Linezolid-associated serotonin toxicity: a systematic review

Adverse reactions caused by high serum concentration of linezolid: Two case reports and literature review

“…This syndrome is a disease of the central nervous system, and its clinical manifestations include altered mental status, ataxia, restlessness, lower extremity hyperreflexia, and sweating, which can progress to severe symptoms such as confusion, seizures, shock, coma, and death 13 . Linezolid has been reported to cause serotonin syndrome in combination with antipsychotic drugs such as venlafaxine, citalopram, paroxetine, sertraline, and fluoxetine, and opioids such as fentanyl, pethidine, and methadone 14 . The diagnostic criteria for serotonin syndrome comprise the use of serotonin medications and the following: spontaneous clonus, induced clonus plus restlessness or sweating, ocular clonus plus restlessness or sweating, tremor plus hyperreflexia, and hypertension plus a temperature of <38°C combined with ocular clonus or induced clonus 15 .…”

“…13 Linezolid has been reported to cause serotonin syndrome in combination with antipsychotic drugs such as venlafaxine, citalopram, paroxetine, sertraline, and fluoxetine, and opioids such as fentanyl, pethidine, and methadone. 14 The diagnostic criteria for serotonin syndrome comprise the use of serotonin medications and the following: spontaneous clonus, induced clonus plus restlessness or sweating, ocular clonus plus restlessness or sweating, tremor plus hyperreflexia, and hypertension plus a temperature of <38°C combined with ocular clonus or induced clonus. 15 The patient developed dizziness, slurred speech, and limb tremor after 5 days of linezolid use.…”

Pharmacotherapeutic Considerations in the Treatment of Nontuberculous Mycobacterial Infections: A Primer for Clinicians

“…This inhibition blocks oxidative deamination to cause the accumulation of endogenous catecholamines (serotonin and norepinephrine). Combining linezolid with serotonergic or adrenergic agents, or tyramine-containing foods, can lead to increased blood pressure or the rare occurrence of serotonin syndrome [ 94 , 95 ]. Of note, contemporary data suggest an incidence of linezolid-associated serotonin syndrome well below 1%, even when co-administered alongside other agents with serotonergic activity [ 94 ].…”

“…Combining linezolid with serotonergic or adrenergic agents, or tyramine-containing foods, can lead to increased blood pressure or the rare occurrence of serotonin syndrome [ 94 , 95 ]. Of note, contemporary data suggest an incidence of linezolid-associated serotonin syndrome well below 1%, even when co-administered alongside other agents with serotonergic activity [ 94 ]. Tedizolid is a newer oral oxazolidinone believed to have an even lower risk of these interactions due to its weaker MAO inhibition and lower central nervous system penetration [ 97 ].…”