Linezolid-Induced Near-Fatal Serotonin Syndrome During Escitalopram Therapy: Case Report and Review of Literature

Kulkarni, Ranganath R.; Kulkarni, Pratibha R.

doi:10.4103/0253-7176.122245

Cited by 15 publications

(16 citation statements)

References 28 publications

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“…A large number of case reports in the literature have reported SS with the use of linezolid. In some of these reported cases, SS developed when linezolid was either used in combination with antidepressants[ 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ] or used alone. [ 21 ] The index case developed SS in the absence of the use of concomitant antidepressants, and fulfilled the criteria of SS, as per both Sternbach's and Boyer's criteria for SS.…”

Section: Discussionmentioning

confidence: 99%

Linezolid-induced serotonin syndrome

et al. 2020

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Linezolid is an oxazolidinone antibiotic, which is a weak, reversible, nonselective monoamine oxidase A and B inhibitor; is known to increase serotonin levels, and has been implicated in the development of serotonin syndrome (SS). There is limited literature on the development of SS with linezolid, when used alone. In this report, we present the case of a 70-year-old female who developed features of SS while being treated with linezolid 600 mg twice daily for pneumonia. The SS in her case was managed with stoppage of linezolid, administration of cyproheptadine, and supportive measures.

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Section: Discussionmentioning

confidence: 99%

Linezolid-induced serotonin syndrome

et al. 2020

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“…A few hours later, the first signs of improvement were noted and 48 hours later, the ventilator was weaned. The patient was discharged home on her home dose of escitalopram 9. Another case occurred in a 56-year-old woman who recently discontinued another SSRI, paroxetine and was initiated on linezolid for a surgical wound infection.…”

Section: Discussionmentioning

confidence: 99%

Linezolid-associated serotonin toxicity after escitalopram discontinuation: concomitant drug considerations

Khoury¹,

Runnstrom

Ebied

et al. 2018

BMJ Case Reports

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We report a case of a hospitalised patient who developed probable serotonin toxicity shortly after the initiation of linezolid in whom the selective serotonin reuptake inhibitor (SSRI) escitalopram had been recently discontinued. On day 2 of linezolid administration, the patient reported severe anxiety and was observed to have full body jerking and twitching motions without mental status change. Notably, the patient was concomitantly receiving the antidepressant, trazodone and the benzodiazepine, clonazepam possibly affecting the severity and manifestations of serotonin toxicity. Linezolid was discontinued after 5 days and the patient’s symptoms resolved. Serotonin toxicity can present with an array of symptoms and be life threatening if left unrecognised. This report highlights the clinical lessons that discontinuation of an SSRI upon initiation of linezolid does not eliminate the risk of serotonin toxicity and that other concomitant medications may worsen or improve some of the symptoms lending delay and uncertainty to the diagnosis.

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“…In addition, due to the patient’s medication history, there was a potential for drug–drug interactions with the patient’s prescribed antipsychotic medication, which included an SSRI and linezolid. Case reports have cautioned against the use of this combination as near-fatal serotonin syndrome has been reported with linezolid’s inhibition of MAO-A and B [ 22 ]. Therefore, ceftaroline was initiated using the 600 mg dose at an 8-h dosing schedule, administered as a 2-h infusion, to maximize the PK/PD of the cephalosporin class (i.e., time-dependent killing) and allowing for infusion of other IV medications simultaneously.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA) Pneumonia with Ceftaroline Fosamil in a Patient with Inhalational Thermal Injury

et al. 2015

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A 48-year-old female, who was found unresponsive and suffered inhalation injury secondary to a house fire, was transferred to our burn center for definitive treatment. Post tracheostomy, the patient became febrile and tachycardic. On hospital day (HD) 5, the patient expressed thick yellow secretions during suctioning and diffuse rhonchi was noted on physical exam. Blood cultures and a culture from the broncheo-alvelolar lavage grew Gram-positive cocci in clusters and the patient was started on empiric vancomycin. Despite aggressive vancomycin dosing (1750 mg intravenously every 6 h), the patient’s status continued to deteriorate. The organism was identified as methicillin-resistant Staphylococcus aureus (MRSA) with a vancomycin minimum inhibitory concentration (MIC) of 2 mg/L. Based on the potential for drug–drug interactions with linezolid, the patient was started on ceftaroline fosamil (MIC = 0.5 mg/L) 600 mg intravenously every 8 h with a prolonged 2-h infusion to anticipate suboptimal concentrations secondary to thermal burn injury. Post change in antibiotic therapy, a rapid clinical improvement was observed with the patient becoming afebrile at 48 h after initiation of ceftaroline. The patient completed a total of 14 days of ceftaroline therapy and was subsequently weaned from the ventilator on HD 22 and decannulated 2 days later. To our knowledge, this is the first report of the use of ceftaroline for the treatment of MRSA pneumonia in a patient with thermal injury.Electronic supplementary materialThe online version of this article (doi:10.1007/s40121-015-0096-4) contains supplementary material, which is available to authorized users.

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Linezolid-Induced Near-Fatal Serotonin Syndrome During Escitalopram Therapy: Case Report and Review of Literature

Cited by 15 publications

References 28 publications

Linezolid-induced serotonin syndrome

Linezolid-induced serotonin syndrome

Linezolid-associated serotonin toxicity after escitalopram discontinuation: concomitant drug considerations

Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA) Pneumonia with Ceftaroline Fosamil in a Patient with Inhalational Thermal Injury

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