LEVOFLOXACIN SERRACLINICS 5 mg/ml SOLUTION FOR INFUSION

2. What you need to know before you use Levofloxacin Serraclinics

Do not use this medicine and consult your doctor if:

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

Do not use this medicine if any of the above cases apply to you. If in doubt, consult your doctor, pharmacist, or nurse before using Levofloxacino Serraclinics.

Warnings and precautions

Before you start taking this medicine

You must not use antibacterial medicines that contain fluoroquinolones or quinolones, including Levofloxacino Serraclinics, if you have experienced any severe side effects in the past when taking a quinolone or fluoroquinolone. If this is the case, you must inform your doctor as soon as possible.

Consult your doctor, pharmacist, or nurse before using this medicine if:

• You are 60 years old or older
• You are taking corticosteroids, sometimes called steroids (see section "Using Levofloxacino Serraclinics with other medicines")
• You have ever had a seizure (convulsions)
• 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 ever had mental problems
• You have ever had heart problems: caution should be exercised when using this type of medicine if you were born with, or have a family history of, prolonged 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 (called "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 "Using Levofloxacino Serraclinics with other medicines")
• You are diabetic
• You have ever had liver problems
• You have myasthenia gravis
• You have been diagnosed with heart valve insufficiency (regurgitation of the heart valves)
• You have a family history of aortic dissections or aneurysms, congenital heart valve disorders, or other risk factors or predisposing conditions (e.g., connective tissue disorders such as Marfan syndrome, 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, hypertension, known atherosclerosis, rheumatoid arthritis (a joint disease), or endocarditis (a heart infection))
• You have ever developed a severe skin rash or skin peeling, blisters, and/or sores in the mouth after taking levofloxacin

Tell your doctor, pharmacist, or nurse before using Levofloxacino Serraclinics if you are not sure whether any of the above cases apply to you.

During treatment with this medicine

Rarely, pain and swelling in the joints and inflammation or rupture of the tendonsmay occur. The risk is greater 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 Levofloxacino Serraclinics. 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 may 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.

If you feel a sudden, severe pain in the abdomen, chest, or back, which can be symptoms of aortic dissection or aneurysm, go to the emergency room immediately. The risk may be increased 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 the ankles, feet, or abdomen, or the appearance of heart palpitations (feeling of rapid or irregular heartbeat), 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 discontinue treatment with levofloxacin and initiate appropriate treatment.

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. If the blood counts are abnormal, your doctor may need to discontinue treatment.

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

If you experience any of these side effects after taking Levofloxacino Serraclinics, contact your doctor immediately before continuing treatment. You and your doctor will decide whether to continue or not, also considering the use of an antibiotic from 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 on the trunk as red, target-like patches or circular spots, often with blisters in the center. They can also appear as ulcers in the mouth, throat, nose, genitals, and eyes (red, 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 enlarged 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.

Using Levofloxacino Serraclinics with other medicines

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

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

• Corticosteroids, sometimes called steroids, used for inflammation. You may be more likely to experience tendon inflammation and/or rupture
• Warfarin, used to make blood more fluid. You may be more likely to experience bleeding. Your doctor may need to perform periodic blood tests to check if your blood is clotting correctly
• Theophylline, used for respiratory problems. You may be more likely to experience a seizure (convulsions) if taken with Levofloxacino Serraclinics
• 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 Levofloxacino Serraclinics
• Cyclosporine, used after organ transplants. You may be more likely to experience the side effects of cyclosporine
• Medicines with known effects 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 Levofloxacino Serraclinics. If you have kidney problems, your doctor may want to give you a lower dose.

Determination of opiates in urine

Urine tests may show "false positive" results for the presence of strong painkillers called "opiates" in patients using Levofloxacino Serraclinics. Inform your doctor that you are using Levofloxacino Serraclinics 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 use this medicine if:

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

Driving and using machines

Some side effects such as dizziness, drowsiness, altered sense of balance (vertigo), or visual disturbances may occur. Some of these side effects may affect your ability to concentrate or slow down your reaction time. If this happens, do not drive or perform any work that requires a high level of attention.

Levofloxacino Serraclinics contains sodium

Patients on low-sodium diets should note that this medicine contains 354 mg of sodium per 500 mg dose.

3. How to use Levofloxacino Serraclinics

• Levofloxacino Serraclinics is a medication for hospital use
• For Levofloxacino Serraclinics 500 mg solution for infusion, the infusion time will be 60 minutes or more
• Your heart rate and blood pressure will be frequently monitored. This is because an unusual rapid heartbeat and a temporary decrease in blood pressure are possible adverse effects that have been seen during the infusion of a similar antibiotic. If your blood pressure drops significantly while you are being administered the infusion, it will be interrupted immediately.

How much Levofloxacino Serraclinics is administered

If you are not sure why you are being administered Levofloxacino Serraclinics or have any questions about how much Levofloxacino Serraclinics you are being administered, consult your doctor, nurse, or pharmacist.

• Your doctor will decide how much Levofloxacino Serraclinics you should be administered
• The dose will depend on the type of infection you have and where it is located in your body
• The duration of treatment will depend on the severity of your infection

Adults and elderly patients

• Pneumonia: 500 mg once or twice a day
• Urinary tract infection, including kidneys or bladder: 500 mg once a day
• Prostate infection: 500 mg once a day
• Skin and soft tissue infections, including muscles: 500 mg once or twice a day

Adults and elderly patients with kidney problems

Your doctor may administer a lower dose to you.

Children and adolescents

This medication should not be administered to children or adolescents.

Protect your skin from sunlight

Do not expose your skin directly to the sun (even if it is cloudy) while you are being administered this medication and for two days after stopping use, as your skin will become much more sensitive to the sun and may burn, sting, or even blister if you do not 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 use more Levofloxacino Serraclinics than you should

If you forget to use Levofloxacino Serraclinics

Your doctor or nurse will have instructions on when to administer this medication to you. It is unlikely that you will not be administered the medication as prescribed. However, if you think you have forgotten a dose, inform your doctor or nurse.

If you interrupt treatment with Levofloxacino Serraclinics

Your doctor or nurse will continue to administer Levofloxacino Serraclinics to you, even if you feel better. If treatment is interrupted too early, you may get worse or the bacteria may become resistant to the medication. After a few days of treatment with the infusion solution, your doctor may decide to switch you to the tablet form of this medication to complete the treatment.

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

4. Possible adverse effects

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

Interrupt treatment with Levofloxacino Serraclinics and contact a doctor or nurse or go to a hospital immediately if you notice the following adverse 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

Interrupt treatment with Levofloxacino Serraclinics and contact a doctor or nurse immediately if you notice the following serious adverse 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
• Epileptic seizures (convulsions)
• Widespread rash, high body temperature, elevated liver enzymes, blood abnormalities (eosinophilia), swollen lymph nodes, and other organs involved (drug reaction with eosinophilia and systemic symptoms, also known as DRESS or drug hypersensitivity syndrome). See also section 2.
• Syndrome associated with alterations in water elimination and low sodium levels (SIADH).

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(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 may be preceded by fever and flu-like symptoms. See also section 2.

Others:

• Lack of appetite, yellowing of skin and eyes, dark urine, itching or painful stomach (abdomen). These can be signs of liver problems that can include fulminant liver failure
• 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 heart valve problems in patients who have received fluoroquinolones. See also section 2.

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

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

Common(may affect up to 1 in 10 people)

• Sleep problems
• Headache, dizziness
• Discomfort (nausea, vomiting) and diarrhea
• Increased levels of some liver enzymes in the blood
• Reactions at the infusion site
• Vein inflammation

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 disorders 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 blood test results due to liver (increased bilirubin) or kidney (increased creatinine) problems
• 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)
• Decrease in blood sugar levels (hypoglycemia). This is important for diabetic patients
• Seeing or hearing things that are not real (hallucinations, paranoia), changes in opinion and thoughts (psychotic reactions) with a risk of having suicidal thoughts or actions
• Depression, mental disorders, feeling of restlessness (agitation), abnormal dreams or nightmares
• Feeling of tingling in hands and feet (paresthesia)
• Ear disorders (tinnitus) or vision problems (blurred vision)
• Abnormally fast heartbeat (tachycardia) or decrease in blood pressure (hypotension)
• Muscle weakness. This is important in people with myasthenia gravis (a rare nervous system disease)
• Changes in kidney function and occasional kidney failure, which can be a consequence of an allergic reaction in the kidney called interstitial nephritis
• Fever
• Red patches clearly delimited with or without blisters that develop a few hours after the administration of levofloxacino and heal with residual post-inflammatory hyperpigmentation; they usually recur in the same area of the skin or mucous membrane after subsequent exposure to levofloxacino.

Other adverse effects include:

• Decrease in red blood cells in the blood (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 diabetic patients
• 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
• Hearing or vision 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, a graphical representation of the heart's electrical activity)
• Difficulty breathing or wheezing (bronchospasm)
• Pulmonary allergic reactions
• Pancreatitis
• Hepatitis
• 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 jerks, muscle spasms, or contractions (myoclonus)
• Porphyria crisis in patients with porphyria (a very rare metabolic disease)
• Persistent headache with or without blurred vision (benign intracranial hypertension)

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), depression, fatigue, sleep disorders, memory loss, and loss of hearing, vision, taste, and smell, in some cases regardless of the presence of pre-existing risk factors.

Reporting adverse effects

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

5. Conservation of Levofloxacino Serraclinics

Keep this medication out of sight and reach of children.

Do not store at a temperature above 30°C.

Keep the bag in the metal outer packaging to protect it from light. It does not need to be protected from light during infusion.

Levofloxacino solution for infusion should be used immediately after removal from the outer packaging to prevent any bacterial contamination.

Do not use this medication after the expiration date shown on the packaging and vial after EXP. The expiration date is the last day of the month indicated.

Do not use Levofloxacino Serraclinics solution for infusion if you notice that the solution is not transparent, not yellowish-green in color, and/or has particles inside.

Medications should not be thrown away through wastewater or household waste. 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 Serraclinics

The active ingredient is levofloxacino.

Levofloxacino Serraclinics solution for infusion is available in a 500 mg presentation in a 100 ml plastic bag with metal outer packaging. One ml of solution for infusion contains 5 mg of levofloxacino.

The other components (excipients) are: sodium chloride, hydrochloric acid (pH adjustment), and water for injectable preparations.

Appearance of the product and package contents

Levofloxacino Serraclinics solution for infusion is a transparent, yellowish-green solution without particles.

The 100 ml bag is available in packs of 1 and 20 units.

Only some pack sizes may be marketed.

Marketing authorization holder and manufacturer

Marketing authorization holder

Laboratorios SERRA PAMIES, S.A.

Ctra. Castellvell, 24

43206 REUS (Tarragona)

Manufacturer

BIOMENDI, S.A.

Pol. Ind. de Bernedo s/n

01118 Bernedo. Álava

This leaflet does not contain all the information about your medication. If you have any questions or are unsure about something, consult your doctor or pharmacist.

Date of the last revision of this leaflet: September 2024.

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