Drug Interaction Report

Aluminum Hydroxide and Levofloxacin Injection: Interaction Details

A pharmacist-reviewed analysis of the Aluminum Hydroxide and Levofloxacin Injection interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Levofloxacin Injection

Levaquin Levaquin® I.V.
+

Aluminum Hydroxide

AlternaGEL® Alu-Cap® Alu-Tab® Amphojel® Derma Gran
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
LinkedIn
Interaction severity
Moderate
Can be significant — usually manageable with monitoring.
How we grade severity & evidence

Severity levels

  • Contraindicated: These should generally not be used together.
  • Major: Potentially serious — often needs a change or close monitoring.
  • Moderate: Can be significant — usually manageable with monitoring.
  • Minor: Usually limited clinical impact.

Evidence grades

  • Established: Well documented — supported by controlled studies or strong clinical data.
  • Probable: Good supporting evidence, though not definitively proven.
  • Suspected: Some evidence suggests this interaction, but it is not well established.
  • Possible: Limited or conflicting evidence; the interaction may occur.
  • Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.

Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.

Of 58 documented Aluminum Hydroxide interactions, 36 are rated moderate — including this one.
Onset
rapid
Evidence
probable
Severity
Moderate

What happens

Decreased oral levofloxacin effectiveness

Interaction Deep Dive

Levofloxacin is capable of forming chelate complexes with metal ions, potentially reducing oral bioavailability12. In one study involving healthy subjects, the absorption of oral levofloxacin 100 mg was reduced significantly during coadministration with either magnesium oxide 500 mg (by 22%) or aluminum hydroxide 1 g (by 44%), based on reductions in the area under the time-concentration curve (AUC). Urinary excretion of levofloxacin was reduced to a significant degree only by aluminum hydroxide (by 28%). Calcium carbonate 1 g did not impair the absorption or urinary excretion of levofloxacin 2. Aluminum, calcium or magnesium containing products have also been reported to reduce the absorption of other quinolones. Levofloxacin should be administered at least two hours before or two hours after antacid administration 3. Reductions in fluoroquinolone bioavailability are less marked if low doses of calcium carbonate or staggered administration is used 4.

Why it happens (mechanism)

Decreased levofloxacin absorption due to chelation

Common questions

Can I take Aluminum Hydroxide and Levofloxacin Injection together?

Decreased oral levofloxacin effectiveness Always confirm with your pharmacist or prescriber before making any change.

How serious is the Aluminum Hydroxide and Levofloxacin Injection interaction?

It is rated moderate. Can be significant — usually manageable with monitoring.

How quickly could this interaction happen?

The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.

How strong is the evidence for this interaction?

The evidence is graded "probable". Good supporting evidence, though not definitively proven.

Questions for your pharmacist

  • Does my dose of Aluminum Hydroxide or Levofloxacin Injection need adjusting while I take them together?
  • What symptoms should prompt me to call you or my prescriber right away?
  • Does the timing of my doses matter for this combination?
  • Is there anything you'd monitor while I'm on both?

References (4)

  1. Anon: Levofloxacin In: Anon: Phase III Profiles, 1, Biomega Corp, Skokie, IL, 1992, pp 1-9.
  2. Shiba K, Sakai O, Shimada J, et al: Effects of antacids, ferrous sulfate, and ranitidine on absorption of DR-3355 in humans. Antimicrob Agents Chemother 1992; 36:2270-2274. PubMed
  3. Product Information: Levaquin(R), levofloxacin. Ortho-McNeil Pharmaceutical, Inc. Raritan, New Jersey, 2000. DailyMed
  4. Marchbanks CR: Drug-drug interactions with fluoroquinolones. Pharmacotherapy 1993; 13:23S-28S. DOI
Was this write-up helpful?
Levofloxacin Injection

Keep reading about Levofloxacin Injection

All Levofloxacin Injection interactions (354) Levofloxacin Injection drug information
Also serious with: Cisapride Terfenadine Sparfloxacin Saquinavir
Aluminum Hydroxide

Keep reading about Aluminum Hydroxide

All Aluminum Hydroxide interactions (58) Aluminum Hydroxide drug information
Also serious with: Hydroxychloroquine Infigratinib Cefuroxime Octreotide Injection
Beyond drug–drug

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

Aluminum Hydroxide + Activated Charcoal Calcium Cinchona Coffee Charcoal European Mandrake Glucomannan Guar Gum Gum Arabic + 27 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

Check another combination

Our instant two-drug interaction checker is almost here.

Coming soon

The instant two-drug checker is on its way.

In the meantime, browse the directory below to look up any drug and see its documented interactions.

Still have questions about this combination?

Every question gets a real answer from a licensed pharmacist — free, and usually within a day.

Ask the pharmacist
This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.