Linezolid-Associated Serotonin Syndrome After Concomitant Treatment With Citalopram and Mirtazepine in a Critically Ill Bone Marrow Transplant Recipient

Abstract

Linezolid was initially discovered as an antidepressant because of its effect on blocking intracellular metabolism of serotonin, norepinephrine, and other biogenic amines. As time passed, it was realized that linezolid possessed antibacterial activity, and linezolid has been developed and marketed as such. In medicine we are quick to categorize drugs into specific classes as a mechanism to recall indication and use. By classifying linezolid as an antibacterial, it is common to forget about its antidepressant roots. A case report involving linezolid with citalopram and mirtazepine in the precipitation of serotonin syndrome in a critically ill bone marrow transplant patient is described in this article.

Potential drug–drug interactions in a medical intensive care unit of a university hospital

“…In earlier case reports concurrent use of antipsychotics and antidepressants such as linezolid and mirtazapine or sertraline was reported to lead to a life-threatening state, the serotonin syndrome (16,17). Because linezolid can block the intracellular metabolism of amines, it can interact with agents acting on amines such as serotonin or noradrenalin in neuronal synapses and can induce a lethal serotonin syndrome.…”

The interplay between depression and tuberculosis

“…Aditionally, one study conducted in Peru showed that psychotherapy with adjunctive psychotropic medications in the anti‐TB treatment of patients with MDR‐TB resulted in improved treatment adherence, completion, and social rehabilitation compared to patients treated with anti‐TB treatment alone . Today, linezolid is an effective first‐line anti‐TB treatment that has been reported as a monoamine oxidase inhibitor with antidepressant properties …”

Linezolid Is Associated with Serotonin Syndrome in a Patient Receiving Amitriptyline, and Fentanyl: A Case Report and Review of the Literature

“…Linezolid is a totally synthetic compound that was initially synthesized as a reversible MAO inhibitor class antidepressant [29]. …”

“…Interactions have been found with the selective serotonin reuptake inhibitors (SSRIs) as citalopram [29, 33–39], escitalopram [34], paroxetine [40], fluoxetine [41, 42], sertraline [43–45], with tryptophan, a precursor of serotonin [46], with noradrenaline and specific serotonergic agents (NaSSA) as mirtazapine [29], with serotonin 2 antagonist/reuptake inhibitor (SARI) as trazodone [36], the azapirone category anxiolytic buspirone that is a serotonin 1A partial agonist and serotonin stabilizer [47], the dual serotonin and noradrenaline reuptake inhibitors (SNRIs) as the antidepressants venlafaxine [36, 48–51] and duloxetine [52], and the tricyclic antidepressant (TCA) imipramine [49]. Although amitriptyline [14, 53–56] and fentanyl [57–64] have been both involved in serotonin syndrome, no case has been reported involving their combination.…”