Cipro vs. Levaquin: Differences Between Side Effects, Uses, and Strength

  • Medical Reviewer: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Cipro (ciprofloxacin) vs. Levaquin (levofloaxacin) quick comparison

What is Cipro? What is Levaquin? How do they work (mechanism of action)?

Both Cipro (ciprofloxacin) and Levaquin (levofloxacin) are antibiotics used for treating bacterial infections. Both drugs work by stopping multiplication of bacteria by preventing the reproduction and repair of their genetic material (DNA). Both Levaquin and Cipro are in a class of antibiotics called fluoroquinolones, a class that includes norfloxacin, (Noroxin), ofloxacin (Floxin), trovafloxacin (Trovan), lomefloxacin (Maxaquin), and moxifloxacin (Avelox).

What are the uses for Cipro vs. Levaquin?

Cipro uses

Doctors and other medical healthcare professionals prescribe Cipro and Cipro XR to treat bacterial infections, for example:

  • Skin infections
  • Lung or airway Infections, for example, TB (tuberculosis), pneumonic and septicemic plague due to Yersinia pestis (Y. pestis), lower respiratory tract infections, and chronic bronchitis)
  • Bone infections
  • Joint infections
  • Urinary tract infections (UTI) caused by certain bacteria such as E. coli.
  • Infectious diarrheas caused by E. coli, Campylobacter jejuni, and Shigella bacteria.
  • Anthrax patients with fever and low white blood cell counts, and intra-abdominal infections.
  • Typhoid fever
  • Cervical and urethral gonorrhea due to Neisseria gonorrhoeae
  • Chronic bacterial prostatitis
  • Acute uncomplicated cystitis

Levaquin uses

  • Levaquin is used to treat infections of the sinuses, skin, lungs, ears, airways, bones, and joints caused by susceptible bacteria.
  • Levaquin also is frequently used to treat urinary infections, including those resistant to other antibiotics, as well as prostatitis (infection of the prostate).
  • Levaquin is effective in treating infectious diarrhea caused by E. coli, Campylobacter jejuni, and Shigella bacteria.
  • Levaquin also can be used to treat various obstetric infections, including mastitis (infection of the breast).
  • Inhalational anthrax exposure also is treated with Levaquin.

What infections should not be treated with Cipro and Levaquin?

Because of serious side effects associate with fluoroquinolones they should not be used for treating certain infections unless there are no other alternatives, and include:

  • Uncomplicated urinary tract infections (UTI)
  • Acute bacterial exacerbation of chronic bronchitis
  • Acute bacterial sinusitis

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What are the serious side effects of Cipro vs. Levaquin?

Cipro serious side effects

Cipro and Cipro XR as well as other antibiotics in the fluoroquinolone class of antibiotics has been associated with tendonitis and even tendon rupture, particularly the Achilles tendon. Some doctors and other medical professionals recommend that their patients discontinue vigorous exercise while they are taking fluoroquinolone antibiotics.

Fluoroquinolones have neuromuscular blocking activity and can worsen muscle weakness in individuals with myasthenia gravis.

Other possible serious side effects of Cipro, Cipro XR include:

Other serious side effects and adverse events of Cipro, Cipro XR include:

  • Cipro, Cipro XR should be used with caution in patients with central nervous system diseases such as seizures, because rare seizures have been reported in patients receiving Cipro, Cipro XR.
  • Cipro, Cipro XR should be avoided in children and adolescents less than 18 years of age, as safe use in these patients has not been established.
  • Many antibiotics, including Cipro, Cipro XR, can alter the normal bacteria in the colon and encourage overgrowth of a bacterium responsible for the development of inflammation of the colon, (C. difficile or pseudomembranous colitis). Patients who develop signs of pseudomembranous colitis after starting Cipro, Cipro XR (diarrhea, fever, abdominal pain, and possibly shock) should contact their doctor immediately.
  • Cardiac arrest
  • Respiratory failure

Levaquin side effects

Possible serious side effects of Levaquin include:

  • Peripheral neuropathy
  • Central nervous system effects
  • Hypoglycemia
  • Hyperglycemia
  • Clostridium difficile-associated diarrhea (CDAD)
  • Abnormal heart beats
  • Liver dysfunction
  • Sun sensitivity

Other serious side effects and adverse events of Levaquin include:

  • Levaquin should be used with caution in patients with central nervous system diseases such as seizures, because rare seizures have been reported in patients receiving Levaquin.
  • Levaquin should be avoided in children and adolescents less than 18 years of age, as safe use in these patients has not been established.
  • Many antibiotics, including Levaquin, can alter the normal bacteria in the colon and encourage overgrowth of a bacterium responsible for the development of inflammation of the colon, (C. difficile or pseudomembranous colitis). Patients who develop signs of pseudomembranous colitis after starting Levaquin (diarrhea, fever, abdominal pain, and possibly shock) should contact their physician immediately.
  • Patients taking Levaquin can develop sensitivity of the skin to direct sunlight (photosensitivity) and should avoid exposure to sunlight or use sunblock.
  • Fluoroquinolones worsen low blood glucose levels when combined with sulfonylureas (for example, glyburide [Micronase, Diabeta, Glynase, Prestab]).
  • Because of serious side effects associate with fluoroquinolones, they should not be used for treating uncomplicated urinary tract infections, acute bacterial exacerbation of chronic bronchitis or acute bacterial sinusitis unless there are no other alternatives.

What are the side effects of Cipro vs. Levaquin?

Cipro side effects

The most common side effects of Cipro, Cipro XR are:

Anaphylaxis, or shock, is a rare allergic reaction to this drug. This allergic reaction is a medical emergency and you are experiencing these symptoms seek medical immediately.

Symptoms of shock include:

Levaquin side effects

Serious side effects and warnings include:

  • Levaquin as well as other antibiotics in the fluoroquinolone class of antibiotics, has been associated with tendinitis and even rupture of tendons, particularly the Achilles tendon.
  • Fluoroquinolones have neuromuscular blocking activity and can worsen muscle weakness in individuals with myasthenia gravis.

The most frequently reported side effects are:

Less common side effects include:

  • Difficulty sleeping
  • Dizziness
  • Abdominal pain
  • Rash
  • Abdominal gas
  • Itching

Rare allergic reactions have been described are:

  • Hives
  • Anaphylaxis (shock)

What is the dosage of Cipro vs. Levaquin?

Cipro dosage instructions

  • For most infections the recommended oral dose for adults is 250-750 mg (immediate release tablets) every 12 hours or 500-1000 mg (extended release tablets) every 24 hours.
  • The usual intravenous dose is 200-400 mg every 8-12 hours.

Levaquin dosage instructions

  • The usual dose is 250-750 mg given once daily for 3-14 days depending on the type of infection.
  • Anthrax is treated with 500 mg daily for 60 days.
  • It is important to take oral formulations at least 2 hours before or 2 hours after any antacid or mineral supplement containing iron, calcium, zinc, or magnesium since these bind Levaquin and prevent its absorption into the body.

What are the drug interactions of Cipro vs. Levaquin?

Cipro drug interactions

  • Ciprofloxacin administered together with theophylline (Respbid, Slo-Bid, Theo-24, Theolair) can lead to elevated, toxic blood levels of theophylline. Theophylline is used to open airways in the treatment of asthma. Toxic levels of theophylline can lead to seizures, and disturbances in heart rhythm. If concurrent use of ciprofloxacin and theophylline cannot be avoided, frequent blood tests to monitor theophylline blood levels are recommended.
  • Ciprofloxacin increases the effect of tizanidine (Zanaflex) that is used to treat muscle spasticity. Therefore, the two drugs should not be combined.
  • Iron salts (for example, ferrous sulfate) may reduce the absorption of ciprofloxacin because of formation of a ciprofloxacin-iron complex that is not absorbable. Antacids also may reduce the absorption of ciprofloxacin. If patients are receiving iron salts or antacids and ciprofloxacin, the ciprofloxacin should be given two hours before or six hours after the iron salt or antacid.
  • Ciprofloxacin may increase the blood thinning effect of warfarin (Coumadin, Jantoven). The reason for this is unknown. Anticoagulant activity should be monitored after starting or stopping ciprofloxacin.
  • Sevelamer (Renagel) may reduce the absorption of ciprofloxacin and possibly reduce the effectiveness of ciprofloxacin. Milk and orange juice also may reduce the absorption of ciprofloxacin. Ciprofloxacin, as with iron and antacids, should be given two hours before or six hours after milk or orange juice.
  • Administration of ciprofloxacin with diabetic medications (for example glyburide [Micronase, Diabeta, Glynase, Prestab]) may lead to severe low blood glucose.
  • Ciprofloxacin may increase blood concentrations of sildenafil (Viagra) that is used for treating erectile dysfunction. This combination should be avoided if possible.
  • Patients taking Cipro, Cipro XR can develop sensitivity of the skin to direct sunlight (photosensitivity) and should avoid exposure to sunlight or use sunblock.
  • Fluoroquinolones worsen low blood glucose levels when combined with sulfonylureas, for example, glyburide (Micronase, Diabeta, Glynase, Prestab).

Levaquin drug interactions

  • Iron, calcium, zinc, or magnesium can attach to Levaquin and other fluoroquinolones and prevent their absorption from the intestine into the blood. Therefore, products (for example, antacids) that contain iron, calcium, zinc or magnesium should be taken at least 2 hours before or 2 hours after Levaquin. Other drugs that contain these minerals and can similarly interact with Levaquin include sucralfate (Carafate) and didanosine (Videx, Videx EC).
  • Taking nonsteroidal anti-inflammatory drugs (NSAIDs) with Levaquin may increase the risk of CNS stimulation, resulting in over-excitation. There have been reports of changes in blood sugar (increases and decreases) in patients treated with fluoroquinolones and antidiabetic agents.
  • Fluoroquinolones may increase the effect of warfarin (Coumadin, Jantoven).

Are Cipro and Levaquin safe to take if I am pregnant or breastfeeding?

Cirpo safety

  • Doctors suggest that should not use this antibiotic if you are pregnant or breastfeeding because they do not know if it is safe.

Levaquin safety

  • Levaquin is not recommended for use in pregnant women since Levaquin causes joint and bone deformities in juvenile animals of several species.
  • Levaquin is excreted in breast milk. Mothers should decide whether to stop breastfeeding or discontinue Levaquin.

Summary

Cipro (ciprofloxacin) and Levaquin (levofloxacin) are antibiotics prescribed to treat bacterial infections of the airways, lungs, bone, joints, and skin. Both Cipro and Levaquin belong to a class of antibiotics called fluoroquinolones. Fluoroquinolones stop the multiplication of bacteria by preventing the reproduction and repair of their genetic material (DNA).

Both Cipro and Levaquin cause side effects, for example, abdominal pain, rash, diarrhea, vomiting, and headache. Side effects of Cipro that do not occur with Levaquin include insomnia, dizziness, intestinal gas, and itching. Levaquin also can cause side effects like restlessness and constipation. Dosage for both antibiotics depends upon the type of infection. Drug interactions occur with both drugs. Cipro and Levaquin are not recommended to take if you are pregnant or breastfeeding.

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Medically Reviewed on 10/31/2017
References
REFERENCE: FDA Prescribing Information.
<https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020634s068,020635s074,021721s035lbl.pdf>

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