In this episode, I’ll discuss linezolid-associated serotonin toxicity in patients receiving linezolid and concomitant serotonergic agents.
Concern that linezolid, when combined with serotonergic medications, could increase the chance of serotonin syndrome has been present since linezolid was first developed, since it has nonselective monoamine oxidase (MAO) type A and MAO type B inhibitory effects. However, systematic reviews have determined that the risk of serotonin toxicity when linezolid is combined with another serotonergic medication is exceedingly low, and in the rare event an interaction does occur, it can be successfully managed simply by discontinuing the medications involved.
To add to the body of evidence available on this topic, a group of researchers published a single center retrospective cohort study with patient data spanning 9 years to examine the demographic and clinical characteristics and potential risk factors for linezolid-associated serotonin toxicity in patients receiving linezolid and concomitant serotonergic agents.
Inclusion criteria was any patient that received at least 1 dose of linezolid and 1 dose of another serotonergic medication within 24 hours of each other. A total of 227 patients were included in the analysis. The mean age was over 62 years and the mean duration of linezolid use was 5 and a half days. 60% of patients were given only 1 additional serotonergic medication and 69% were considered to have received a low dose of the serotonergic medications given. In this cohort, only 2 patients had possible serotonergic toxicity and only 1 of them was judged by investigators to be possibly associated with linezolid.
The authors concluded:
The incidence of serotonin toxicity in hospitalized patients receiving linezolid with concomitant serotonergic agents was low in our study. Linezolid is likely safe in patients receiving select concomitant agents.
This study supports the viewpoints reached in prior studies that, when linezolid is the optimal therapy for a patient who is also receiving serotonergic agents, it need not be changed to another antibiotic out of concern for serotonin syndrome.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
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