Drug & supplement interaction

Sweet Orange + Levofloxacin

Levofloxacin brand names: Levaquin, Levaquin Injection, Leva-pak.

Major Interaction
Medically reviewed by · Updated September 2026
The bottom line Major

Levofloxacin falls into 2 drug categories that Sweet Orange can interact with; the most serious is rated major. Consuming sweet orange juice can decrease oral absorption of OATP substrates.

Read the full interaction report
SeverityMajor
LikelihoodLikely
Interactions2
EvidenceB
What do Severity, Likelihood & Evidence mean?
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Interaction report

Sweet Orange and Levofloxacin

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

Sweet Orange interacts with whole categories of medication. Levofloxacin falls into 2 of those categories, so it can interact with Sweet Orange in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Major).

Major

ORGANIC ANION-TRANSPORTING POLYPEPTIDE SUBSTRATES (OATP)

1 of 2

Why this applies to Levofloxacin

Levofloxacin falls under ORGANIC ANION-TRANSPORTING POLYPEPTIDE SUBSTRATES (OATP) — the group Sweet Orange interacts with.

Consuming sweet orange juice can decrease oral absorption of OATP substrates. Separate administration by at least 4 hours.
Clinical research shows that consuming sweet orange juice inhibits OATP, which reduces bioavailability of oral drugs that are substrates of OATP. For example, sweet orange juice decreases bioavailability of fexofenadine, a substrate of OATP, by about 72% and of celiprolol, another OATP substrate, by up to 90%. Since sweet orange juice seems to affect OATP for a short time, recommend separating drug administration and consumption of sweet orange juice by at least 4 hours.
Severity Major Likelihood Likely Evidence B

Well-controlled human studies have demonstrated the likely existence of this interaction.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the practical concern with this combo. Orange juice can temporarily block a gut transporter called OATP that helps shuttle levofloxacin from your intestine into your bloodstream. When that doorway gets jammed, less of your antibiotic actually gets absorbed. Levofloxacin isn't a prodrug, so this isn't about toxicity. It's the opposite worry: you could end up with lower drug levels than you need.

Why that matters with an antibiotic? You're taking it to knock out an infection like pneumonia or a UTI. If absorption drops, the medicine may not reach a high enough level to do its job well, which can mean a slower recovery or treatment that doesn't fully work. The easy fix is timing: keep your levofloxacin and orange juice at least 4 hours apart. A regular morning glass of juice is fine as long as it's not right around your dose. Check with your pharmacist if you're unsure how to space them.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Bailey DG, Dresser GK, Munoz C, et al. Reduction of fexofenadine bioavailability by fruit juices. Clin Pharmacol Ther 2001;69:P21.
  2. Lilja JJ, Juntti-Patinen L, Neuvonen PJ. Orange juice substantially reduces the bioavailability of the beta-adrenergic-blocking agent celiprolol. Clin Pharmacol Ther 2004;75:184-90.
  3. Greenblatt DJ. Analysis of drug interactions involving fruit beverages and organic anion-transporting polypeptides. J Clin Pharmacol 2009;49:1403-7. PubMed
  4. Bailey DG. Fruit juice inhibition of uptake transport: a new type of food-drug interaction. Br J Clin Pharmacol 2010;70:645-55. PubMed
Moderate

QUINOLONE ANTIBIOTICS

2 of 2

Levofloxacin also falls under QUINOLONE ANTIBIOTICS.

Calcium-fortified sweet orange juice might reduce quinolone absorption.
Calcium binds to quinolones in the gut. Theoretically, the calcium in certain fortified orange juices can also bind to quinolone antibiotics and reduce their absorption and levels.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the thing to watch with levofloxacin: it's not the orange juice itself that's the concern, it's whether the juice is calcium-fortified. Calcium can grab onto levofloxacin in your stomach and gut, forming a clump that your body can't absorb well. The worry is that less of the antibiotic gets into your bloodstream, which could mean it doesn't fight your infection as strongly as it should.

This is a theoretical concern based on how the drug behaves, not something proven in big studies, so don't panic. A plain orange or regular juice is unlikely to be a problem. To be safe, separate calcium-fortified drinks and supplements from your dose by a few hours, and check with your pharmacist about the best timing.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Murry JJ, Healy MD. Drug-mineral interactions: a new responsibility for the hospital dietician. J Am Diet Assoc 1991;91:66-73.
  2. Pletz MW, Petzold P, Allen A, et al. Effect of calcium carbonate on bioavailability of orally administered gemifloxacin. Antimicrob Agents Chemother 2003;47:2158-60.. PubMed
  3. Huang SM, Lesko LJ. Drug-drug, drug-dietary supplement, and drug-citrus fruit and other food interactions: what have we learned? J Clin Pharmacol 2004;44:559-69. PubMed
  4. Kays MB, Overholser BR, Mueller BA, et al. Effects of sevelamer hydrochloride and calcium acetate on the oral bioavailability of ciprofloxacin. Am J Kidney Dis. 2003;42(6):1253-9. PubMed
  5. Neuhofel, A. L., Wilton, J. H., Victory, J. M., Hejmanowsk, L. G., and Amsden, G. W. Lack of bioequivalence of ciprofloxacin when administered with calcium-fortified orange juice: a new twist on an old interaction. J Clin Pharmacol. 2002;42(4):461-466. DOI

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Sweet Orange Also Interacts With Other Medications

Sweet Orange has 47 major, 198 moderate known drug interactions in our database — the Levofloxacin one above is among them. If you take anything else, check it against the full list below.

Major 47 Moderate 198 No known interaction 2,585 (incl. Levofloxacin)
Taking anything else?

Check Another of Your Medications Against Sweet Orange

Covers the 2,830 medications we’ve checked against Sweet Orange. Pick one to open its full report.

From our Q&A

Questions About Sweet Orange or Levofloxacin

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Sweet Orange or Levofloxacin, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Levofloxacin

This page covers Sweet Orange only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Levofloxacin page lists 155 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), American Hellebore (major), Apple (major), Arsenic (major) and Asarabacca (major).

By severity: 13 major · 121 moderate · 21 minor.

From our pharmacist’s overview on the Levofloxacin page

“Levofloxacin (Levaquin) is a potent fluoroquinolone antibiotic, and its supplement list deserves real respect, with 13 of the 155 entries rated major. The most everyday hazards are fruit juices.”

Reviewed by 2 · Jul 18, 2026

Open the Levofloxacin interaction page

One more smart check

Taking Sweet Orange as Part of a Dietary Supplement Product? Check It for Interactions

We hold 678 real supplement products containing Sweet Orange, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Sweet Orange. Your product may carry other ingredients that interact with Levofloxacin too, on top of Sweet Orange — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Sweet Orange and Levofloxacin Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Sweet Orange
Top 25%

#266 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Levofloxacin
Top 25%

#435 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Sweet Orange

What is Sweet Orange?

Sweet Orange
  • Vitamin C source
  • Digestive upset
  • Stress and relaxation (aromatherapy)
  • Cold and respiratory support
  • Antioxidant support

Sweet orange is a common citrus fruit that is a good source of vitamin C, fiber, and antioxidants, and is enjoyed as a food worldwide. Its peel and essential oil are used in aromatherapy and traditional remedies, but strong scientific proof for most medicinal claims is limited. The fruit and juice are safe for most people as food, while concentrated oils and extracts deserve more caution.

Read the full Sweet Orange monograph & all interactions
Medication

About Levofloxacin

What Is Levofloxacin Used For?

Brand names: Levaquin, Levaquin Injection, Leva-pak

Levofloxacin treats bacterial infections in adults, including pneumonia (both community-acquired and hospital-acquired), skin infections, urinary tract infections, kidney infections, chronic bacterial prostatitis, and sinus infections. It is also used after exposure to inhalational anthrax and for plague.

Because levofloxacin carries significant risks, it should only be used for uncomplicated urinary tract infections, acute bacterial worsening of chronic bronchitis, and acute bacterial sinusitis when no other treatment option is available. Always use it only for infections confirmed or strongly suspected to be bacterial.

See full Levofloxacin drug information
Keep checking

Other Drugs & Sweet Orange

Browse every other medication we’ve checked against Sweet Orange — both the ones with a known interaction and the ones without. Select any drug for the full detail.

47Major
198Moderate
0Minor
2,584No known interaction
47 Major 198 Moderate 2,584 No interaction
Major

47 interactions

Moderate

198 interactions

Showing 60 of 198 moderate interactions — see all 198 on the Sweet Orange page.

No interaction 2,584 drugs checked — show the list

We also checked Sweet Orange against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,584 medications checked with no known interaction — see the full Sweet Orange list.

See the full Sweet Orange interactions page
See every supplement checked against Levofloxacin, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Sweet Orange monograph › Uses, safety, and every drug interaction in one place Levofloxacin supplement interactions › Every supplement checked against Levofloxacin, ranked by severity Levofloxacin drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Sweet Orange and Levofloxacin Together: Common Questions

Can you take Sweet Orange with Levofloxacin?
This is rated a major interaction, so the combination is best avoided unless your doctor or pharmacist has specifically told you otherwise. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 2 interactions listed for Sweet Orange and Levofloxacin?
Levofloxacin belongs to more than one drug category, and Sweet Orange interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Sweet Orange and Levofloxacin interaction?
We rate it Major. This is a clinically significant combination that is generally best avoided, or used only under the direct supervision of your physician or pharmacist.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Levofloxacin and Sweet Orange?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.