Escitalopram and Linezolid Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Escitalopram
Linezolid Injection
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 happens
An increased risk of serotonin syndrome
Interaction Deep Dive
Concurrent use of escitalopram and linezolid, an MAOI, is contraindicated. A systematic review (SR) identified 2 cases and 2 subsequently published case reports describe serotonin syndrome occurring during concurrent use of linezolid and escitalopram, the S-enantiomer of citalopram (7 cases with citalopram, including 1 fatality, identified in SR). This interaction is rated probable according to the Horn Drug Interaction probability Scale. In 1 case, rapid clinical deterioration occurred within 24 hours of coadministration and required intubation34. Concurrent use of escitalopram and linezolid (an MAOI) is contraindicated due to an increased risk of serotonin syndrome. In addition, do not initiate escitalopram in a patient who is being treated with MAOIs such as linezolid. If it is necessary to initiate treatment with an MAOI such as linezolid in a patient taking escitalopram, discontinue escitalopram before initiating treatment with the MAOI. Wait at least 14 days after discontinuing linezolid before initiating escitalopram. Wait at least 14 days after discontinuing escitalopram before initiating therapy with linezolid 2.
Why it happens (mechanism)
Additive serotonergic effects
Literature reports
2 reports — tap to read
a) In a retrospective cohort study (N=1134), serotonin syndrome occurred in fewer than 6 patients (less than 0.5%) who were taking a concurrent antidepressant and linezolid (n=215). In a propensity score-matched cohort (n=332), there was no significant difference in the risk of serotonin syndrome in patients taking concomitant antidepressants and linezolid compared with patients not taking antidepressants (adjusted risk difference, -1.2%; 95% CI, -2.9% to 0.5%). There was also no significant difference in the rate of altered mental status or confusion, hospitalization, or death from any cause between groups. Clinically significant serotonin syndrome was defined as requiring an ambulatory care visit, emergency department visit, or hospitalization. Patients were 66 years of age or older, all were taking linezolid 600 mg orally twice daily, and of those taking antidepressants, 103 (47.9%) were taking an SSRI, 36 (16.7%) were taking an SNRI, 15 (7%) were taking a tricyclic antidepressant, 7 (3.3%) were taking a norepinephrine and dopamine reuptake inhibitor 1.
b) A systematic review identified 2 cases, and 2 subsequently published case reports describe serotonin syndrome occurring in patients given concomitant therapy with linezolid and escitalopram, the S-enantiomer of citalopram (7 cases with citalopram, including 1 fatality, identified in the systematic review) 345. According to the Horn Drug Interaction probability Scale, this interaction is rated as probable 3. In 1 case, the patient had rapid clinical deterioration within the first 24 hours of concomitant use that required intubation 4.
Common questions
Can I take Escitalopram and Linezolid Injection together?
An increased risk of serotonin syndrome Always confirm with your pharmacist or prescriber before making any change.
How serious is the Escitalopram and Linezolid Injection interaction?
It is rated contraindicated. These should generally not be used together.
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 strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Escitalopram or Linezolid Injection 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 a safer alternative to one of these medications for me?
References (5)
- Bai AD, McKenna S, Wise H, et al: Association of linezolid with risk of serotonin syndrome in patients receiving antidepressants. JAMA Netw Open 2022; 5(12):e2247426. DOI
- Product Information: LEXAPRO(R) oral tablets, oral solution, escitalopram oral tablets, oral solution. Abbvie, Inc (per FDA), North Chicago, IL, 2023. DailyMed
- Ramsey T, Lau T, & Ensom M: Serotonergic and adrenergic drug interactions associated with linezolid: a critical review and practical management approach. Ann Pharmacother 2013; 47(4):543-560. PubMed
- Kulkami R & Kulkami P: Linezolid-induced near-fatal serotonin syndrome during escitalopram therapy: case report and review of literature. Indian J Psychol Med 2013; 35(4):413-416. PubMed
- Ma J, Zhu P, Tu G, et al: Serotonin syndrome under combination of linezolid and low-dose citalopram with amiodarone. Psychiatry Clin Neurosci 2013; 67(6):457-. PubMed
Keep reading about Escitalopram
Keep reading about Linezolid Injection
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