Levofloxacin vs. Ciprofloxacin: How Do These Antibiotics Compare?
Key takeaways:
Levofloxacin and ciprofloxacin (Cipro) are both fluoroquinolone antibiotics (quinolones). They can treat a variety of bacterial infections, including skin infections and urinary tract infections (UTIs).
Due to their serious risks, quinolones should be avoided for more mild infections unless there are no other treatment options. Serious side effects include tendon ruptures, nerve damage, and mental health side effects.
Levofloxacin and ciprofloxacin are both available as lower-cost generics. GoodRx can help you save over 75% off the average retail price at certain pharmacies.
Table of contents
Fluoroquinolone antibiotics (“quinolones”) are a commonly prescribed group of antibiotics. They’re what’s known as “broad-spectrum” antibiotics. This means they can kill a lot of different bacteria. Two of the most well-known quinolones are levofloxacin and ciprofloxacin (Cipro).
But even though they’re in the same medication class, these antibiotics do have some key differences. Let’s dig in and compare levofloxacin and ciprofloxacin.
What is levofloxacin?
Levofloxacin is a quinolone antibiotic that was first FDA approved in 1996. Many people still refer to it by its original brand name, Levaquin. But brand-name Levaquin was discontinued and is no longer on the U.S. market.
Only generic versions of levofloxacin are currently available. Levaquin’s discontinuation wasn’t due to any safety concerns. It’s common for brand-name medications to be discontinued once generic versions become available.
Levofloxacin comes as 250 mg, 500 mg, and 750 mg oral tablets. It’s also available as a 25 mg/mL oral solution (liquid) and an injectable solution that can be given in hospitals. There’s an eye drop version of levofloxacin as well.
What conditions are levofloxacin approved to treat?
Levofloxacin is FDA approved to treat a variety of bacterial infections, including:
Pneumonia
Skin infections like cellulitis
Urinary tract infections (UTIs)
Pyelonephritis (a type of kidney infection)
Sinus infections
Exacerbations (flare-ups) of chronic bronchitis
Pink eye (eye drops only)
Corneal ulcers(eyes drops only)
Read more like this
Explore these related articles, suggested for readers like you.
There are other times and infections where levofloxacin may be useful. If a blood test shows this antibiotic can kill a type of bacteria, it may be a potential treatment option.
What is ciprofloxacin?
Ciprofloxacin is another quinolone that’s been available in the U.S. since 1987. Many people simply refer to it as Cipro, its brand name. But it’s available as both a brand-name and generic medication.
Ciprofloxacin comes as a 250 mg and 500 mg oral tablet, as well as an oral suspension that offers the same doses. There’s an injectable version that can be used in hospital settings, too. Cirpofloxacin can also be found as an eye drop and ear drop.
What conditions are ciprofloxacin approved to treat?
Ciprofloxacin is also FDA approved to treat many types of infections, such as:
Skin infections
Bone and joint infections
Infectious diarrhea
UTIs
Cystitis (bladder infection)
Exacerbations (flare-ups) of chronic bronchitis
Sinus infections
External ear infections (ear drops only)
Pink eye (eye drops only)
Similar to levofloxacin, there are other infections that ciprofloxacin could be helpful in treating. Whether it can be used depends on the type of bacteria causing your infection.
How do quinolone antibiotics work?
Quinolone antibiotics directly kill the bacteria causing an infection. They interfere with enzymes (proteins) that the bacteria need to grow and multiply. You start feeling symptom relief after the antibiotic has killed a portion of the bacteria.
How are oral levofloxacin and ciprofloxacin dosed?
The exact dose you take depends on the infection you have. More serious infections often require higher or longer doses.
Typically, oral levofloxacin doses are taken once a day with or without food. The length of treatment depends on the type of infection you have. In many cases, it ranges from 3 to 14 days. But more serious infections may need longer courses of levofloxacin.
Oral ciprofloxacin is usually taken every 12 hours. While doses can be taken with or without food, you should avoid dairy products (more on this later). Length of treatment ranges from 3 to 14 days for many infections. But there are instances where ciprofloxacin may be needed longer than this.
Regardless of which quinolone you’re taking, it’s important to stay well hydrated during treatment. This helps prevent the medication from building up too much in the bladder.
What are the known side effects and dangers of levofloxacin and ciprofloxacin?
Quinolones are known to have several risks, some of which are severe. Side effects are similar for both levofloxacin and ciprofloxacin.
Mild side effects include:
Nausea and/or vomiting
Diarrhea
Stomach pain
Headache
Dizziness
Increased sensitivity to the sun
What are the serious side effects of quinolone antibiotics?
In the past, quinolones were often a go-to choice for many infections because they worked well in a short amount of time. But now, the FDA and other health experts recommend that healthcare providers avoid prescribing them when other options are available. This is because quinolones, like levofloxacin and ciprofloxacin, have a number of serious side effects.
The FDA has required several boxed warnings be provided in quinolone package inserts. Boxed warnings are the most serious warning the FDA can give for a medication. They’re used to raise awareness of side effects that can be life-threatening or pose serious health risks.
These boxed warnings include:
Tendinitis and tendon rupture
Worsening of myasthenia gravis (MG) symptoms
Nerve damage, which may be permanent for some people
Mental health side effects, such as hallucinations or suicidal thoughts
Nervous system complications, such as seizures
These types of serious complications can also be called fluoroquinolone toxicity. There are cases of people who have experienced fluoroquinolone toxicity to multiple parts of the body. This is called fluoroquinolone-associated disability.
Levofloxacin and ciprofloxacin can cause other serious side effects. These aren’t included as boxed warnings, but they can still be dangerous or even fatal.
Other serious quinolone side effects include:
Severe hypoglycemia (low blood sugar)
Hyperglycemia (high blood sugar)
Tears in the wall of the aorta (the main artery of the body)
Arrhythmias (abnormal heart rhythms)
Severe skin reactions, such as Stevens-Johnson syndrome
What interactions do levofloxacin and ciprofloxacin have?
There are a number of medications that interact with levofloxacin and ciprofloxacin, including:
Warfarin (Coumadin, Jantoven)
Theophylline (Theo-24, Elixophyllin)
Diabetes medications, such as insulin and sulfonylureas
Tricyclic antidepressants like amitriptyline
Medications or supplements containing magnesium, aluminum, or zinc
Medications that contain iron
Sucralfate (Carafate)
This isn’t a full list of possible interactions for levofloxacin and ciprofloxacin. Be sure to share an updated medication list with your healthcare provider and pharmacist before starting your antibiotic. This can help them spot and manage interactions before they happen.
An interaction that’s unique to ciprofloxacin is calcium. This mineral interferes with how the medication is absorbed. This means it’s best to separate dairy products like milk from your ciprofloxacin doses.
How can I save on levofloxacin or ciprofloxacin?
There are many ways to save on levofloxacin and ciprofloxacin, which are both available as lower-cost generics.
Save with GoodRx. GoodRx can help you save over 75% off the average retail price of the generic version. Generic levofloxacin’s price at certain pharmacies is as low as $12.07 with a free GoodRx discount. Generic ciprofloxacin’s price at certain pharmacies is as low as $4.06 with a free GoodRx discount.
Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for levofloxacin’s and ciprofloxacin’s patient assistance programs, which offer the medication free of cost.
Who should not take levofloxacin or ciprofloxacin?
With all the serious risks associated with quinolones, you’d expect them to have several contraindications. A contraindication is when a certain situation can raise your risk of complications while taking a medication. But surprisingly, these antibiotics don’t list many.
The only levofloxacin contraindication listed by the manufacturer is a history of an allergic reaction to quinolones. Ciprofloxacin contraindications include history of an allergic reaction and current use of the medication tizanidine (Zanaflex).
However, there are situations that raise your risk of the serious side effects discussed above. These aren’t contraindications. But they may be a reason your healthcare provider avoids prescribing a quinolone. These include if you:
Have a history of tendon problems
Have a history of neuropathy
Have MG
Have had an aortic aneurysm before
Have a greater risk of arrhythmias
Have diabetes, or a history of hypoglycemia
The bottom line
Levofloxacin and ciprofloxacin are quinolone antibiotics. Levofloxacin is usually taken once daily, while ciprofloxacin is typically taken twice daily. They can treat a variety of infections, including skin infections, UTIs, and exacerbations of chronic bronchitis. But because of their serious risks, they’re typically avoided for mild infections when possible.
Severe side effects of levofloxacin and ciprofloxacin include tendon ruptures, nerve damage, and mental health side effects. They also raise the risk of severe blood sugar changes and tears in the aorta. Be sure to discuss the risks of levofloxacin and ciprofloxacin before taking either.
Why trust our experts?
References
Akorn. (2022). Levofloxacin [package insert].
Bayer HealthCare Pharmaceuticals Inc. (2021). Cipro [package insert].
BPI Labs LLC. (2020). Levofloxacin [package insert].
Cardinal Health 107, LLC. (2020). Levofloxacin [package insert].
ClinCalc. (2020). Quinolones.
Fresenius Kabi USA, LLC. (2019). Levofloxacin [package insert].
Hospira, Inc. (2022). Ciprofloxacin in dextrose [package insert].
Oliphant, C. M., et al. (2002). Quinolones: A comprehensive review. American Family Physician.
Quality Care Products, LLC. (2022). Ciprofloxacin [package insert].
U.S. Food and Drug Administration. (n.d.). FDA-approved drugs: Bayer Healthcare.
U.S. Food and Drug Administration. (n.d.). FDA-approved drugs: Janssen Pharms.
U.S. Food and Drug Administration. (2013). FDA drug safety communication: FDA requires label changes to warn of risk for possibly permanent nerve damage from antibacterial fluoroquinolone drugs taken by mouth or injection.
U.S. Food and Drug Administration. (2016). Information for healthcare professionals: Fluoroquinolone antimicrobial drugs [ciprofloxacin (marketed as cipro and generic ciprofloxacin), ciprofloxacin extended-release (marketed as cipro XR and proquin XR), gemifloxacin (marketed as factive), levofloxacin (marketed as levaquin), moxifloxacin (marketed as avelox), norfloxacin (marketed as noroxin), and ofloxacin (marketed as floxin)].
U.S. Food and Drug Administration. (2017). Fluoroquinolone safety labeling changes.
U.S. Food and Drug Administration. (2020). FDA reinforces safety information about serious low blood sugar levels and mental health side effects with fluoroquinolone antibiotics; requires label changes.
U.S. Food and Drug Administration. (2020). FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients.
Wraser, LLC. (2017). Cetraxal [package insert].
Yan, A., et al. (2022). Quinolones. StatPearls.
