In this case of a 72-year-old male, I want to discuss levofloxacin risks as there can be numerous. He currently lives in an assisted living. He has a past medical history of arrhythmia, depression, GERD, hypertension and gout. He was recently diagnosed with community-acquired pneumonia and his physician has prescribed levofloxacin.
His current medications besides the levofloxacin include:
- Lisinopril 10 mg daily
- Aspirin 81 mg daily
- Citalopram 30 mg daily
- Amiodarone 200 mg BID
- Pantoprazole 40 mg daily
- Hydrochlorothiazide 25 mg daily
- Potassium 10 meq BID
- Allopurinol 100 mg BID
- Calcium carbonate 500 mg TID
Of all the many levofloxacin risks, the first one I would look at in this situation is QTc prolongation. We don’t have a baseline to go off of, but if the physician doesn’t feel an alternative to levofloxacin is appropriate, we should at least at a minimum check an EKG to monitor for this risk. The amiodarone and citalopram place him at a higher risk for QTc prolongation with the addition of levofloxacin. In addition, recall that electrolyte imbalances such as hypokalemia can increase the risk for cardiac abnormalities. It would be nice to know a potassium level in this situation as well.
If all was well with the EKG and it was determined to move forward with levofloxacin, the next concern I would have is with this patient’s calcium supplement. Calcium can bind up levofloxacin and ultimately reduce the absorption of the drug into the systemic circulation. We don’t have a clear indication of why he is taking it (?GERD) so my sense would be to hold it at least while he is taking the levofloxacin.
The final thing I would investigate here is the uric acid level and use of allopurinol in association with the hydrochlorothiazide. Thiazides can increase uric acid levels and it may contribute to gout issues.
So that wraps up my initial thoughts on levofloxacin risks and this case study. What else would you like to investigate or dig into further?
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