Our review of the AERS database suggests that there is a risk of serotonin toxicity during therapy with linezolid and drugs that increase serotonin concentration.
Sofias Avenue, Athens, Greece. In healthy volunteers, the concurrent administration of linezolid with phenylpropanolamine or pseudoephedrine yielded an enhanced but reversible pressor response [ 28 ]. These classes of drugs include paroxetine Paxilfluvoxamine Luvoxfluoxetine Prozac, Symbyax sertraline Zoloftcitalopram Celexaescitalopram Lexaprovilazodone Viibrydvenlafaxine Effexordesvenlafaxine Pristiqand duloxetine Cymbalta.
The manufacturer of linezolid has recently changed the precaution section of the product label to include additional warnings about the risk of serotonin toxicity during concurrent administration of a SSRI or an antidepressant [ 31 ]. Pain Medicine News Report.
Time to resolution of symptoms was within the first 48 h range, 24 h—9 days for 7 of 11 patients. View at Google Scholar D. Linezolid possesses nonspecific monoamine oxidase inhibition. Patient outcomes for the remaining 13 patients were not provided by the reporter.
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Potential conflict of interest. The most common class of drugs received concurrently with linezolid was SSRIs 26 of 43 patientsfollowed by tricyclic antidepressants 6 of 43 patients and atypical antidepressants 4 of 43 patients.
These select patients should be educated on the symptoms of serotonin syndrome and should be closely monitored by their primary caregivers. The use of the AERS database yielded 29 cases of serotonin toxicity associated with linezolid, of which 9 cases were previously published.
Linezolid inhibits protein synthesis of susceptible bacteria by binding to 23S on the 50S subunit of bacterial ribosomal RNA to prevent the formation of the 70S-initiation complex necessary for translation. Specifically, we requested all reports of serotonin syndrome or any report of cognitive or behavioral symptoms confusion, visual hallucinations, delusions, elevated mood, agitation, insomnia, nervousness, delirium, or comaautonomic instability fever, hyperhidrosis, hypertension, palpitations, or tachycardiaand neuromuscular excitability myoclonus, tremors, chills, rigidity, hyperreflexia, or akathisia.
Citing articles via Web of Science The most widely recognized case is that of Libby Zion, an year-old patient who died as a result of a preventable interaction between meperidine, an unsuspected inhibitor of serotonin reuptake, and phenelzine, an irreversible MAO inhibitor [ 6 ].
A patient with an active infection requiring linezolid therapy cannot wait two weeks before starting an antibiotic. View large Download slide. If linezolid must be used, the serotonergic drug must be stopped immediately, and the patient must be carefully monitored for two weeks for signs of serotonin syndrome -- except if the drug is fluoxetine, which has a long half-life, necessitating five weeks of monitoring. Receive exclusive offers and updates from Oxford Academic.
Care of patients consisted of discontinuing linezolid or the concomitant agent or both. Sign In or Create an Account. Myelosuppression and serotonin syndrome associated with concurrent use of linezolid and selective serotonin reuptake inhibitors in bone marrow transplant recipients. Linezolide is metabolised via oxidation procedure in a way independent of cytochrome P CYP ; consequently there is no possible pharmacokinetic mechanism of interaction between linezolide and other medication metabolized through CYP pathways [ 27 ].
We assessed the case summaries obtained from the Adverse Event Reporting System database for serotonin toxicity.