Comparative Evaluation of Serotonin Toxicity among Veterans Affairs Patients Receiving Linezolid and Vancomycin

Abstract

. Matching criteria included VISN-2 hospital, hospital ward, prior hospital length of stay, age, and baseline platelet counts. The patients' electronic medical records were evaluated for symptoms consistent with ST and the Hunter serotonin toxicity criteria (HSTC) using an intensive, natural word search algorithm. The study included 251 matched pairs. Demographics and comorbidities were similar between groups. Over half of the study population received at least one concurrent medication with serotonergic activity. Receipt of agents with serotonergic activity was more pronounced in the vancomycin group, and the higher frequency was due to concomitant antihistamine and antiemetic use. Antidepressant use, including selective serotonin reuptake inhibitors (SSRIs), was similar between groups. No patients in either group were found to meet the criteria using the word search algorithm for ST. Fewer linezolid patients than vancomycin patients met the HSTC overall (3.2% versus 8.8%) and when stratified by receipt of a concurrent serotonergic agent (4.3% versus 12.4%). Of the patients meeting the HSTC, most had past or present comorbidities that may have contributed to or overlapped the HSTC. This study of hospitalized patients revealed comparably low frequencies of adverse events potentially related to ST among patients who received linezolid or vancomycin.

Contemporary Pharmacotherapies for Nontuberculosis Mycobacterial Infections: A Narrative Review

“…Linezolid has reversible, weak inhibitory properties against monoamine oxidase, which led to labeling precautions for serotonin syndrome when it is combined with other serotonergic agents and for hypertensive crisis with tyramine-rich foods. Serotonin syndrome risk, although low overall, may increase with concomitant administration of serotonergic agents and according to their serotonergic potential [50][51][52].…”

A Case Series on Serotonin Syndrome from Concomitant use of linezolid With Methadone, Buprenorphine, and/or Dextroamphetamine

“…1,[11][12][13] Studies, thus far, have evaluated the risk of concomitant administration of linezolid with mainly SSRI and SNRIs. 13,14,[18][19][20] More recently, cases of SS have been reported from concurrent use of linezolid with non-SSRI or SNRI agents, such as methadone and fentanyl. [14][15][16][17] Linezolid has high oral bioavailability and reliable coverage against methicillin-resistant Staphylococcus aureus as well as other Gram-positive species.…”