Linezolid with Escitalopram Interaction Details
Brand Names Associated with Linezolid
- Linezolid
- Zyvox®
Brand Names Associated with Escitalopram
- Escitalopram
- Lexapro®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 13, 2023
Interaction Effect
An increased risk of serotonin syndrome
Interaction Summary
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 intubation. In a retrospective cohort study in older adults, serotonin syndrome occurred in less than 0.5% of patients who were taking a concurrent antidepressant and linezolid . Concurrent use of escitalopram and linezolid (an MAOI) is contraindicated due to an increased risk of serotonin syndrome. Wait at least 14 days after discontinuing linezolid before initiating escitalopram. Wait at least 14 days after discontinuing escitalopram before initiating therapy with linezolid .
Severity
Contraindicated
Onset
Rapid
Evidence
Established
How To Manage Interaction
Concurrent use of escitalopram and linezolid (an MAOI) is contraindicated due to an increased risk of serotonin syndrome. Wait at least 14 days after discontinuing linezolid before initiating escitalopram. Wait at least 14 days after discontinuing escitalopram before initiating therapy with linezolid.
Mechanism Of Interaction
Additive serotonergic effects
Literature Reports
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 .
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) . According to the Horn Drug Interaction probability Scale, this interaction is rated as probable . In 1 case, the patient had rapid clinical deterioration within the first 24 hours of concomitant use that required intubation .
Linezolid Overview
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Linezolid is used to treat infections, including pneumonia, and infections of the skin . Linezolid is in a class of antibacterials called oxazolidinones. It works by stopping the growth of bacteria.
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Antibiotics such as linezolid will not work for colds, flu, and other viral infections. Using antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.
Escitalopram Overview
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Escitalopram is used to treat depression in adults and children and teenagers 12 years of ago or older. Escitalopram is also used to treat generalized anxiety disorder (GAD; excessive worry and tension that disrupts daily life and lasts for 6 months or longer) in adults. Escitalopram is in a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.