Linezolid with Sertraline Interaction Details
Brand Names Associated with Linezolid
- Linezolid
- Zyvox®
Brand Names Associated with Sertraline
- Sertraline
- Zoloft®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 13, 2023
Interaction Effect
An increased risk of serotonin syndrome (hypertension, tachycardia, hyperthermia, myoclonus, mental status changes)
Interaction Summary
Concurrent use of sertraline and an MAOI, such as linezolid, is contraindicated. Wait at least 14 days after discontinuing an MAOI intended to treat psychiatric disorders before initiating sertraline. Wait at least 14 days after discontinuing sertraline before initiating therapy with an MAOI intended to treat psychiatric disorders. If urgent treatment with linezolid is necessary in a patient receiving sertraline and alternatives are not available, promptly discontinue sertraline and then administer linezolid. 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. In the propensity score-matched cohort, there was no difference in the risk of serotonin syndrome in patients taking concomitant antidepressants and linezolid compared with patients not taking antidepressants. There was also no difference in the rate of altered mental status or confusion, hospitalization, or death from any cause between groups .
Severity
Contraindicated
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Concurrent use of sertraline and an MAOI, such as linezolid, is contraindicated. Wait at least 14 days after discontinuing an MAOI intended to treat psychiatric disorders before initiating sertraline. Wait at least 14 days after discontinuing sertraline before initiating therapy with an MAOI intended to treat psychiatric disorders. If urgent treatment with linezolid is necessary in a patient receiving sertraline and alternatives are not available, promptly discontinue sertraline and then administer linezolid.
Mechanism Of Interaction
Additive serotonergic effects
Literature Reports
A) In a retrospective cohort study in older adults who were prescribed oral linezolid 600 mg twice daily (N=1134), serotonin syndrome occurred in fewer than 6 patients (less than 0.5%) who were taking a concomitant antidepressant (n=215). In the propensity score-matched cohort (n=332), there was no difference in the risk of clinically significant serotonin syndrome in patients taking concomitant antidepressants and linezolid compared with patients taking linezolid without antidepressants (adjusted risk difference, -1.2%; 95% CI, -2.9% to 0.5%). There was also no difference in the rate of altered mental status or confusion, hospitalization, or death from any cause between groups. Patients were aged 66 years or older, and of those taking an antidepressant, 47.9% were taking an SSRI, 16.7% were taking an SNRI, 7% were taking a tricyclic antidepressant, 3.3% were taking a norepinephrine and dopamine reuptake inhibitor, and none were taking an MAOI .
B) Serotonin syndrome was reported in a 47-year-old woman on 2 occasions following the addition of linezolid 600 mg twice daily to her medication regimen (which included sertraline 100 mg daily) for the treatment of a stump wound infection after an above the knee amputation. On the first occasion, confusion, hypertension, and incoordination were noted following on day 4 of linezolid therapy; the symptoms subsided 4 days after vancomycin was substituted for linezolid. On the second occasion, delirium, confusion, myoclonus, and incoordination developed on day 9 of linezolid therapy despite sertraline being discontinued on day 1; cardiopulmonary arrest occurred, along with diarrhea and tachycardia, and left the patient in a coma with an anoxic brain injury. Linezolid was discontinued and cyproheptadine (a serotonin antagonist) was started, and within 4 days the tachycardia and diarrhea resolved. The patient subsequently died after not recovering from brain injury; the ventilator and dialysis were stopped .
C) A case of serotonin syndrome occurred in a patient who was prescribed linezolid and sertraline. A 45-year-old man with a history of schizoaffective disorder was admitted to the trauma service after an acute suicide attempt that resulted in a T6 level spinal cord injury and paraplegia. Pharmacotherapy with sertraline (200 mg daily) and risperiDONE (1 mg twice daily) was initiated after the patient was diagnosed with acute depression and psychosis. BuPROPion 75 mg twice daily, traZODone 50 mg every evening, and lithium 300 mg twice daily were added to his therapy. The patient underwent sacral flap closure with a bilateral gluteal myocutaneous flap and then developed a deep sacral decubitus ulcer. His temperature and WBC count remained elevated for several days. Culture of the ulcer revealed a vancomycin-resistant Enterococcus faecalis. He was started on linezolid 600 mg IV every 12 hours and metroNIDAZOLE 500 mg every 6 hours. Lithium was discontinued after the patient's lithium level was found to be elevated at 1.1 mEq/L. Ten days after linezolid therapy was initiated, the patient complained of increasing tremor, nausea, vomiting, diarrhea, and dry mouth. Sertraline, buPROPion, and traZODone were discontinued. His concurrent medications included baclofen, promethazine, docusate sodium, bisacodyl, megestrol, lansoprazole, and risperiDONE. The following day, the patient became delirious marked by acute confusion, visual hallucinations, and delusions. His temperature was elevated to 100.1 degrees F, pulse 101, respirations 20/min, and blood pressure 100/71 mmHg. He displayed coarse tremor and myoclonus. His pupils were dilated to 6 mm and minimally reactive. A diagnosis of serotonin syndrome was considered. Symptoms of serotonin syndrome resolved with cyproheptadine treatment .
D) In one case report, a 36-year-old man experienced symptoms of serotonin syndrome after concomitant treatment with linezolid and sertraline. The patient underwent an allogeneic stem cell transplant after receiving high-dose cycloPHOSphamide, total body irradiation, and antithymocyte globulin. His recovery was hindered by severe hemorrhagic cystitis, steroid-refractory graft-versus-host disease, thrombotic thrombocytic purpura, renal failure, and multiple pulmonary infections. On day 137, the patient received linezolid 600 mg IV every 12 hours. Current medications included tacrolimus, corticosteroids, thalidomide 100 mg daily, sertraline 50 mg daily, morphine, and ALPRAZolam. On day 5 of linezolid therapy, the patient experienced confusion, restlessness, delirium, and agitation. He developed hypertension and a high fever (40 degrees C). WBC and platelet counts began to diminish considerably. On day 6 of therapy, all medications with neurological effects were discontinued, including sertraline, thalidomide, ALPRAZolam, and morphine. The patient's symptoms subsided within a day. Thalidomide, ALPRAZolam, and morphine were reinstated with no reoccurrence of symptoms .
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.
Sertraline Overview
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Sertraline is used to treat depression, obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over), panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks), posttraumatic stress disorder (disturbing psychological symptoms that develop after a frightening experience), and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). It is also used to relieve the symptoms of premenstrual dysphoric disorder, including mood swings, irritability, bloating, and breast tenderness. Sertraline is in a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amounts 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.