Linezolid with Meperidine Interaction Details
Brand Names Associated with Linezolid
- Linezolid
- Zyvox®
Brand Names Associated with Meperidine
- Demerol®
- Isonipecaine
- Meperidine
- Pethidine
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 13, 2023
Interaction Effect
Increased risk of serotonin syndrome or opioid toxicity
Interaction Summary
Coadministration of meperidine with MAOIs may result in severe and possibly fatal reactions; symptoms resembling acute narcotic overdose have occurred, and serotonin syndrome may occur. Other reactions included hyperexcitability, convulsions, tachycardia, fever, and hypertension. Therefore, concomitant administration of meperidine and MAOIs, or meperidine administration within 14 days of receiving an MAOI, is contraindicated. Isolated cases of a syndrome characterized by coma, hyperpyrexia, and cardiac instability (sometimes fatal) have been reported in association with the use of MAO inhibitors and meperidine in patients undergoing emergency or elective surgery . Based upon a critical review of the literature, it is suggested that morphine is the narcotic analgesic of choice in patients receiving MAOIs and requiring emergency or elective surgery .
Severity
Contraindicated
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Concomitant administration of meperidine and MAOIs, or meperidine administration within 14 days of receiving an MAOI, is contraindicated due to increased risk of unpredictable, severe, and sometimes fatal reactions in addition to increased risk of serotonin syndrome and opioid toxicity.
Mechanism Of Interaction
Additive serotonergic effects
Literature Reports
A) Coadministration of meperidine with MAOIs may result in severe and possibly fatal reactions; symptoms resembling acute narcotic overdose have occurred, and serotonin syndrome may occur. Other reactions included hyperexcitability, convulsions, tachycardia, fever, and hypertension . Based upon a critical review of the literature, it is suggested that morphine is the narcotic analgesic of choice in patients receiving MAOIs and requiring emergency or elective surgery . Isolated cases of a syndrome characterized by coma, hyperpyrexia, and cardiac instability (sometimes fatal) have been reported in association with the use of MAO inhibitors and meperidine in patients undergoing emergency or elective surgery . Inhibition of monoamine oxidase by furazolidone has been demonstrated in man when administered in recommended doses for 5 days. However, no cases of hypertensive crisis have been reported with the use of furazolidone in doses of 400 mg daily for more than 48 months .
B) A 27-year-old male patient with a diagnosis of acute myeloid leukemia experienced serotonin syndrome-like symptoms following concomitant use of linezolid and meperidine, which were given after high-dose chemotherapy resulting in febrile neutropenia after broad-spectrum antibiotics failed to resolve the febrile condition. The patient was premedicated with intravenous meperidine 25 mg, before and halfway through daily liposomal amphotericin B administration, for amphotericin-associated rigors. After 6 days of amphotericin B treatment, fever persisted and linezolid was initiated following positive stool cultures for vancomycin-resistant enterococcus. Two hours after the third linezolid dose and 30 minutes after meperidine was administered, the patient experienced marked psychomotor agitation, trembling with myoclonus, paranoid ideation, and transient visual hallucinations. The patient had a temperature of 40.5 degrees Celsius, a respiratory rate of 26 breaths/minute, a heart rate of 120 beats/minute, and a blood pressure of 124/50 mm Hg. Meperidine was discontinued and methotrimeprazine hydrochloride was given to treat the agitation. Neuropsychiatric symptoms abated within 2 hours, and the patient defervesced following broad-spectrum antimicrobial therapy .
C) A case of serotonin syndrome was reported in a 73-year-old woman being treated with moclobemide 750 mg daily, in addition to nortriptyline 100 mg and lithium 750 mg every night. Seven months after the initiation of antidepressant therapy, the patient presented to the hospital with abdominal pain. After treatment with pethidine (meperidine) 75 mg, the patient became confused, restless, diaphoretic, and developed myoclonus, indicating serotonin syndrome; these symptoms, disappeared after withdrawal of pethidine. Although blood analysis revealed lithium levels of 1.2 mmol/L and nortriptyline levels of 500 mcg/L, the patient had been stable on these doses for months, indicating that pethidine was the precipitating cause of the patient's reaction .
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.
Meperidine Overview
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Meperidine is used to relieve moderate to severe pain. Meperidine is in a class of medications opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain.
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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.