Why does Levaquin cause hypotension?

[Bumashes, MSN, APRN, NP]

Hey all, I searched the site and did a quick google (not an intense search) and couldn't find the answer to this one. I've been told time and again that certain IV abx can cause hypotension, especially Levaquin. And I've seen it happen, too. However, it just crossed my mind that no one has ever mentioned WHY this is so. Anybody there that can clue me in? Does it just simply vasodilate or is it more complex than that? Also, which abx exactly are the culprits besides Levaquin? Thanks guys. Just up late and had this conundrum floating around in my head. If no one knows, then I'll ask the docs at work when I go back in a few days.

[Anna Flaxis, BSN, RN]

I believe it's due to bacterial endotoxins being released into the blood stream when gram negative bacterial cells are lysed.

[Bumashes, MSN, APRN, NP]

Ah, that would at least make sense then.

[Asystole RN]

fluoroquinolones and aminoglycosides are weak neuromuscular blockers. if infused slowly their action is too weak to cause a reaction. infused too quickly and rapid hypotension, along with cardiac arrhythmias, may show up. in addition to this, many antibiotics do not play nicely with many hypertension meds. for example, macrolides and calcium channel blockers to not mix well and can cause sudden severe hypotension.

[Asystole RN]

i believe it's due to bacterial endotoxins being released into the blood stream when gram negative bacterial cells are lysed.

fluoroquinolones work on both gram-positive and gram-negative bacteria, one of the beautiful things about them. their action is to bind to and inhibit enzymes within the bacterial cells that facilitate dna replication. they effectively kill the bacteria by stopping all dna synthesis, stopping any type of bacterial metabolism. the bacteria are killed while maintaining the integrity of the cell structure itself. phagocytosis typically takes many hours to fully destroy the now dead cells, not to mention the cells are typically consumed in whole with few of them actually being lysed and spilling their contents.

[morte, LPN, LVN]

Asystole, does this apply to PO meds as well as IV? I am in LTC, and frequently see ABT with HTN meds...

[Asystole RN]

Asystole, does this apply to PO meds as well as IV? I am in LTC, and frequently see ABT with HTN meds...

ABT reactions with hypertension medications certainly does. To be honest, there isn't too much you can do about these reactions, they need the ABT and they need their HTN meds. What you can do is make sure the practitioner is aware (especially on-all practitioners) of their full medication list and just beaware that there may be sudden drop in BP. If this is something new that the patient is being put on then be prudent and check their BP and administering the dose.

[Bumashes, MSN, APRN, NP]

Cool beans. Thanks for the info because all I could ever locate was the same statement about it causing the low BP, but there was never any real reason attached to it.