Acarbose and Linezolid: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 10, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Linezolid
Acarbose
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.
What's going on: Linezolid (Zyvox) is an antibiotic that also acts like a mild MAOI. When it's combined with acarbose (Precose), a diabetes medicine that helps lower blood sugar, your blood sugar can drop lower than usual. That's called hypoglycemia.
Watch for signs like shakiness, sweating, dizziness, confusion, or feeling suddenly weak or hungry. The good news is this is very manageable. Your care team can check your blood sugar more often and adjust your dose if needed. Keep taking both medicines as prescribed, and let your pharmacist or doctor know if you notice low blood sugar symptoms.
Effect: Increased risk of hypoglycemia when linezolid (a weak, reversible, nonselective MAOI) is combined with acarbose.
Mechanism: Not fully established. MAOIs may enhance the glucose-lowering effect of hypoglycemic agents, possibly via MAOI-associated hyperinsulinemia in type 2 patients with retained insulin secretory capacity. Neither agent is metabolically activated in a way that reverses direction.
- Onset: rapid
- Evidence: probable
- Severity: moderate
Management: Monitor blood glucose closely, especially when linezolid is started or stopped. Doses of acarbose (or other hypoglycemics) may need to be adjusted and individualized; rarely, discontinuation of one agent may be warranted.
What happens
An increased risk of hypoglycemia
Interaction Deep Dive
When certain MAOIs are taken together with hypoglycemic agents, the blood glucose lowering action of those agents may be enhanced 23. In individuals with type 2 diabetes who retain the ability to secrete insulin, MAOIs can produce hyperinsulinemia 7. Blood glucose should be monitored carefully whenever an MAOI is introduced or withdrawn in a patient who is taking a hypoglycemic agent. It may be necessary to reduce the dose of insulin or oral hypoglycemic agents 12, or alternatively to discontinue one of the interacting drugs 4.
Why it happens (mechanism)
Unknown
How to manage this interaction
How your care team handles this:
- They may check your blood glucose more often, especially in the days after linezolid is started or stopped.
- Your acarbose dose (or other diabetes medicine) may need to be adjusted and individualized by your care team.
- In some cases they may choose a different antibiotic or diabetes medicine.
What you can do: Keep taking both medicines exactly as prescribed. Know the signs of low blood sugar (shaking, sweating, dizziness, confusion) and treat as instructed. Tell your pharmacist or prescriber if you notice these symptoms so they can fine-tune your plan.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) MAOI medications can intensify the hypoglycemic action of hypoglycemic agents. The suggested mechanism involved MAOI drugs disrupting the homeostatic adrenergic response to hypoglycemia 5, although this mechanism was not verified 6. MAOIs seem to produce hyperinsulinemia 7.
b) Administration of selegiline (a selective MAO-B inhibitor) resulted in severe hypoglycemia in a 70-year old man who had Parkinson's disease. The hypoglycemia occurred together with hyperinsulinemia and continued for one week after selegiline was stopped 8.
Common questions
Can I take Acarbose and Linezolid together?
Combining linezolid with acarbose can push your blood sugar too low, so your team will likely monitor glucose more closely and may adjust your diabetes dose. Keep taking both as prescribed and report any low-blood-sugar symptoms. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acarbose and Linezolid 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 is the Acarbose and Linezolid interaction managed?
How your care team handles this: They may check your blood glucose more often, especially in the days after linezolid is started or stopped. Your acarbose dose (or other diabetes medicine) may need to be adjusted and individualized by your care team. In some cases they may choose a different antibiotic or diabetes medicine. What you can do: Keep taking both medicines exactly as prescribed. Know th… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Acarbose or Linezolid 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 (8)
- Product Information: TOUJEO(R) subcutaneous injection, insulin glargine subcutaneous injection. sanofi-aventis (per manufacturer), Bridgewater, NJ, 2015. DailyMed
- Product Information: AMARYL(R) oral tablets, glimepiride oral tablets. Sanofi-Aventis U.S. LLC (per FDA), Bridgewater, NJ, 2013. DailyMed
- Product Information: Starlix(R) oral tablets, nateglinide oral tablets. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2011. DailyMed
- Product Information: ZYVOX(R) intravenous injection, oral tablets suspension, linezolid intravenous injection, oral tablets suspension. Pfizer Inc. (per FDA), New York, NY, 2013. DailyMed
- Cooper AJ & Ashcroft G: Modification of insulin and sulfonylurea hypoglycemia by monoamine-oxidase inhibitor drugs. Diabetes 1967; 16:272-274. PubMed
- Adnitt PI: Hypoglycemic action of monoamineoxidase inhibitors (MAOI'S). Diabetes 1968; 17:628-633. PubMed
- Bressler R, Vargas-Cord M, & Lebovitz HE: Tranylcypromine: a potent insulin secretagogue and hypoglycemic agent. Diabetes 1968; 17:617-624. PubMed
- Rowland MJ, Bransome ED Jr. & Hendry LB: Hypoglycemia caused by selegiline, an antiparkinsonian drug: can such side effects be predicted?. J Clin Pharmacol 1994; 34:80-85. DOI
Keep reading about Linezolid
Keep reading about Acarbose
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