Meperidine and Linezolid Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Meperidine
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
Increased risk of serotonin syndrome or opioid toxicity
Interaction Deep Dive
Coadministration of meperidine with MAOIs may result in severe and possibly fatal reactions; serotonin syndrome and opioid toxicity (coma, severe respiratory depression, cyanosis, and hypotension) 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 contraindicated23. Isolated cases of a syndrome characterized by coma, hyperpyrexia, and cardiac instability have been reported with the use of MAOIs and meperidine for emergency or elective surgery 561. Based upon a literature, it is suggested that morphine is the narcotic analgesic of choice in patients receiving MAOIs and requiring emergency or elective surgery 1.
Why it happens (mechanism)
Additive serotonergic effects
Literature reports
4 reports — tap to read
a) 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 1. 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 5671. 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 8.
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 9.
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 10.
d) Cases of serotonin syndrome, a potentially life-threatening condition, have been reported during concomitant use of meperidine Injection with serotonergic drugs such as MAOI 2.
Common questions
Can I take Meperidine and Linezolid Injection together?
Increased risk of serotonin syndrome or opioid toxicity Always confirm with your pharmacist or prescriber before making any change.
How serious is the Meperidine 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 "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Meperidine 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 (10)
- Stack CG, Rogers P, & Linter SP: Monoamine oxidase inhibitors and anaesthesia. Br J Anaesth 1988; 60:222-227. DOI
- Product Information: MEPERGAN intramuscular, intravenous injection, meperidine HCl, promethazine HCl intramuscular, intravenous injection. West-Ward Pharmaceuticals Corp (per FDA), Eatontown, NJ, 2023.
- Product Information: DEMEROL(R) oral tablets, oral solution, meperidine HCl oral tablets, oral solution. Validus Pharmaceuticals LLC (per FDA), Parsippany, NJ, 2023. DailyMed
- Product Information: Demerol(TM) intramuscular, subcutaneous, intravenous injection, meperidine HCl intramuscular, subcutaneous, intravenous injection. Hospira Inc (per FDA), Lake Forest, IL, 2022.
- Shee JC: Dangerous potentiation of pethidine by iproniazid and its treatment. Br Med J 1960; 2:507-509. PubMed
- Evans-Prosser CDG: The use of pethidine and morphine in the presence of monoamine oxidase inhibitors. Br J Anaesth 1968; 40:279-282. DOI
- Jounela AJ & Kivimaki T: Possible sensitivity to meperidine in phenyl-ketonuria (letter). N Engl J Med 1973; 288:1411.
- Product Information: Furoxone(R), furazolidone. Roberts Pharmaceutical Corp. Eatontown, NJ, 1994. DailyMed
- Das PK, Warkentin DI, Hewko R, et al: Serotonin syndrome after concomitant treatment with linezolid and meperidine. Clin Infect Dis 2008; 46(2):264-265. PubMed
- Gillman PK: Possible serotonin syndrome with moclobemide and pethidine (letter). Med J Aust 1995; 162:554. PubMed
Keep reading about Meperidine
Keep reading about Linezolid Injection
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