Risperidone with Linezolid Interaction Details

Brand Names Associated with Risperidone

Brand Names Associated with Linezolid

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 13, 2023

Interaction Effect

Increased risk of serotonin syndrome

Interaction Summary

In a review of post-marketing data, 1 case of serotonin toxicity was reported with the concurrent use of linezolid and risperiDONE, which was coadministered with other serotonergic agents . RisperiDONE, in combination with other serotonergic agents, has been associated with the serotonin syndrome . There have been spontaneous reports of serotonin syndrome associated with concomitant use of linezolid and serotonergic agents . Although coadministration of linezolid and serotonergic agents did not result in serotonin syndrome in phase 1, 2, or 3 clinical trials, linezolid is a reversible, non-selective MAOI and can potentially interact with serotonergic agents, precipitating the serotonin syndrome. If concurrent use of linezolid and a serotonergic agent is clinically warranted, monitor patients closely for signs and symptoms of serotonin syndrome. Consider discontinuing either one or both agents if these symptoms occur, keeping in mind that discontinuation of the concomitant serotonergic agent may result in associated discontinuation symptoms .

Severity

Major

Onset

Unspecified

Evidence

Probable

How To Manage Interaction

Serotonin toxicity has been reported in 1 individual with the concurrent use of linezolid and risperiDONE, which was coadministered with other serotonergic agents. If concurrent use of linezolid and risperiDONE, particularly with additional serotonergic agents, is clinically necessary, monitor patients closely for signs and symptoms of serotonin syndrome, such as neuromuscular abnormalities (including hyper-reflexia, tremor, muscle rigidity, clonus, peripheral hypertonicity, and shivering), autonomic hyperactivity (including tachycardia, mydriasis, diaphoresis, and diarrhea), and mental status changes (including agitation and delirium). Serotonin syndrome can be life-threatening. If serotonin syndrome develops, discontinue the offending agents and provide supportive care and other therapy as necessary . Keep in mind that discontinuation of the concomitant serotonergic agent may result in associated discontinuation symptoms .

Mechanism Of Interaction

Inhibition of serotonin metabolism by monoamine oxidase

Literature Reports

A) In a review of post-marketing data, one case of serotonin toxicity was reported in the concurrent use of linezolid and risperiDONE, which was coadministered with other serotonergic agents. A review was conducted of post-marketing adverse events reported to the US Food and Drug Administration's Adverse Event Reporting System (AERS) database between November 1997 and September 2003 regarding serotonin toxicity with linezolid use. A serotonin toxicity case was defined as having: (a) linezolid as the primary suspect drug, (b) concomitant administration of 1 or more secondary suspect drug with CNS serotonergic activity, and (c) serotonin toxicity, as defined by the modified Hunter Serotonin Toxicity Criteria or by the reporter of the adverse event. A total of 29 cases were identified (age range 17 to 83 years), where linezolid was used concomitantly with 1 drug (n=20), with 2 drugs (n=6), and with 3 or more drugs (n=3). While SSRIs were the most common class of drugs received concomitantly with linezolid (n=26), other drug classes included tricyclic antidepressants (n=6), and atypical antidepressants (n=4). Additionally, drugs used concurrently included carbidopa-levodopa (n=2), dextromethorphan (n=1), lithium (n=1), metoclopramide (n=1), risperiDONE (n=1), and traMADol (n=1). Symptoms of serotonin toxicity included tremor, fever, seizure, clonus, sweating, agitation, akathesia, rigors, twitching, and muscle rigidity. Intervention including hospitalization was required in 13 patients, and 3 deaths were reported with concurrent SSRI use. For the 1 case identified with the concurrent use linezolid and risperiDONE, additional coadministered serotonergic drugs included bupropion, sertraline and trazodone .

Risperidone Overview

• Risperidone is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions) in adults and teenagers 13 years of age and older. It is also used to treat episodes of mania (frenzied, abnormally excited, or irritated mood) or mixed episodes (symptoms of mania and depression that happen together) in adults and in teenagers and children 10 years of age and older with bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Risperidone is also used to treat behavior problems such as aggression, self-injury, and sudden mood changes in teenagers and children 5 to 16 years of age who have autism (a condition that causes repetitive behavior, difficulty interacting with others, and problems with communication). Risperidone is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.

Linezolid Overview

• 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.

• 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:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

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.