Seizures associated with levofloxacin: case presentation and literature review

Eur J Clin Pharmacol. 2009 Oct;65(10):959-62. doi: 10.1007/s00228-009-0717-5. Epub 2009 Aug 26.

Abstract

Purpose: We present a case of a patient who developed seizures shortly after initiating treatment with levofloxacin and to discuss the potential drug-drug interactions related to the inhibition of cytochrome P450 (CYP) 1A2 in this case, as well as in other cases, of levofloxacin-induced seizures.

Methods: Several biomedical databases were searched including MEDLINE, Cochrane and Ovid. The main search terms utilized were case report and levofloxacin. The search was limited to studies published in English.

Results: Six cases of levofloxacin-induced seizures have been reported in the literature. Drug-drug interactions related to the inhibition of CYP1A2 by levofloxacin are likely involved in the clinical outcome of these cases.

Conclusions: Clinicians are exhorted to pay close attention when initiating levofloxacin therapy in patients taking medications with epileptogenic properties that are CYP1A2 substrates.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenergic alpha-Antagonists / adverse effects
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects*
  • Bacteremia / diagnosis
  • Bacteremia / microbiology*
  • Cytochrome P-450 CYP1A2 / drug effects
  • Cytochrome P-450 CYP1A2 / metabolism
  • Dopamine Antagonists / adverse effects
  • Drug Administration Schedule
  • Drug Synergism
  • Female
  • Humans
  • Klebsiella Infections / diagnosis*
  • Klebsiella Infections / drug therapy
  • Levofloxacin*
  • Male
  • Metoclopramide / adverse effects
  • Mianserin / adverse effects
  • Mianserin / analogs & derivatives
  • Middle Aged
  • Mirtazapine
  • Ofloxacin / administration & dosage
  • Ofloxacin / adverse effects*
  • Phosphodiesterase Inhibitors / adverse effects
  • Seizures / chemically induced*
  • Theophylline / adverse effects

Substances

  • Adrenergic alpha-Antagonists
  • Anti-Bacterial Agents
  • Dopamine Antagonists
  • Phosphodiesterase Inhibitors
  • Mianserin
  • Levofloxacin
  • Mirtazapine
  • Ofloxacin
  • Theophylline
  • Cytochrome P-450 CYP1A2
  • Metoclopramide