7: Instill 1 to 2 drops into affected eye(s) every 4 hours while awake, up to 4 times/day
There are no dosage adjustments provided in the manufacturer’s labeling; however, dosage adjustment unlikely due to low systemic absorption.
There are no dosage adjustments provided in the manufacturer’s labeling; however, dosage adjustment unlikely due to low systemic absorption.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%:
Gastrointestinal: Diarrhea (1% to 2%), dysgeusia (8% to 10%), dyspepsia (1% to 2%), nausea (1% to 2%)
Nervous system: Headache (1% to 10%)
Ophthalmic: Blurred vision (1% to 2%), burning sensation of eyes (1% to 3%), eye discomfort (1% to 3%), eye infection (1% to 2%), eye irritation (1% to 2%), eye pain (1% to 3%), foreign body sensation of eye (1% to 3%), photophobia (1% to 3%), temporary vision loss (1% to 3%)
Respiratory: Pharyngitis (1% to 3%), throat irritation (1% to 2%)
Miscellaneous: Fever (1% to 3%)
<1%:
Endocrine & metabolic: Chemosis
Hypersensitivity reaction: Hypersensitivity reaction
Ophthalmic: Corneal erosion, diplopia, dry eye syndrome, erythema of eyelid, eye pruritus, eyelid edema, seeing spots (floaters)
Postmarketing: Ophthalmic: Blepharitis (Kanda 2012), conjunctival hyperemia (Kanda 2012), conjunctivitis (Kanda 2012), episcleritis (Kanda 2012), eyelid pruritus (Kanda 2012), increased lacrimation (Kanda 2012), keratitis (including punctate keratitis) (Kanda 2012)
Hypersensitivity to levofloxacin, other quinolones, or to any component of the formulation.
Concerns related to adverse effects:
• Hypersensitivity: Serious hypersensitivity reactions, including anaphylaxis, have been reported with systemic quinolone therapy. Prompt discontinuation of drug should occur if skin rash or other symptoms arise.
• Superinfection: Prolonged use may lead to overgrowth of nonsusceptible organisms, including fungi. Discontinue use and institute appropriate alternative therapy if superinfection is suspected.
Other warnings/precautions:
• Appropriate use: For topical use only. Do not inject subconjunctivally or introduce into anterior chamber of the eye. Contact lenses should not be worn during treatment.
Ophthalmic administration of fluoroquinolones has not been shown to affect weight-bearing joints.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Ophthalmic:
Generic: 0.5% (5 mL [DSC])
Solution, Ophthalmic [preservative free]:
Generic: 1.5% (5 mL)
Yes
Solution (levoFLOXacin Ophthalmic)
1.5% (per mL): $13.00
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
For topical ophthalmic use only; not for injection. Avoid touching tip of applicator to eye or other surfaces.
For topical ophthalmic use only; not for injection: Apply finger pressure to lacrimal sac during and for 1 to 2 minutes after instillation to decrease risk of absorption and systemic effects; avoid contacting bottle tip with skin
Bacterial conjunctivitis: 0.5% solution: Treatment of bacterial conjunctivitis caused by susceptible strains of Corynebacterium species, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus groups C/F, Streptococcus group G, Viridans group streptococci, Acinetobacter lwoffii, Haemophilus influenzae, and Serratia marcescens.
Corneal ulcers: 1.5% solution: Treatment of corneal ulcers caused by susceptible strains of Corynebacterium species, Pseudomonas aeruginosa, Serratia marcescens, S. aureus, S. epidermidis, S. pneumoniae, and Viridans group streptococci.
LevoFLOXacin may be confused with levETIRAcetam, levodopa, levothyroxine
None known.
There are no known significant interactions.
Adverse events have been observed in some animal reproduction studies. When administered orally or IV, levofloxacin crosses the placenta (Ozyüncü and Beksac 2010; Ozyüncü and Nemutlu 2010). The amount of levofloxacin available systemically following topical application of the ophthalmic drops is significantly less in comparison to oral or IV doses. If ophthalmic agents are needed during pregnancy, the minimum effective dose should be used in combination with punctal occlusion for 3 to 5 minutes after application to decrease potential exposure to the fetus (Samples 1988).
When administered orally or IV, levofloxacin enters breast milk (Cahill 2005). The amount of levofloxacin available systemically following topical application of the ophthalmic drops is significantly less in comparison to oral or IV doses. The manufacturer recommends that caution be exercised when administering levofloxacin ophthalmic drops to nursing women.
Levofloxacin is the L-isomer of ofloxacin. Levofloxacin inhibits DNA-gyrase and topoisomerase IV in susceptible organisms and thereby inhibits relaxation of supercoiled DNA and promotes breakage of DNA strands. DNA gyrase (topoisomerase II), is an essential bacterial enzyme that maintains the superhelical structure of DNA and is required for DNA replication, transcription, repair, and recombination.
Absorption: Only small amounts are absorbed systemically after ophthalmic instillation
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