LEVOFLOXACIN KRKA 500 mg FILM-COATED TABLETS

Introduction

Package Leaflet: Information for the Patient

Levofloxacino Krka 500 mg film-coated tablets EFG

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

• Keep this leaflet, you may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

Contents of the pack

1. What is Levofloxacino Krka and what is it used for
2. What you need to know before you take Levofloxacino Krka
3. How to take Levofloxacino Krka
4. Possible side effects

5 Conservation of Levofloxacino Krka

1. Contents of the pack and other information

1. What is Levofloxacino Krka and what is it used for

The name of this medicine is Levofloxacino Krka. This medicine contains the active substance levofloxacin, which belongs to a group of medicines called antibiotics. Levofloxacin is a quinolone antibiotic, and it works by killing the bacteria that cause infections in your body.

Levofloxacino Krka can be used to treat infections in:

• The paranasal sinuses,
• The lungs, in people with long-term respiratory problems or pneumonia,
• The urinary tract, including the kidneys or bladder,
• The prostate, when the infection is persistent,
• The skin and under the skin, including muscles. This is sometimes referred to as "soft tissues".

In some special situations, levofloxacin can be used to reduce the risk of getting a lung infection called anthrax or worsening of such disease after being exposed to the anthrax-causing bacteria.

2. What you need to know before you take Levofloxacino Krka

Do not take Levofloxacino Krka

• If you are allergic to levofloxacin, to other quinolone antibiotics such as moxifloxacin, ciprofloxacin, or ofloxacin, or to any of the other ingredients of this medicine (listed in section 6).
• If the signs of an allergic reaction include: skin rash, difficulty swallowing or breathing, swelling of lips, face, throat, or tongue.
• If you have or have had epilepsy.
• If you have ever had tendon problems, such as tendonitis, that were related to taking quinolone medicines. The tendon is the tissue that connects your muscle to your skeleton.
• If you are a child or adolescent in the growth phase.
• If you are pregnant, might be pregnant, or think you might be pregnant.
• If you are breastfeeding.

Do not take this medicine if any of the above applies to you. In case of doubt, consult your doctor or pharmacist before taking this medicine.

Warnings and precautions

Consult your doctor or pharmacist before starting to take Levofloxacino Krka if:

• You are 60 years old or older.
• You are using corticosteroids, sometimes called steroids (see section "Other medicines and Levofloxacino Krka").
• You have received a transplant.
• You have had a seizure (convulsions) before.
• You have had brain damage due to a stroke or other brain injury.
• You have kidney problems.
• You have what is known as "glucose-6-phosphate dehydrogenase deficiency", as you may be prone to having serious blood problems when taking this medicine.
• You have had mental problems before.
• You have had heart problems: caution should be exercised when using this type of medicine if you were born with, or have a family history of, prolongation of the QT interval (seen on the electrocardiogram (ECG), a graphical representation of the heart's electrical activity), have an imbalance in blood salt levels (especially low potassium or magnesium levels in the blood), have a slow heart rate (bradycardia), have a weak heart (heart failure), have a history of heart attack (myocardial infarction), if you are a woman or an elderly person, or are taking other medicines that may cause abnormal changes in the ECG (see section "Other medicines and Levofloxacino Krka").
• You have peripheral neuropathy (nerve damage).
• You have been diagnosed with an aneurysm (a bulge in a large blood vessel) or a large peripheral blood vessel aneurysm.
• You have had a previous episode of aortic dissection (tear in the aorta wall).
• You have been diagnosed with heart valve insufficiency (regurgitation of the heart valves).
• You have a family history of aortic aneurysm or aortic dissection or congenital heart valve disorders or other risk factors or predisposing conditions (e.g., connective tissue disorders such as Marfan syndrome or Ehlers-Danlos syndrome, Turner syndrome, or Sjögren's syndrome (an autoimmune inflammatory disease), or vascular disorders such as Takayasu arteritis, giant cell arteritis, Behçet's disease, high blood pressure, or atherosclerosis, rheumatoid arthritis (a joint disease), or endocarditis (a heart infection)).
• You are diabetic.
• You have had liver problems before.
• You have myasthenia gravis.
• You have developed a severe skin rash or peeling of the skin, blisters, and/or sores in the mouth after taking levofloxacin.

Before taking this medicine

Do not take antibacterial medicines that contain fluoroquinolones or quinolones, including levofloxacin, if you have experienced a severe adverse reaction before taking a quinolone or fluoroquinolone. If this is the case, you should inform your doctor as soon as possible.

During treatment with this medicine

If you feel a sudden, severe pain in your abdomen, chest, or back, which can be symptoms of aortic dissection or aneurysm, go immediately to the emergency room. The risk may increase if you are receiving systemic corticosteroid treatment.

If you start experiencing sudden onset of shortness of breath, especially when lying down, or if you notice swelling in your ankles, feet, or abdomen, or the appearance of heart palpitations (feeling of rapid or irregular heartbeat), you should inform your doctor immediately.

If you start experiencing sudden, involuntary jerks, muscle spasms, or muscle contractions - consult a doctor immediately, as these could be signs of myoclonus. Your doctor may need to interrupt treatment with levofloxacin and initiate secondary treatment.

If you have nausea, general discomfort, have intense discomfort, or continuous pain, or worsening pain in the stomach area, or vomiting; consult your doctor immediately, as this could be a sign of pancreatitis (inflammation of the pancreas).

If you experience fatigue, pale skin, bruising, uncontrolled bleeding, fever, sore throat, and a severe deterioration of your general condition, or a feeling that your resistance to infections may be decreased - consult a doctor immediately, as these could be signs of blood disorders. Your doctor should monitor your blood with blood counts. In case of abnormal blood counts, your doctor may need to interrupt treatment.

Rarely, pain and swelling in the joints and inflammation or rupture of the tendons can occur. The risk is higher if you are an elderly person (over 60 years old), have received an organ transplant, have kidney problems, or are being treated with corticosteroids. Tendon inflammation and rupture can occur within the first 48 hours of treatment and even several months after stopping treatment with levofloxacin. At the first sign of pain or inflammation of a tendon (e.g., in the ankle, wrist, elbow, shoulder, or knee), stop taking levofloxacin, contact your doctor, and rest the affected area. Avoid any unnecessary exercise, as this could increase the risk of tendon rupture.

Rarely, you may experience symptoms of nerve damage (neuropathy) such as pain, burning, tingling, numbness, and/or weakness, especially in the feet and legs or hands and arms. If this happens, stop taking levofloxacin and inform your doctor immediately to prevent the development of a potentially irreversible disorder.

Severe, disabling, long-lasting, and potentially irreversible adverse reactions

Antibacterial medicines that contain fluoroquinolones or quinolones, including levofloxacin, have been associated with very rare but serious adverse effects, some of which were long-lasting (persisting for months or years), disabling, or potentially irreversible. These include pain in the tendons, muscles, and joints of the upper and lower limbs, difficulty walking, abnormal sensations such as pins and needles, tingling, burning, numbness, or pain (paresthesia), sensory disorders such as decreased vision, taste, smell, or hearing, depression, decreased memory, intense fatigue, and severe sleep disorders.

If you experience any of these adverse effects after taking levofloxacin, contact your doctor immediately, before continuing treatment. You and your doctor will decide whether to continue or not with the treatment, also considering the use of an antibiotic of another class.

Severe skin reactions

Severe skin reactions have been reported, including Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) with the use of levofloxacin.

• SJS/TEN may initially appear as red, target-like spots or circular patches, often with blisters in the center, on the trunk. They can also appear as ulcers in the mouth, throat, nose, genitals, and eyes (red and swollen eyes). These severe skin rashes are often preceded by fever and/or flu-like symptoms. The rashes can progress to widespread skin peeling and life-threatening complications.

• DRESS is initially manifested by flu-like symptoms and a rash on the face, followed by a more widespread rash with elevated body temperature, elevated liver enzymes observed in blood tests, and an increase in a type of white blood cell (eosinophilia) and swollen lymph nodes.

If you develop a severe rash or any of these skin symptoms, stop taking levofloxacin and contact your doctor or seek medical attention immediately.

If you are not sure if any of these cases apply to you, consult your doctor or pharmacist before taking this medicine.

Children and adolescents

This medicine should not be given to children or adolescents.

Other medicines and Levofloxacino Krka

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines. This is because levofloxacin can affect the way other medicines work. Also, some medicines can affect the way levofloxacin works.

In particular, tell your doctor if you are taking any of the following medicines, as this may increase the risk of side effects when taken with levofloxacin:

• Corticosteroids, sometimes called steroids, used for inflammation. You may be more likely to experience tendon inflammation and/or rupture.
• Warfarin - used to make the blood more fluid. You may be more likely to experience bleeding. Your doctor may need to perform regular blood tests to check if your blood is clotting properly.
• Theophylline - used for respiratory problems. You may be more likely to experience a seizure (convulsions) if taken with levofloxacin.
• Non-steroidal anti-inflammatory drugs (NSAIDs) - used for pain and inflammation, such as acetylsalicylic acid, ibuprofen, fenbufen, ketoprofen, indomethacin. You may be more likely to experience a seizure (convulsions) when taken with levofloxacin.
• Cyclosporin - used after organ transplants. You may be more likely to experience the adverse effects of cyclosporin.
• Medicines with a known effect on heart rhythm. This includes medicines used for irregular heart rhythm (antiarrhythmics such as quinidine, hydroquinidine, disopyramide, sotalol, dofetilide, ibutilide, and amiodarone), for depression (tricyclic antidepressants such as amitriptyline and imipramine), for psychiatric disorders (antipsychotics), and for bacterial infections (macrolide antibiotics such as erythromycin, azithromycin, and clarithromycin).
• Probenecid (used for gout) and cimetidine (used for ulcers and heartburn). Special care should be taken when these medicines are taken with levofloxacin. If you have kidney problems, your doctor may want to give you a lower dose.

Do not take levofloxacin at the same time as the following medicines, as this may affect the way levofloxacin works:

• Iron tablets (for anemia), zinc supplements, antacids that contain aluminum or magnesium (for acidity or heartburn), didanosine, or sucralfate (for stomach ulcers). See section 3 "If you are already taking iron, zinc supplements, antacids, didanosine, or sucralfate" below.

Determination of opiates in urine

Urine tests may show "false positive" results for the presence of strong painkillers called "opiates" in patients taking levofloxacin. Inform your doctor that you are taking levofloxacin if you have been prescribed a urine test.

Tuberculosis test

This medicine may cause a "false negative" result in some laboratory tests used to detect the bacteria that cause tuberculosis.

Pregnancy and breastfeeding

Do not take this medicine if:

• you are pregnant, might be pregnant, or think you might be pregnant,
• you are breastfeeding or plan to breastfeed

If you are pregnant or breastfeeding, think you might be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medicine.

Driving and using machines

Some adverse effects such as dizziness, drowsiness, imbalance (vertigo), or visual disturbances may occur. Some of these adverse effects can affect your ability to concentrate or slow your reaction time. If this happens, do not drive or operate any machinery that requires a high level of attention.

Levofloxacino Krka contains orange yellow S (yellow sunset FCF) (E110)

This medicine may cause allergic reactions because it contains sunset yellow. It can trigger asthma, especially in patients allergic to acetylsalicylic acid.

3. How to take Levofloxacino Krka

Follow exactly the administration instructions of this medication indicated by your doctor. In case of doubt, consult your doctor or pharmacist again.

How to take this medication

• Take this medication by mouth.
• Swallow the tablets whole with a little water.
• The tablets can be taken during or between meals.
• The tablets can be divided into equal doses.

Protect your skin from sunlight

Do not expose your skin directly to the sun (even if it's cloudy) while taking this medication and for two days after stopping it, as your skin will become much more sensitive to the sun and may burn, sting, or even blister if you don't take the following precautions:

• Make sure to use high-protection sun creams.
• Always wear a hat and clothing that covers your arms and legs.
• Avoid UVA lamps.

If you are already taking iron tablets, zinc supplements, antacids, didanosine, or sucralfate

Do not take these medications at the same time as levofloxacino. You should take these medications at least two hours before or two hours after taking levofloxacino.

What dose should you take

• Your doctor will decide what amount of levofloxacino tablets you should take.
• The dose will depend on the type of infection you have and where the infection is located in your body.
• The duration of treatment will depend on the severity of your infection.
• If you think the effect of the medication is too weak or too strong, do not change the dose yourself, ask your doctor.

Adults and elderly patients

Sinus infection

• One 500 mg levofloxacino tablet, once a day

Lung infection, in people with long-term respiratory problems

• One 500 mg levofloxacino tablet, once a day

Pneumonia

• One 500 mg levofloxacino tablet, once or twice a day

Urinary tract infection, including kidneys or bladder

• Half a tablet, or one 500 mg levofloxacino tablet, once a day

Prostate infection

• One 500 mg levofloxacino tablet, once a day

Skin and soft tissue infection, including muscles

• One 500 mg levofloxacino tablet, once or twice a day

Adults and elderly patients with kidney problems

Your doctor may give you a lower dose.

Use in children and adolescents

This medication should not be given to children or adolescents.

If you take more Levofloxacino Krka than you should

If you accidentally take more tablets than you should, inform your doctor or get immediate medical help. Take the medication with you so the doctor knows what you have taken. The effects that may appear are: epileptic seizures (convulsions), confusion, dizziness, decreased consciousness, tremors, heart disorders that can cause irregular heartbeats as well as nausea or stomach burning.

In case of overdose, consult your doctor or pharmacist immediately, you can also call the Toxicological Information Service, phone 91 562 04 20 indicating the medication and the amount ingested .

If you forget to take Levofloxacino Krka

If you forget to take a dose, take it as soon as possible, unless it is almost time for your next dose. Do not take a double dose to make up for forgotten doses.

If you stop treatment with Levofloxacino

Do not stop your treatment with levofloxacino even if you feel better. It is important that you finish the treatment that your doctor has prescribed. If you stop taking them too soon, the infection may appear again, your condition may worsen, or the bacteria may become resistant to the medication.

If you have any other questions about the use of this medication, ask your doctor or pharmacist.

4. Possible side effects

Like all medications, this medication can cause side effects, although not everyone will experience them. They are usually mild to moderate and tend to disappear in a short time.

Stop treatment with levofloxacino and contact a doctor or go to a hospital immediately if you notice the following side effects:

Very rare(may affect up to 1 in 10,000 people)

• If you have an allergic reaction. The signs may include: skin rash, difficulty swallowing or breathing, swelling of lips, face, throat, or tongue.

Stop treatment with levofloxacino and contact a doctor immediately if you notice the following serious side effects, as you may need urgent medical treatment:

Rare(may affect up to 1 in 1,000 people)

• Watery diarrhea that may contain blood, possibly with stomach cramps and fever. These could be signs of a serious intestinal problem.
• Pain and inflammation in the tendons or ligaments, which could lead to rupture. The Achilles tendon is the one most frequently affected.
• Epiplectic seizures (convulsions).
• Seeing or hearing things that are not real (hallucinations, paranoia).
• Depression, mental disorders, feeling of restlessness (agitation), abnormal dreams or nightmares.
• Widespread rash, high body temperature, elevated liver enzymes, blood abnormalities (eosinophilia), swollen lymph nodes, and other body organs involved (drug reaction with eosinophilia and systemic symptoms, also known as DRESS or drug hypersensitivity syndrome). See also section 2.
• Syndrome associated with changes in water elimination and low sodium levels (SIADH).
• Decrease in blood sugar levels (hypoglycemia) or decrease in blood sugar levels leading to coma (hypoglycemic coma). This is important for people with diabetes.

Very rare(may affect up to 1 in 10,000 people)

• Burning, tingling, pain, or numbness. These can be signs of what is called "neuropathy".

Frequency not known(frequency cannot be estimated from available data)

• Severe skin rashes, including Stevens-Johnson syndrome and toxic epidermal necrolysis. These can appear on the trunk as reddish spots in a target shape or circular patches, often with blisters in the center, skin peeling, ulcers in the mouth, throat, nose, genitals, and eyes, and can be preceded by flu-like symptoms. See also section 2.

• Lack of appetite, yellowish skin and eyes, dark urine, itching or painful stomach (abdomen). These can be signs of liver problems, which can include fulminant liver failure.
• Changes in opinion or thoughts (psychotic reactions) with risk of having suicidal thoughts or actions.
• Nausea, general discomfort, stomach upset, or vomiting. This can be a symptom of pancreatitis (inflammation of the pancreas). See section 2.

Consult an eye specialist immediately if your vision deteriorates or you have any other eye problems while taking levofloxacino.

The administration of antibiotics containing quinolones and fluoroquinolones has been associated with very rare cases of long-lasting (even months or years) or permanent adverse reactions, such as tendon inflammation, tendon rupture, joint pain, limb pain, difficulty walking, abnormal sensations such as pinching, tingling, burning, numbness, or pain (neuropathy), fatigue, decreased memory and concentration, effects on mental health (which can include sleep disorders, anxiety, panic attacks, depression, and suicidal thoughts), as well as decreased hearing, vision, taste, and smell, in some cases regardless of the presence of pre-existing risk factors.

There have been reports of increased size and weakening or tearing of the aortic wall (aneurysms and dissections), which could lead to rupture and be fatal, and cardiac valve insufficiency in patients who have received fluoroquinolones. See also section 2.

Tell your doctor if any of the following side effects worsen or last more than a few days:

Common(may affect up to 1 in 10 people)

• Sleep problems
• Headache, dizziness
• Nausea (nausea, vomiting) and diarrhea
• Increased levels of some liver enzymes in the blood

Uncommon(may affect up to 1 in 100 people)

• Changes in the number of other bacteria or fungi, infection by a fungus called Candida, which may require treatment.
• Changes in the number of white blood cells in your blood test results (leukopenia, eosinophilia).

• Stress (anxiety), confusion, nervousness, drowsiness, tremors, feeling of dizziness (vertigo).

• Difficulty breathing (dyspnea).
• Changes in taste, loss of appetite, stomach upset, or indigestion (dyspepsia), stomach pain, feeling of bloating (flatulence), or constipation.
• Itching and skin rash, intense itching or hives (urticaria), excessive sweating (hyperhidrosis).
• Joint or muscle pain.
• Abnormal values in your blood tests due to liver problems (increased bilirubin) or kidney problems (increased creatinine).
• General weakness.

Rare(may affect up to 1 in 1,000 people)

• Appearance of bruises and easy bleeding due to a decrease in the number of platelets in the blood (thrombocytopenia).
• Decrease in the number of white blood cells in the blood (neutropenia).
• Exaggerated immune response (hypersensitivity).

• Tingling sensation in hands and feet (paresthesia).
• Ear disorders (tinnitus) or vision disorders (blurred vision).
• Abnormally fast heartbeat (tachycardia) or decreased blood pressure (hypotension).
• Muscle weakness. This is important in people with myasthenia gravis (a rare nervous system disease).
• Memory problems.
• Changes in kidney function and occasional kidney failure, which can be a consequence of an allergic reaction in the kidney called interstitial nephritis.
• Fever.
• Erythematous patches clearly delimited with or without blisters that develop a few hours after administration of levofloxacino and heal with residual post-inflammatory hyperpigmentation; usually, it recurs in the same skin or mucous membrane site after subsequent exposure to levofloxacino.

Frequency not known(frequency cannot be estimated from available data)

• Decrease in red blood cells (anemia): this can cause the skin to become pale or yellowish due to damage to red blood cells; decrease in the number of all types of blood cells (pancytopenia).
• The bone marrow stops producing new blood cells, which can cause fatigue, decreased ability to fight infections, and uncontrolled bleeding (bone marrow failure).
• Fever, sore throat, and persistent general malaise. This can be due to a decrease in the number of white blood cells (agranulocytosis).
• Circulatory collapse (anaphylactic shock).
• Increased blood sugar levels (hyperglycemia) or decreased blood sugar levels that can lead to coma (hypoglycemic coma). This is important in people with diabetes.
• Changes in smell, loss of smell or taste (parosmia, anosmia, ageusia).
• Feeling very excited, euphoric, agitated, or enthusiastic (mania).
• Movement and gait disorders (dyskinesia, extrapyramidal disorders).
• Temporary loss of consciousness or posture (syncope).
• Temporary loss of vision, eye inflammation.
• Hearing or ear problems.

• Abnormally fast heartbeat, irregular heartbeat with life-threatening risk, including cardiac arrest, alteration of heart rhythm (called "prolongation of the QT interval", observed in the ECG, graphical representation of the heart's electrical activity).
• Difficulty breathing or wheezing (bronchospasm).

• Allergic pulmonary reactions.
• Pancreatitis (inflammation of the pancreas).
• Hepatitis (inflammation of the liver).
• Increased skin sensitivity to sunlight and ultraviolet light (photosensitivity), darker skin areas (hyperpigmentation).
• Inflammation of the blood vessels that carry blood throughout the body due to an allergic reaction (vasculitis).
• Inflammation of the tissue inside the mouth (stomatitis).
• Muscle rupture and destruction (rhabdomyolysis).
• Red and swollen joints (arthritis).
• Pain, including back, chest, and limb pain.
• Sudden, involuntary muscle jerks or spasms (myoclonus).
• Porphyria crisis in patients with porphyria (a very rare metabolic disease).
• Persistent headache with or without blurred vision (benign intracranial hypertension).

Reporting of side effects:

If you experience any side effects, consult your doctor or pharmacist, even if it is a possible side effect that does not appear in this leaflet. You can also report them directly through the Spanish Pharmacovigilance System for Human Use Medicines: https://www.notificaram.es. By reporting side effects, you can help provide more information on the safety of this medication.

5. Storage of Levofloxacino Krka

Keep this medication out of sight and reach of children.

Do not use this medication after the expiration date that appears on the packaging and blister after CAD. The expiration date is the last day of the month indicated.

This medication does not require special storage conditions.

Medications should not be thrown away in drains or trash. Deposit the packaging and medications you no longer need in the SIGRE collection point at the pharmacy. If in doubt, ask your pharmacist how to dispose of the packaging and medications you no longer need. This will help protect the environment.

6. Package contents and additional information

Composition of Levofloxacino Krka tablets

• The active ingredient is levofloxacino. Each film-coated tablet of Levofloxacino Krka contains 500 mg of levofloxacino as levofloxacino hemihydrate.
• The other ingredients are:

Core of the tablet:microcrystalline cellulose, hydroxypropylcellulose, crospovidone (type A), and magnesium stearate.

Coating of the tablet:hypromellose, indigotine (indigo carmine) (E132), orange yellow S (sunset yellow FCF) (E110), macrogol 4000, titanium dioxide (E171), red iron oxide (E172), and yellow iron oxide (E172).

Appearance of the product and package contents

The film-coated tablets are orange, oblong, biconvex, with a score line, measuring 19.3 mm x 7.8 mm and a thickness of 5.0 mm. The tablet can be divided into equal doses.

The tablets are available in boxes of 1, 5, 7, 10, and 14 tablets in blisters.

Not all pack sizes may be marketed.

Marketing authorization holder and manufacturer

Marketing authorization holder

KRKA, d.d., Novo mesto,

Šmarješka cesta 6,

8501 Novo mesto, Slovenia

Manufacturer

KRKA, d.d., Novo mesto,

Šmarješka cesta 6,

8501 Novo mesto, Slovenia

Or

PHARMATHEN S.A.,

Dervenakion 6,

Pallini 15351, Attikis

Greece

You can request more information about this medication by contacting the local representative of the marketing authorization holder:

KRKA Farmacéutica, S.L., C/ Anabel Segura 10, Pta. Baja, Oficina 1, 28108 Alcobendas, Madrid, Spain

This medication is authorized in the Member States of the European Economic Area with the following names:

Date of last revision of this leaflet:January 2025

Detailed information about this medication is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/