The LINEZOLID AND SEROTONIN SYNDROME
Abstract
Linezolid is an antimicrobial agent with a spectrum of activity against multidrug-resistant gram-positive bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), moreover, linezolid has activity against nontuberculous mycobacteria (NTM). On the other hand, linezolid inhibits monoamine oxidase (MAO), which leading to an increase of serotonergic activity. Serotonin syndrome is the adverse event of linezolid, especially when using with serotonergic agents, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and opioids. Citalopram, escitalopram, and methadone are the most common reports causing serotonin syndrome when administered with linezolid. United States Food and Drug Administration (U.S. FDA) warns against the co-administration of linezolid with serotonergic agents and a washout period of these medications is recommended. However, in life-threatening conditions, treatment of infection with linezolid should not be delayed. Whether discontinuation of serotonergic agents should weigh the risks and benefits meanwhile determine the risk of withdrawal syndromes. When co-administration without a washout period of linezolid with serotonergic agents, signs and symptoms of serotonin syndrome should be observed. If serotonin syndrome occurs, the doctor should discontinue the medication most suspected to be the cause, supportive treatment and prompt consider the role of cyproheptadine.
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