FDA label a13d2414-c7fe-4202-9cb4-a78984cb1fba

WARNING Fluoroquinolones, including levofloxacin, are associated with an increased risk of tendinitis and tendon rupture in all ages. This risk is further increased in older patients usually over 60 years of age, in patients taking corticosteroid drugs, and in patients with kidney, heart or lung transplants [ See Warnings and Precautions (5.1) ] . Fluoroquinolones, including levofloxacin, may exacerbate muscle weakness in persons with myasthenia gravis. Avoid levofloxacin in patients with a known history of myasthenia gravis [ See Warnings and Precautions (5.2) ] . WARNING: Fluoroquinolones, including levofloxacin, are associated with an increased risk of tendinitis and tendon rupture in all ages. This risk is further increased in older patients usually over 60 years of age, in patients taking corticosteroid drugs, and in patients with kidney, heart or lung transplants [See Warnings and Precautions (5.1) ]. Fluoroquinolones, including levofloxacin, may exacerbate muscle weakness in persons with myasthenia gravis. Avoid levofloxacin in patients with a known history of myasthenia gravis [See Warnings and Precautions (5.2) ]. To reduce the development of drug-resistant bacteria and maintain the effectiveness of levofloxacin and other antibacterial drugs, levofloxacin tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.

5 WARNINGS AND PRECAUTIONS Risk of tendinitis and tendon rupture is increased. This risk is further increased in older patients usually over 60 years of age, in patients taking corticosteroids, and in patients with kidney, heart or lung transplants. Discontinue if pain or inflammation in a tendon occurs ( 5.1 , 8.5 ) May exacerbate muscle weakness in persons with myasthenia gravis. Avoid use in patients with a known history of myasthenia gravis ( 5.2 ). Anaphylactic reactions and allergic skin reactions, serious, occasionally fatal, may occur after first dose ( 4 , 5.3 ) Hematologic (including agranulocytosis, thrombocytopenia), and renal toxicities may occur after multiple doses ( 5.4 ) Hepatotoxicity: Severe, and sometimes fatal, hepatoxicity has been reported. Discontinue immediately if signs and symptoms of hepatitis occur ( 5.5 ) Central nervous system effects, including convulsions, anxiety, confusion, depression, and insomnia may occur after the first dose. Use with caution in patients with known or suspected disorders that may predispose them to seizures or lower the seizure threshold ( 5.6 ) Clostridium difficile-associated colitis: evaluate if diarrhea occurs ( 5.7 ) Peripheral neuropathy: discontinue if symptoms occur in order to prevent irreversibility ( 5.8 ) Prolongation of the QT interval and isolated cases of torsade de pointes have been reported. Avoid use in patients with known prolongation, those with hypokalemia, and with other drugs that prolong the QT interval ( 5.9 , 8.5 ) 5.1 Tendinopathy and Tendon Rupture Fluoroquinolones, including levofloxacin, are associated with an increased risk of tendinitis and tendon rupture in all ages. This adverse reaction most frequently involves the Achilles tendon, and rupture of the Achilles tendon may require surgical repair. Tendinitis and tendon rupture in the rotator cuff (the shoulder), the hand, the biceps, the thumb, and other tendon sites have also been reported. The risk of developing fluoroquinolone-associated tendinitis and tendon rupture is further increased in older patients usually over 60 years of age, in those taking corticosteroid drugs, and in patients with kidney, heart or lung transplants. Factors, in addition to age and corticosteroid use, that may independently increase the risk of tendon rupture include strenuous physical activity, renal failure, and previous tendon disorders such as rheumatoid arthritis. Tendinitis and tendon rupture have been reported in patients taking fluoroquinolones who do not have the above risk factors. Tendon rupture can occur during or after completion of therapy; cases occurring up to several months after completion of therapy have been reported. Levofloxacin should be discontinued if the patient experiences pain, swelling, inflammation or rupture of a tendon. Patients should be advised to rest at the first sign of tendinitis or tendon rupture, and to contact their healthcare provider regarding changing to a non-quinolone antimicrobial drug. [see Adverse Reactions (6.3) ; Patient Counseling Information (17.3) ]. 5.2 Exacerbation of Myasthenia Gravis Fluoroquinolones, including levofloxacin, have neuromuscular blocking activity and may exacerbate muscle weakness in persons with myasthenia gravis. Postmarketing serious adverse events, including deaths and requirement for ventilatory support, have been associated with fluoroquinolone use in persons with myasthenia gravis. Avoid levofloxacin in patients with a known history of myasthenia gravis [see Adverse Reactions (6.3) ; Patient Counseling Information (17.3) ]. 5.3 Hypersensitivity Reactions Serious and occasionally fatal hypersensitivity and/or anaphylactic reactions have been reported in patients receiving therapy with fluoroquinolones, including levofloxacin. These reactions often occur following the first dose. Some reactions have been accompanied by cardiovascular collapse, hypotension/shock, seizure, loss of consciousness, tingling, angioedema (including tongue, laryngeal, throat, or facial edema/swelling), airway obstruction (including bronchospasm, shortness of breath, and acute respiratory distress), dyspnea, urticaria, itching, and other serious skin reactions. Levofloxacin should be discontinued immediately at the first appearance of a skin rash or any other sign of hypersensitivity. Serious acute hypersensitivity reactions may require treatment with epinephrine and other resuscitative measures, including oxygen, intravenous fluids, antihistamines, corticosteroids, pressor amines, and airway management, as clinically indicated [see Adverse Reactions (6) ; Patient Counseling Information (17.3) ]. 5.4 Other Serious and Sometimes Fatal Reactions Other serious and sometimes fatal events, some due to hypersensitivity, and some due to uncertain etiology, have been reported rarely in patients receiving therapy with fluoroquinolones, including levofloxacin. These events may be severe and generally occur following the administration of multiple doses. Clinical manifestations may include one or more of the following: fever, rash, or severe dermatologic reactions (e.g., toxic epidermal necrolysis, Stevens-Johnson Syndrome); vasculitis; arthralgia; myalgia; serum sickness; allergic pneumonitis; interstitial nephritis; acute renal insufficiency or failure; hepatitis; jaundice; acute hepatic necrosis or failure; anemia, including hemolytic and aplastic; thrombocytopenia, including thrombotic thrombocytopenic purpura; leukopenia; agranulocytosis; pancytopenia; and/or other hematologic abnormalities. The drug should be discontinued immediately at the first appearance of skin rash, jaundice, or any other sign of hypersensitivity and supportive measures instituted [see Adverse Reactions (6) ; Patient Counseling Information (17.3) ]. 5.5 Hepatotoxicity Post-marketing reports of severe hepatotoxicity (including acute hepatitis and fatal events) have been received for patients treated with levofloxacin. No evidence of serious drug-associated hepatotoxicity was detected in clinical trials of over 7,000 patients. Severe hepatotoxicity generally occurred within 14 days of initiation of therapy and most cases occurred within 6 days. Most cases of severe hepatotoxicity were not associated with hypersensitivity [see Warnings and Precautions (5.4) ]. The majority of fatal hepatotoxicity reports occurred in patients 65 years of age or older and most were not associated with hypersensitivity. Levofloxacin should be discontinued immediately if the patient develops signs and symptoms of hepatitis [see Adverse Reactions (6) ; Patient Counseling Information (17.3) ]. 5.6 Central Nervous System Effects Convulsions and toxic psychoses have been reported in patients receiving fluoroquinolones, including levofloxacin. Fluoroquinolones may also cause increased intracranial pressure and central nervous system stimulation which may lead to tremors, restlessness, anxiety, lightheadedness, confusion, hallucinations, paranoia, depression, nightmares, insomnia, and, rarely, suicidal thoughts or acts. These reactions may occur following the first dose. If these reactions occur in patients receiving levofloxacin, the drug should be discontinued and appropriate measures instituted. As with other fluoroquinolones, levofloxacin should be used with caution in patients with a known or suspected central nervous system (CNS) disorder that may predispose them to seizures or lower the seizure threshold (e.g., severe cerebral arteriosclerosis, epilepsy) or in the presence of other risk factors that may predispose them to seizures or lower the seizure threshold (e.g., certain drug therapy, renal dysfunction.) [see Adverse Reactions (6) ; Drug Interactions (7.4 , 7.5 ); Patient Counseling Information (17.3) ]. 5.7 Clostridium difficile-Associated Diarrhea Clostridium difficile -associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including levofloxacin, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile. C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated [see Adverse Reactions (6.2) , Patient Counseling Information (17.3) ]. 5.8 Peripheral Neuropathy Rare cases of sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias and weakness have been reported in patients receiving fluoroquinolones, including levofloxacin. Levofloxacin should be discontinued if the patient experiences symptoms of neuropathy including pain, burning, tingling, numbness, and/or weakness or other alterations of sensation including light touch, pain, temperature, position sense, and vibratory sensation in order to prevent the development of an irreversible condition [see Adverse Reactions (6) , Patient Counseling Information (17.3) ]. 5.9 Prolongation of the QT Interval Some fluoroquinolones, including levofloxacin, have been associated with prolongation of the QT interval on the electrocardiogram and infrequent cases of arrhythmia. Rare cases of torsade de pointes have been spontaneously reported during postmarketing surveillance in patients receiving fluoroquinolones, including levofloxacin. Levofloxacin should be avoided in patients with known prolongation of the QT interval, patients with uncorrected hypokalemia, and patients receiving class IA (quinidine, procainamide), or class III (amiodarone, sotalol) antiarrhythmic agents. Elderly patients may be more susceptible to drug-associated effects on the QT interval [see Adverse Reactions (6.3) , Use in Specific Populations (8.5) , and Patient Counseling Information (17.3) ]. 5.10 Musculoskeletal Disorders in Pediatric Patients and Arthropathic Effects in Animals Levofloxacin is indicated in pediatric patients (≥6 months of age) only for the prevention of inhalational anthrax (post-exposure) [see Indications and Usage (1.13) ]. An increased incidence of musculoskeletal disorders (arthralgia, arthritis, tendinopathy, and gait abnormality) compared to controls has been observed in pediatric patients receiving levofloxacin [see Use in Specific Populations (8.4) ]. In immature rats and dogs, the oral and intravenous administration of levofloxacin resulted in increased osteochondrosis. Histopathological examination of the weight-bearing joints of immature dogs dosed with levofloxacin revealed persistent lesions of the cartilage. Other fluoroquinolones also produce similar erosions in the weight-bearing joints and other signs of arthropathy in immature animals of various species [see Animal Toxicology and/or Pharmacology (13.2) ]. 5.11 Blood Glucose Disturbances As with other fluoroquinolones, disturbances of blood glucose, including symptomatic hyper- and hypoglycemia, have been reported with levofloxacin, usually in diabetic patients receiving concomitant treatment with an oral hypoglycemic agent (e.g., glyburide) or with insulin. In these patients, careful monitoring of blood glucose is recommended. If a hypoglycemic reaction occurs in a patient being treated with levofloxacin, levofloxacin should be discontinued and appropriate therapy should be initiated immediately [see Adverse Reactions (6.2) ; Drug Interactions (7.3) ; Patient Counseling Information (17.4) ]. 5.12 Photosensitivity/Phototoxicity Moderate to severe photosensitivity/phototoxicity reactions, the latter of which may manifest as exaggerated sunburn reactions (e.g., burning, erythema, exudation, vesicles, blistering, edema) involving areas exposed to light (typically the face, "V" area of the neck, extensor surfaces of the forearms, dorsa of the hands), can be associated with the use of fluoroquinolones after sun or UV light exposure. Therefore, excessive exposure to these sources of light should be avoided. Drug therapy should be discontinued if photosensitivity/phototoxicity occurs [see Adverse Reactions (6.3) ; Patient Counseling Information (17.3) ]. 5.13 Development of Drug Resistant Bacteria Prescribing levofloxacin in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria [see Patient Counseling Information (17.1) ].

6 ADVERSE REACTIONS The most common reactions (≥ 3%) were nausea, headache, diarrhea, insomnia, constipation and dizziness ( 6.2 ). To report SUSPECTED ADVERSE REACTIONS, contact at or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Serious and Otherwise Important Adverse Reactions The following serious and otherwise important adverse drug reactions are discussed in greater detail in other sections of labeling: Tendon Effects [see Warnings and Precautions (5.1) ] Exacerbation of Myasthenia Gravis [see Warnings and Precautions (5.2) ] Hypersensitivity Reactions [see Warnings and Precautions (5.3) ] Other Serious and Sometimes Fatal Reactions [see Warnings and Precautions (5.4) ] Hepatotoxicity [see Warnings and Precautions (5.5) ] Central Nervous System Effects [see Warnings and Precautions (5.6) ] Clostridium difficile -Associated Diarrhea [see Warnings and Precautions (5.7) ] Peripheral Neuropathy [see Warnings and Precautions (5.8) ] Prolongation of the QT Interval [see Warnings and Precautions (5.9) ] Musculoskeletal Disorders in Pediatric Patients [see Warnings and Precautions (5.10) ] Blood Glucose Disturbances [see Warnings and Precautions (5.11) ] Photosensitivity/Phototoxicity [see Warnings and Precautions (5.12) ] Development of Drug Resistant Bacteria [see Warnings and Precautions (5.13) ] Crystalluria and cylindruria have been reported with quinolones, including levofloxacin. Therefore, adequate hydration of patients receiving levofloxacin should be maintained to prevent the formation of a highly concentrated urine [see Dosage and Administration (2.5) ]. 6.2 Clinical Trial Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The data described below reflect exposure to levofloxacin in 7537 patients in 29 pooled Phase 3 clinical trials. The population studied had a mean age of 50 years (approximately 74% of the population was < 65 years of age), 50% were male, 71% were Caucasian, 19% were Black. Patients were treated with levofloxacin for a wide variety of infectious diseases [see Indications and Usage (1) ]. Patients received levofloxacin doses of 750 mg once daily, 250 mg once daily, or 500 mg once or twice daily. Treatment duration was usually 3-14 days, and the mean number of days on therapy was 10 days. The overall incidence, type and distribution of adverse reactions was similar in patients receiving levofloxacin tablets doses of 750 mg once daily, 250 mg once daily, and 500 mg once or twice daily. Discontinuation of levofloxacin due to adverse drug reactions occurred in 4.3% of patients overall, 3.8% of patients treated with the 250 mg and 500 mg doses and 5.4% of patients treated with the 750 mg dose. The most common adverse drug reactions leading to discontinuation with the 250 and 500 mg doses were gastrointestinal (1.4%), primarily nausea (0.6%); vomiting (0.4%); dizziness (0.3%); and headache (0.2%). The most common adverse drug reactions leading to discontinuation with the 750 mg dose were gastrointestinal (1.2%), primarily nausea (0.6%), vomiting (0.5%); dizziness (0.3%); and headache (0.3%). Adverse reactions occurring in ≥1% of levofloxacin-treated patients and less common adverse reactions, occurring in 0.1 to <1% of levofloxacin-treated patients, are shown in Table 4 and Table 5, respectively. The most common adverse drug reactions (≥3%) are nausea, headache, diarrhea, insomnia, constipation, and dizziness. Table 4: Common (≥1%) Adverse Reactions Reported in Clinical Trials with Levofloxacin System/Organ Class Adverse Reaction % (N=7537) * N = 7274 † N = 3758 (women) Infections and Infestations moniliasis 1 Psychiatric Disorders insomnia*[see Warnings and Precautions (5.6) ] 4 Nervous System Disorders headache 6 dizziness [see Warnings and Precautions (5.6) ] 3 Respiratory, Thoracic and Mediastinal Disorders dyspnea [see Warnings and Precautions (5.3) ] 1 Gastrointestinal Disorders nausea 7 diarrhea 5 constipation 3 abdominal pain 2 vomiting 2 dyspepsia 2 Skin and Subcutaneous rash [see Warnings and Precautions (5.3) ] 2 Tissue Disorders pruritus 1 Reproductive System and Breast Disorders vaginitis 1† General Disorders and Administration Site edema 1 Conditions injection site reaction 1 chest pain 1 Table 5: Less Common (0.1 to 1%) Adverse Reactions Reported in Clinical Trials with Levofloxacin (N=7537) System/Organ Class Adverse Reaction *N = 7274 Infections and Infestations genital moniliasis Blood and Lymphatic anemia System Disorders thrombocytopenia granulocytopenia [see Warnings and Precautions (5.4) ] Immune System Disorders allergic reaction [see Warnings and Precautions (5.3 , 5.4 )] Metabolism and Nutrition hyperglycemia Disorders hyperglycemia [see Warnings and Precautions (5.11) ] hyperkalemia Psychiatric Disorders anxiety agitation confusion depression hallucination nightmare* [see Warnings and Precautions (5.6) ] sleep disorder* anorexia abnormal dreaming* Nervous System Disorders tremor convulsions [see Warnings and Precautions (5.6) ] paresthesia [see Warnings and Precautions (5.8) ] vertigo hypertonia hyperkinesias abnormal gait somnolence*syncope Respiratory, Thoracic and Mediastinal Disorders epistaxis Cardiac Disorders cardiac arrest palpitation ventricular tachycardia ventricular arrhythmia Vascular Disorders phlebitis Gastrointestinal Disorders gastritis stomatitis pancreatitis esophagitis gastroenteritis glossitis pseudomembraneous/ C. difficile colitis [see Warnings and Precautions (5.7) ] Hepatobiliary Disorders abnormal hepatic function increased hepatic enzymes increased alkaline phosphatase Skin and Subcutaneous Tissue Disorders urticaria [see Warnings and Precautions (5.3) ] Musculoskeletal and arthralgia Connective Tissue Disorders tendinitis [see Warnings and Precautions (5.1) ] myalgia skeletal pain Renal and Urinary Disorders abnormal renal function acute renal failure [see Warnings and Precautions (5.4) ] In clinical trials using multiple-dose therapy, ophthalmologic abnormalities, including cataracts and multiple punctate lenticular opacities, have been noted in patients undergoing treatment with quinolones, including levofloxacin. The relationship of the drugs to these events is not presently established. 6.3 Postmarketing Experience Table 6 lists adverse reactions that have been identified during post-approval use of levofloxacin. Because these reactions are reported voluntarily from a population of uncertain size, reliably estimating their frequency or establishing a causal relationship to drug exposure is not always possible. Table 6: Postmarketing Reports Of Adverse Drug Reactions System/Organ Class Adverse Reaction Blood and Lymphatic System Disorders pancytopenia aplastic anemia leukopenia hemolytic anemia [see Warnings and Precautions (5.4) ] eosinophilia Immune System Disorder hypersensitivity reactions, sometimes fatal including: anaphylactic/anaphylactoid reactions anaphylactic shock angioneurotic edema serum sickness [see Warnings and Precautions (5.3 , 5.4) ] Psychiatric Disorders psychosis paranoia isolated reports of suicide attempt and suicidal ideation [see Warnings and Precautions (5.6) ] Nervous System Disorders exacerbation of myasthenia gravis [see Warnings and Precautions (5.2) ] anosmia ageusia parosmia dysgeusia peripheral neuropathy [see Warnings and Precautions (5.8) ] isolated reports of encephalopathy abnormal electroencephalogram (EEG) dysphonia Eye Disorders vision disturbance, including diplopia visual acuity reduced vision blurred scotoma Ear and Labyrinth hypoacusis Disorders tinnitus Cardiac Disorders isolated reports of torsade de pointes electrocardiogram QT prolonged [see Warnings and Precautions (5.9) ] tachycardia Vascular Disorders vasodilatation Respiratory, Thoracic and Mediastinal Disorders isolated reports of allergic pneumonitis [see Warnings and Precautions (5.4) ] Hepatobiliary Disorders hepatic failure (including fatal cases) hepatitis jaundice [see Warnings and Precautions (5.4 , 5.5) ] Skin and Subcutaneous Tissue Disorders bullous eruptions to include: Stevens-Johnson Syndrome toxic epidermal necrolysis erythema multiforme [see Warnings and Precautions (5.4) ] photosensitivity/phototoxicity reaction [see Warnings and Precautions (5.12) ] leukocytoclastic vasculitis Musculoskeletal and Connective Tissue Disorders tendon rupture [see Warnings and Precautions (5.1) ] muscle injury, including rupture rhabdomyolysis Renal and Urinary Disorders interstitial nephritis [see Warnings and Precautions (5.4) ] General Disorders and Administration Site Conditions multi-organ failure pyrexia Investigations prothrombin time prolonged international normalized ratio prolonged muscle enzymes increased

<table frame="void" width="568"> <caption> Table 4: Common (&#x2265;1%) Adverse Reactions Reported in Clinical Trials with Levofloxacin</caption> <thead> <tr> <td styleCode="Toprule" valign="top"> <content styleCode="bold">System/Organ Class</content> </td> <td styleCode="Toprule" valign="top"> <content styleCode="bold">Adverse Reaction</content> </td> <td styleCode="Toprule" valign="top"> <content styleCode="bold">%</content> </td> </tr> <tr> <td styleCode="Botrule" valign="top"/> <td styleCode="Botrule" valign="top"/> <td styleCode="Botrule" valign="top"> <content styleCode="bold">(N=7537)</content> </td> </tr> </thead> <tfoot> <tr> <td styleCode="Toprule" valign="top" colspan="3"> * N = 7274 </td> </tr> <tr> <td valign="top" colspan="3"> &#x2020; N = 3758 (women) </td> </tr> </tfoot> <tbody> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Infections and Infestations</content> </td> <td styleCode="Botrule Toprule" valign="top">moniliasis</td> <td styleCode="Botrule Toprule" valign="top">1</td> </tr> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Psychiatric Disorders</content> </td> <td styleCode="Botrule Toprule" valign="top">insomnia*[see <linkHtml href="#bf27a660-c114-4f01-a9c8-0f9922acf361">Warnings and Precautions (5.6)</linkHtml>]</td> <td styleCode="Botrule Toprule" valign="top">4</td> </tr> <tr> <td styleCode="Toprule" valign="top"> <content styleCode="bold">Nervous System Disorders</content> </td> <td styleCode="Toprule" valign="top">headache</td> <td styleCode="Toprule" valign="top">6</td> </tr> <tr> <td styleCode="Botrule" valign="top"/> <td styleCode="Botrule" valign="top">dizziness [see <linkHtml href="#bf27a660-c114-4f01-a9c8-0f9922acf361">Warnings and Precautions (5.6)</linkHtml>]</td> <td styleCode="Botrule" valign="top">3</td> </tr> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Respiratory, Thoracic and Mediastinal Disorders</content> </td> <td styleCode="Botrule Toprule" valign="top">dyspnea [see <linkHtml href="#b4eb14ba-c9de-4b04-9115-08dc1e39a106">Warnings and Precautions (5.3)</linkHtml>]</td> <td styleCode="Botrule Toprule" valign="top">1</td> </tr> <tr> <td styleCode="Toprule" valign="top"> <content styleCode="bold">Gastrointestinal Disorders</content> </td> <td styleCode="Toprule" valign="top">nausea</td> <td styleCode="Toprule" valign="top">7</td> </tr> <tr> <td valign="top"/> <td valign="top">diarrhea</td> <td valign="top">5</td> </tr> <tr> <td valign="top"/> <td valign="top">constipation</td> <td valign="top">3</td> </tr> <tr> <td valign="top"/> <td valign="top">abdominal pain</td> <td valign="top">2</td> </tr> <tr> <td valign="top"/> <td valign="top">vomiting</td> <td valign="top">2</td> </tr> <tr> <td styleCode="Botrule" valign="top"/> <td styleCode="Botrule" valign="top">dyspepsia</td> <td styleCode="Botrule" valign="top">2</td> </tr> <tr> <td styleCode="Toprule" valign="top"> <content styleCode="bold">Skin and Subcutaneous</content> </td> <td styleCode="Toprule" valign="top">rash [see <linkHtml href="#b4eb14ba-c9de-4b04-9115-08dc1e39a106">Warnings and Precautions (5.3)</linkHtml>]</td> <td styleCode="Toprule" valign="top">2</td> </tr> <tr> <td styleCode="Botrule" valign="top"> <content styleCode="bold">Tissue Disorders</content> </td> <td styleCode="Botrule" valign="top">pruritus</td> <td styleCode="Botrule" valign="top">1</td> </tr> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Reproductive System and Breast Disorders</content> </td> <td styleCode="Botrule Toprule" valign="top">vaginitis</td> <td styleCode="Botrule Toprule" valign="top">1&#x2020;</td> </tr> <tr> <td styleCode="Toprule" valign="top"> <content styleCode="bold">General Disorders and Administration Site</content> </td> <td styleCode="Toprule" valign="top">edema</td> <td styleCode="Toprule" valign="top">1</td> </tr> <tr> <td valign="top"> <content styleCode="bold">Conditions</content> </td> <td valign="top">injection site reaction</td> <td valign="top">1</td> </tr> <tr> <td styleCode="Botrule" valign="top"/> <td styleCode="Botrule" valign="top">chest pain</td> <td styleCode="Botrule" valign="top">1</td> </tr> </tbody> </table>

<table frame="void" width="568"> <caption> Table 5: Less Common (0.1 to 1%) Adverse Reactions Reported in Clinical Trials with Levofloxacin (N=7537)</caption> <thead> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">System/Organ Class</content> </td> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Adverse Reaction</content> </td> </tr> </thead> <tfoot> <tr> <td styleCode="Toprule" valign="top" colspan="2"> *N = 7274 </td> </tr> </tfoot> <tbody> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Infections and Infestations</content> </td> <td styleCode="Botrule Toprule" valign="top">genital moniliasis</td> </tr> <tr> <td styleCode="Toprule" valign="top"> <content styleCode="bold">Blood and Lymphatic</content> </td> <td styleCode="Toprule" valign="top">anemia</td> </tr> <tr> <td valign="top"> <content styleCode="bold">System Disorders</content> </td> <td valign="top">thrombocytopenia</td> </tr> <tr> <td valign="top"/> <td valign="top">granulocytopenia</td> </tr> <tr> <td styleCode="Botrule" valign="top"/> <td styleCode="Botrule" valign="top">[see <linkHtml href="#b092d1d7-a440-445c-91cc-c8d5e6e0b8f7">Warnings and Precautions (5.4)</linkHtml>]</td> </tr> <tr> <td styleCode="Toprule" valign="top"> <content styleCode="bold">Immune System Disorders</content> </td> <td styleCode="Toprule" valign="top">allergic reaction</td> </tr> <tr> <td styleCode="Botrule" valign="top"/> <td styleCode="Botrule" valign="top">[see <linkHtml href="#b4eb14ba-c9de-4b04-9115-08dc1e39a106">Warnings and Precautions (5.3</linkHtml>, <linkHtml href="#b092d1d7-a440-445c-91cc-c8d5e6e0b8f7">5.4</linkHtml>)]</td> </tr> <tr> <td styleCode="Toprule" valign="top"> <content styleCode="bold">Metabolism and Nutrition</content> </td> <td styleCode="Toprule" valign="top">hyperglycemia</td> </tr> <tr> <td valign="top"> <content styleCode="bold">Disorders</content> </td> <td valign="top">hyperglycemia</td> </tr> <tr> <td valign="top"/> <td valign="top">[see <linkHtml href="#b6f25d37-1ccf-4ce8-a962-8984990ddcd7">Warnings and Precautions (5.11)</linkHtml>]</td> </tr> <tr> <td styleCode="Botrule" valign="top"/> <td styleCode="Botrule" valign="top">hyperkalemia</td> </tr> <tr> <td styleCode="Toprule" valign="top"> <content styleCode="bold">Psychiatric Disorders</content> </td> <td styleCode="Toprule" valign="top">anxiety</td> </tr> <tr> <td valign="top"/> <td valign="top">agitation</td> </tr> <tr> <td valign="top"/> <td valign="top">confusion</td> </tr> <tr> <td valign="top"/> <td valign="top">depression</td> </tr> <tr> <td valign="top"/> <td valign="top">hallucination</td> </tr> <tr> <td valign="top"/> <td valign="top">nightmare*</td> </tr> <tr> <td valign="top"/> <td valign="top">[see <linkHtml href="#bf27a660-c114-4f01-a9c8-0f9922acf361">Warnings and Precautions (5.6)</linkHtml>]</td> </tr> <tr> <td valign="top"/> <td valign="top">sleep disorder*</td> </tr> <tr> <td valign="top"/> <td valign="top">anorexia</td> </tr> <tr> <td styleCode="Botrule" valign="top"/> <td styleCode="Botrule" valign="top">abnormal dreaming*</td> </tr> <tr> <td styleCode="Toprule" valign="top"> <content styleCode="bold">Nervous System Disorders</content> </td> <td styleCode="Toprule" valign="top">tremor</td> </tr> <tr> <td valign="top"/> <td valign="top">convulsions</td> </tr> <tr> <td valign="top"/> <td valign="top">[see <linkHtml href="#bf27a660-c114-4f01-a9c8-0f9922acf361">Warnings and Precautions (5.6)</linkHtml>]</td> </tr> <tr> <td valign="top"/> <td valign="top">paresthesia [see <linkHtml href="#b49ff3ac-f227-4b5b-8466-9d6d84309705">Warnings and Precautions (5.8)</linkHtml>]</td> </tr> <tr> <td valign="top"/> <td valign="top">vertigo</td> </tr> <tr> <td valign="top"/> <td valign="top">hypertonia</td> </tr> <tr> <td valign="top"/> <td valign="top">hyperkinesias</td> </tr> <tr> <td valign="top"/> <td valign="top">abnormal gait</td> </tr> <tr> <td styleCode="Botrule" valign="top"/> <td styleCode="Botrule" valign="top">somnolence*syncope</td> </tr> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Respiratory, Thoracic and Mediastinal Disorders</content> </td> <td styleCode="Botrule Toprule" valign="top">epistaxis</td> </tr> <tr> <td styleCode="Toprule" valign="top"> <content styleCode="bold">Cardiac Disorders</content> </td> <td styleCode="Toprule" valign="top">cardiac arrest</td> </tr> <tr> <td valign="top"/> <td valign="top">palpitation</td> </tr> <tr> <td valign="top"/> <td valign="top">ventricular tachycardia</td> </tr> <tr> <td styleCode="Botrule" valign="top"/> <td styleCode="Botrule" valign="top">ventricular arrhythmia</td> </tr> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Vascular Disorders</content> </td> <td styleCode="Botrule Toprule" valign="top">phlebitis</td> </tr> <tr> <td styleCode="Toprule" valign="top"> <content styleCode="bold">Gastrointestinal Disorders</content> </td> <td styleCode="Toprule" valign="top">gastritis</td> </tr> <tr> <td valign="top"/> <td valign="top">stomatitis</td> </tr> <tr> <td valign="top"/> <td valign="top">pancreatitis</td> </tr> <tr> <td valign="top"/> <td valign="top">esophagitis</td> </tr> <tr> <td valign="top"/> <td valign="top">gastroenteritis</td> </tr> <tr> <td valign="top"/> <td valign="top">glossitis</td> </tr> <tr> <td valign="top"/> <td valign="top">pseudomembraneous/ <content styleCode="italics">C. difficile</content> colitis</td> </tr> <tr> <td styleCode="Botrule" valign="top"/> <td styleCode="Botrule" valign="top">[see <linkHtml href="#be9bf018-1734-438a-831b-72890e4647b8">Warnings and Precautions (5.7)</linkHtml>]</td> </tr> <tr> <td styleCode="Toprule" valign="top"> <content styleCode="bold">Hepatobiliary Disorders</content> </td> <td styleCode="Toprule" valign="top">abnormal hepatic function</td> </tr> <tr> <td valign="top"/> <td valign="top">increased hepatic enzymes</td> </tr> <tr> <td styleCode="Botrule" valign="top"/> <td styleCode="Botrule" valign="top">increased alkaline phosphatase</td> </tr> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Skin and Subcutaneous Tissue Disorders</content> </td> <td styleCode="Botrule Toprule" valign="top">urticaria [see <linkHtml href="#b4eb14ba-c9de-4b04-9115-08dc1e39a106">Warnings and Precautions (5.3)</linkHtml>]</td> </tr> <tr> <td styleCode="Toprule" valign="top"> <content styleCode="bold">Musculoskeletal and</content> </td> <td styleCode="Toprule" valign="top">arthralgia</td> </tr> <tr> <td valign="top"> <content styleCode="bold">Connective Tissue Disorders</content> </td> <td valign="top">tendinitis</td> </tr> <tr> <td valign="top"/> <td valign="top">[see <linkHtml href="#b0b5a31a-013f-4ce8-943f-f2c1ab70177e">Warnings and Precautions (5.1)</linkHtml>]</td> </tr> <tr> <td valign="top"/> <td valign="top">myalgia</td> </tr> <tr> <td styleCode="Botrule" valign="top"/> <td styleCode="Botrule" valign="top">skeletal pain</td> </tr> <tr> <td styleCode="Toprule" valign="top"> <content styleCode="bold">Renal and Urinary Disorders</content> </td> <td styleCode="Toprule" valign="top">abnormal renal function</td> </tr> <tr> <td styleCode="Botrule" valign="top"/> <td styleCode="Botrule" valign="top">acute renal failure [see <linkHtml href="#b092d1d7-a440-445c-91cc-c8d5e6e0b8f7">Warnings and Precautions (5.4)</linkHtml>]</td> </tr> </tbody> </table>

<table frame="void" width="568"> <caption> Table 6: Postmarketing Reports Of Adverse Drug Reactions</caption> <thead> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">System/Organ Class</content> </td> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Adverse Reaction</content> </td> </tr> </thead> <tbody> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Blood and Lymphatic System Disorders</content> </td> <td styleCode="Botrule Toprule" valign="top">pancytopenia aplastic anemia leukopenia hemolytic anemia [see <linkHtml href="#b092d1d7-a440-445c-91cc-c8d5e6e0b8f7">Warnings and Precautions (5.4)</linkHtml>] eosinophilia</td> </tr> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Immune System Disorder</content> </td> <td styleCode="Botrule Toprule" valign="top">hypersensitivity reactions, sometimes fatal including: anaphylactic/anaphylactoid reactions anaphylactic shock angioneurotic edema serum sickness [see <linkHtml href="#b4eb14ba-c9de-4b04-9115-08dc1e39a106">Warnings and Precautions (5.3</linkHtml>, <linkHtml href="#b092d1d7-a440-445c-91cc-c8d5e6e0b8f7">5.4)</linkHtml>]</td> </tr> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Psychiatric Disorders</content> </td> <td styleCode="Botrule Toprule" valign="top">psychosis paranoia isolated reports of suicide attempt and suicidal ideation [see <linkHtml href="#bf27a660-c114-4f01-a9c8-0f9922acf361">Warnings and Precautions (5.6)</linkHtml>]</td> </tr> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Nervous System Disorders</content> </td> <td styleCode="Botrule Toprule" valign="top">exacerbation of myasthenia gravis [see <linkHtml href="#bbb02e3b-902e-4189-9028-229738bb050c">Warnings and Precautions (5.2)</linkHtml>] anosmia ageusia parosmia dysgeusia peripheral neuropathy [see <linkHtml href="#b49ff3ac-f227-4b5b-8466-9d6d84309705">Warnings and Precautions (5.8)</linkHtml>] isolated reports of encephalopathy abnormal electroencephalogram (EEG) dysphonia</td> </tr> <tr> <td styleCode="Toprule" valign="top"> <content styleCode="bold">Eye Disorders</content> </td> <td styleCode="Toprule" valign="top">vision disturbance, including diplopia</td> </tr> <tr> <td valign="top"/> <td valign="top">visual acuity reduced</td> </tr> <tr> <td valign="top"/> <td valign="top">vision blurred</td> </tr> <tr> <td styleCode="Botrule" valign="top"/> <td styleCode="Botrule" valign="top">scotoma</td> </tr> <tr> <td styleCode="Toprule" valign="top"> <content styleCode="bold">Ear and Labyrinth</content> </td> <td styleCode="Toprule" valign="top">hypoacusis</td> </tr> <tr> <td styleCode="Botrule" valign="top"> <content styleCode="bold">Disorders</content> </td> <td styleCode="Botrule" valign="top">tinnitus</td> </tr> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Cardiac Disorders</content> </td> <td styleCode="Botrule Toprule" valign="top">isolated reports of torsade de pointes electrocardiogram QT prolonged [see <linkHtml href="#b502589c-4dec-475b-bb1c-fe5598d31a6f">Warnings and Precautions (5.9)</linkHtml>] tachycardia</td> </tr> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Vascular Disorders</content> </td> <td styleCode="Botrule Toprule" valign="top">vasodilatation</td> </tr> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Respiratory, Thoracic and Mediastinal Disorders</content> </td> <td styleCode="Botrule Toprule" valign="top">isolated reports of allergic pneumonitis [see <linkHtml href="#b092d1d7-a440-445c-91cc-c8d5e6e0b8f7">Warnings and Precautions (5.4)</linkHtml>]</td> </tr> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Hepatobiliary Disorders</content> </td> <td styleCode="Botrule Toprule" valign="top">hepatic failure (including fatal cases) hepatitis jaundice [see <linkHtml href="#b092d1d7-a440-445c-91cc-c8d5e6e0b8f7">Warnings and Precautions (5.4</linkHtml>, <linkHtml href="#b4affe90-743b-493e-bdce-7e02d2a97350">5.5)</linkHtml>]</td> </tr> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Skin and Subcutaneous Tissue Disorders</content> </td> <td styleCode="Botrule Toprule" valign="top">bullous eruptions to include: Stevens-Johnson Syndrome toxic epidermal necrolysis erythema multiforme [see <linkHtml href="#b092d1d7-a440-445c-91cc-c8d5e6e0b8f7">Warnings and Precautions (5.4)</linkHtml>] photosensitivity/phototoxicity reaction [see <linkHtml href="#beadd39f-507a-4613-bf22-84ef8d830232">Warnings and Precautions (5.12)</linkHtml>] leukocytoclastic vasculitis</td> </tr> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Musculoskeletal and Connective Tissue Disorders</content> </td> <td styleCode="Botrule Toprule" valign="top">tendon rupture [see <linkHtml href="#b0b5a31a-013f-4ce8-943f-f2c1ab70177e">Warnings and Precautions (5.1)</linkHtml>] muscle injury, including rupture rhabdomyolysis</td> </tr> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">Renal and Urinary Disorders</content> </td> <td styleCode="Botrule Toprule" valign="top">interstitial nephritis [see <linkHtml href="#b092d1d7-a440-445c-91cc-c8d5e6e0b8f7">Warnings and Precautions (5.4)</linkHtml>]</td> </tr> <tr> <td styleCode="Botrule Toprule" valign="top"> <content styleCode="bold">General Disorders and Administration Site Conditions</content> </td> <td styleCode="Botrule Toprule" valign="top">multi-organ failure pyrexia</td> </tr> <tr> <td styleCode="Toprule" valign="top"> <content styleCode="bold">Investigations</content> </td> <td styleCode="Toprule" valign="top">prothrombin time prolonged</td> </tr> <tr> <td valign="top"/> <td valign="top">international normalized ratio prolonged</td> </tr> <tr> <td styleCode="Botrule" valign="top"/> <td styleCode="Botrule" valign="top">muscle enzymes increased</td> </tr> </tbody> </table>