Levofloxacin Dosing in Renal Impairment

Dosing Recommendations

• For patients with end-stage renal disease (CrCl <10 mL/min) or hemodialysis, the maintenance dose of levofloxacin should be 50% of the normal dose every 48 hours, and administered after hemodialysis to facilitate dosing and avoid premature drug removal 1, 2

Monitoring Recommendations

• Patients with severe renal impairment should be monitored for signs of toxicity, including CNS effects such as dizziness, headache, and insomnia, as levofloxacin can cause adverse effects 3

Common Pitfalls to Avoid

• Administering levofloxacin before hemodialysis can remove some of the drug, and therefore it is recommended to administer after hemodialysis 1
• Not spacing administration from divalent cation-containing products, such as antacids or supplements, can significantly decrease absorption of levofloxacin 3