Linezolid with Ginseng Interaction Details
Brand Names Associated with Linezolid
- Linezolid
- Zyvox®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 13, 2023
Interaction Effect
Insomnia, tremor, headache, agitation, and worsening of depression
Interaction Summary
Two case reports suggest that ginseng when taken with phenelzine may result in insomnia, tremor, headache, agitation, and worsening of depression suggestive of manic-type symptoms. The exact type of ginseng (i.e. Panax, Siberian, American, etc) was not reported. Similar effects may be seen when taken with other monoamine oxidase inhibitors. The exact mechanism of action is unknown but ginseng may cause mania independently . Ginseng increased GABA metabolism in the brain and dopamine levels in the adrenals. Its impact also may be correlated with its effect on corticosteroid secretion . Saponins and prosapogenins containing 20 (2)-protopanaxadiol from the roots of Panax ginseng inhibited cyclic AMP phosphodiesterase which parallels corticosteroid production. This may partly account for the manic episodes .
Severity
Moderate
Onset
Rapid
Evidence
Probable
How To Manage Interaction
Patients should be advised to avoid use of any ginseng products while taking an MAOI and for several weeks after discontinuation.
Mechanism Of Interaction
Ginseng may increase GABA metabolism; inhibition of cAMP phosphodiesterase increasing corticosteroid production
Literature Reports
A) A 64-year-old woman experienced headache and tremulousness when she added ginseng (Natrol High(R)) to her phenelzine regimen (the dosage of neither entity was specified). She had used phenelzine without effect but when she initiated a rechallenge with this combination, headache and tremulousness resumed. A time frame for either occurrence was not provided .
B) An ethanolic extract of ginseng was administered orally to female mice for 52 days in doses of 30 or 150 milligrams/kilogram/day (mg/kg/day) to determine the effect on neurotransmitters in the brain and adrenals. The higher dose significantly increased the activities of glutamate decarboxylase and GABA-transaminase in the brain and increased dopamine (p less than 0.001), but not norepinephrine or epinephrine, levels in the adrenals compared to controls. Dopamine and norepinephrine levels in the hypothalamus were not significantly changed at either dose .
C) A 42-year old woman had experienced refractory depression with no history of any manic or hypomanic episodes. She was started on phenelzine, escalating doses gradually to 45 milligrams per day (mg/day). The patient was taking ginseng during this time in an unspecified amount. The patient experienced relief from symptoms of depression, becoming very active and optimistic unlike her formerly introverted self. She invited strangers to her house for dinner, slept less, became irritable, and experienced tension headaches as well as vague visual hallucinations. She discontinued phenelzine with full return of depression. She resumed phenelzine to 45 mg/day without the desired therapeutic effect but did experience headaches. The authors report the patient was no longer taking ginseng "at this point" but did not specify the time of discontinuation .
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.
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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.