Levofloxacin (Levaquin and others)

How Medicare covers it

Part D (tablets, oral liquid, and eye drops used at home). Part A during a covered inpatient stay. A clinician-administered intravenous form also has a Part B basis (see Part B status).

What it treats

Levofloxacin is a fluoroquinolone antibiotic for adults with bacterial infections, including hospital-acquired and community-acquired pneumonia, complicated and uncomplicated skin and skin-structure infections, chronic bacterial prostatitis, complicated and uncomplicated urinary tract infections, acute kidney infection (pyelonephritis), acute bacterial worsening of chronic bronchitis, and acute bacterial sinusitis. It is also used for inhalational anthrax after exposure and for plague, in adults and children where indicated. It works only against bacteria and should be used only for infections proven or strongly suspected to be bacterial.

What it is for, in depth

Levofloxacin is a fluoroquinolone antibiotic for adults with bacterial infections. It treats hospital-acquired and community-acquired pneumonia, complicated and uncomplicated skin infections, long-term bacterial prostate infection, and complicated and uncomplicated urinary tract infections, including kidney infection. It also treats a sudden bacterial worsening of chronic bronchitis and acute bacterial sinus infections. It is also used for inhalational anthrax after exposure and for plague, in adults and in children where the label allows it. It works only against bacteria, by blocking the tools bacteria need to copy and repair their DNA, so the bacteria die instead of multiplying. It should be used only for infections proven or strongly suspected to be bacterial. It comes as tablets in 250 mg, 500 mg, and 750 mg, usually taken once a day, with the dose and number of days set by the type of infection.

How it works

It is a fluoroquinolone antibacterial. It kills bacteria by blocking the enzymes bacteria need to copy and repair their DNA (DNA gyrase and topoisomerase IV), so the bacteria die instead of multiplying.

How it is taken

Tablets (250 mg, 500 mg, and 750 mg) taken by mouth, usually once a day; the dose and number of days depend on the infection, and people with kidney problems need lower or less frequent doses. Take levofloxacin tablets at least 2 hours before or 2 hours after antacids, sucralfate, iron, zinc, or multivitamins, which block its absorption. Drink plenty of fluids while taking it.

Common side effects

Common side effects (1% or more of patients) include nausea, diarrhea, headache, dizziness, trouble sleeping (insomnia), constipation, abdominal pain, and vomiting. Nausea, vomiting, dizziness, and headache were the effects that most often led people to stop the drug in trials.

Serious warnings

Levofloxacin can cause disabling and potentially permanent nerve damage (peripheral neuropathy), tendon inflammation and tendon rupture, central nervous system effects including seizures, confusion, tremors, hallucinations, and worsening of myasthenia gravis. Other serious risks include liver injury, QT prolongation (a dangerous heart rhythm change), aortic aneurysm and dissection, severe diarrhea from C. difficile, blood sugar disturbances (both low and high blood sugar), severe allergic and skin reactions, and increased sun sensitivity. Stop the drug and get care at once for tendon pain or swelling, numbness or weakness, or a severe rash.

Boxed warning

WARNING: SERIOUS ADVERSE REACTIONS INCLUDING TENDINITIS, TENDON RUPTURE, PERIPHERAL NEUROPATHY, CENTRAL NERVOUS SYSTEM EFFECTS AND EXACERBATION OF MYASTHENIA GRAVIS. Fluoroquinolones, including levofloxacin, have been associated with disabling and potentially irreversible serious adverse reactions that have occurred together: tendinitis and tendon rupture, peripheral neuropathy, and central nervous system effects. Stop levofloxacin at once and avoid fluoroquinolones if any of these occur. Fluoroquinolones may worsen muscle weakness in people with myasthenia gravis, so levofloxacin should be avoided in people with a known history of myasthenia gravis. Because fluoroquinolones have been associated with serious adverse reactions, levofloxacin is reserved for patients with no alternative treatment options for uncomplicated urinary tract infection, acute bacterial exacerbation of chronic bronchitis, and acute bacterial sinusitis.

Who should be careful

People with a history of tendon problems or tendon rupture, myasthenia gravis (avoid), epilepsy or other seizure or central nervous system disorders, QT prolongation or low potassium or magnesium, diabetes, kidney impairment (dose changes needed), and older adults, who have a higher risk of tendon rupture (higher still with corticosteroids) and QT prolongation. Children can develop joint and tendon (musculoskeletal) problems, so use in children is limited to the indications on the label.

Major interactions

Antacids with magnesium or aluminum, sucralfate, iron and other metal cations, didanosine, and multivitamins with zinc cut levofloxacin absorption — separate them by at least 2 hours. Warfarin's effect may increase, so prothrombin time/INR should be monitored and bleeding watched for. Diabetes medicines need careful blood-sugar monitoring because levofloxacin can raise or lower blood sugar. NSAIDs taken with a fluoroquinolone can raise the risk of central nervous system stimulation and seizures, and corticosteroids raise tendon-rupture risk.

Why it is in its tier

Levofloxacin is most often placed on Tier 1. It is listed by 100.0% of Part D plans in the data, and 49.39% of the plans that list it put it on Tier 1. Tier 1 is the lowest-cost tier, usually for preferred generic drugs, and the standard copay range on this tier is $0-$15. The drivers you can see in the data fit that place: levofloxacin is a generic antibiotic, not a brand-only drug, and its cost level is very low. The CMS dashboard puts average spending per beneficiary at $8.00 for 2024. That is a CMS program average, not a copay and not what you will pay at the pharmacy. Individual plans vary, so check your own plan for your exact cost.

Sources

• LEVOFLOXACIN TABLET, FILM COATED [PD-RX PHARMACEUTICALS, INC.] — DailyMed
• MedlinePlus — National Library of Medicine
• MedlinePlus — Levofloxacin

What official patient guides say

Levofloxacin is taken by mouth every 24 to 48 hours, trying to take each dose around the same time of day for as long as your doctor tells you. The tablet may be taken with or without food, but the liquid solution should be taken 1 hour before or 2 hours after eating, and you should drink plenty of water or other fluids while taking it. If you miss a dose, take it as soon as you remember up to 8 hours before the next dose; if less than 8 hours remain, wait for the next dose and do not double up. Store it tightly closed at room temperature, away from excess heat and moisture.

Source: MedlinePlus — Levofloxacin

Part D formulary coverage

Source: CMS Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files — Monthly file 2026-10-15 (plan year 2027), file 2027_20261008.zip (data.cms.gov dataset ed1496ea-23e7-41f1-9292-172fa842ccfb): basic drugs formulary file + plan information file, both dated 20261031 inside the zip; downloaded and aggregated 2026-10-30. Medication RxCUI sets resolved through the NLM RxNav (RxNorm) API.

What you pay

Without insurance, the cash benchmark is $1.3322 per unit (LEVOFLOXACIN 25 MG/ML SOLUTION) — about $39.97 for 30 units. NADAC benchmark — the average price pharmacies pay (CMS, as of 2026-11-04). Pharmacy shelf prices vary.

A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.

Sources: CMS Plan Benefit Package + formulary data; CMS NADAC · Checked 2026-11-08

Coverage by plan and tier

Of the 5,495 Medicare drug plans we track for 2027, 5,495 list Levofloxacin (Levaquin and others) — 100% of plans. Most of those plans put it on Tier 1: 2,714 plans, 49.4% of the plans that list it. Other plans place it on Tier 2 (2,696 plans), Tier 4 (48 plans) or Tier 3 (37 plans). For example: Aetna Medicare Dual Extra (HMO D-SNP) puts it on Tier 2; Aetna Medicare Dual Extra Care (PPO D-SNP) puts it on Tier 2; Aetna Medicare Value Plus (PPO) puts it on Tier 2. You can compare these plans side by side on our Medicare Advantage hub. A tier is not a price. What you pay also depends on whether you have met your plan's deductible, whether the drug costs a flat copay or a share of the price, and whether you get Extra Help or Medicaid.

Read next

• Part D in 2027: The $700 Deductible, the $2,400 Cap, and the $35 Insulin Rule
• Extra Help in 2027: Lower Drug Copays and Who Qualifies
• Checking Medicare Savings Programs and Extra Help

Part D spending averages (2024)

Source: CMS Medicare Part D Spending by Drug (Drug Spending Dashboard), release RY26 P04 V10, data through 2024 (DSD_PTD_RY26_P04_V10_DY24_BGM.csv), downloaded 2026-10-30

Companies covering this drug

Part D and Medicare Advantage plan sponsors that list this drug on a formulary, 50 at a time.