Linezolid

Linezolid Brand Name– Zyvox

What is Linezolid

Linezolid is a synthetic oxazolidinone antibiotic.

It is indicated for gram-positive infections and is approved for the treatment of bacterial pneumonia, skin and skin structure infections, and for vancomycin-resistant enterococcal (VRE) infections, including infections due to susceptible organisms which are complicated by bacteremia.

The drug provides an alternative to vancomycin, particularly in inpatient settings. In April 2001, scientists reported that linezolid-resistant VRE organisms were being discovered in various institutions.

Inappropriate use of linezolid leading to an increase in resistant organisms is a concern, and treatment alternatives should be carefully considered prior to using linezolid in outpatient settings.

As of March 16, 2007, the FDA is evaluating preliminary results of an open-label, randomized trial comparing linezolid to vancomycin, oxacillin, and dicloxacillin for catheter-related bloodstream infections including catheter-site infections. It was reported that, for linezolid-treated patients, there was a higher chance of death than with any of the comparator agents and the chance of death was related to the type of organism causing the infection.

In the linezolid arm of the study, mortality was higher in patients infected with gram negative bacteria alone, in patients infected with both gram positive and gram negative bacteria, and in patients who had no observed infection when enrolled in the study. No difference in mortality was noted in linezolid-treated patients with only gram positive infections.

Linezolid is not approved for treating gram-negative infections, catheter-related bloodstream infections, or catheter-site infections.

Health care providers are also advised that linezolid is a non-selective inhibitor of monoamine oxidase (MAO), a property that has potential implications for medication safety and drug interactions.

Final FDA approval for linezolid use in adults was granted in April 2000; FDA-approval for use in pediatric patients was granted in December 2002.

Indications

  1. anthrax
  2. bacteremia
  3. bone and joint infections
  4. brain abscess
  5. cellulitis
  6. community-acquired pneumonia
  7. diabetic foot ulcer
  8. endocarditis
  9. Enterococcus faecalis
  10. Enterococcus faecium
  11. febrile neutropenia
  12. infectious arthritis
  13. meningitis
  14. nosocomial pneumonia
  15. orthopedic device-related infection
  16. osteomyelitis
  17. Pasteurella multocida
  18. pneumonia
  19. sepsis
  20. skin and skin structure infections
  21. Staphylococcus aureus (MRSA)
  22. Staphylococcus aureus (MSSA)
  23. Staphylococcus epidermidis
  24. Staphylococcus haemolyticus
  25. Streptococcus agalactiae (group B streptococci)
  26. Streptococcus pneumoniae
  27. Streptococcus pyogenes (group A beta-hemolytic streptococci)
  28. subdural empyema
  29. tuberculosis infection
  30. vancomycin-resistant enterococci (VRE)
  31. ventriculitis
  32. Viridans streptococci

Side Effects

  1. abdominal pain
  2. anaphylactic shock
  3. anaphylactoid reactions
  4. anemia
  5. angioedema
  6. blurred vision
  7. bullous rash
  8. candidiasis
  9. diarrhea
  10. dizziness
  11. dysgeusia
  12. elevated hepatic enzymes
  13. eosinophilia
  14. headache
  15. hypertension
  16. hypoglycemia
  17. lactic acidosis
  18. leukopenia
  19. nausea
  20. neuroleptic malignant syndrome-like symptoms
  21. optic neuritis
  22. pancytopenia
  23. peripheral neuropathy
  24. pruritus
  25. pseudomembranous colitis
  26. rash
  27. seizures
  28. serotonin syndrome
  29. sideroblastic anemia
  30. Stevens-Johnson syndrome
  31. superinfection
  32. thrombocytopenia
  33. tongue discoloration
  34. tooth discoloration
  35. toxic epidermal necrolysis
  36. vertigo
  37. visual impairment
  38. vomiting

Monitoring Parameters

  • CBC with differential
  • ophthalmologic exam

Contraindications

  • alcoholism
  • bone marrow suppression
  • breast-feeding
  • children
  • colitis
  • diabetes mellitus
  • diarrhea
  • geriatric
  • GI disease
  • hypertension
  • hyperthyroidism
  • hypoglycemia
  • infants
  • infertility
  • inflammatory bowel disease
  • MAOI therapy
  • neonates
  • optic neuritis
  • phenylketonuria
  • pheochromocytoma
  • pregnancy
  • premature neonates
  • pseudomembranous colitis
  • radiographic contrast administration
  • seizure disorder
  • seizures
  • spinal anesthesia
  • surgery
  • thyrotoxicosis
  • ulcerative colitis

Interactions

  • Acebutolol
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Codeine
  • Acetaminophen; Dextromethorphan
  • Acetaminophen; Dextromethorphan; Doxylamine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Guaifenesin; Phenylephrine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Pentazocine
  • Acetaminophen; Pseudoephedrine
  • Acetaminophen; Tramadol
  • Acetohexamide
  • Aclidinium; Formoterol
  • Acrivastine; Pseudoephedrine
  • Albiglutide
  • Albuterol
  • Albuterol; Ipratropium
  • Alfentanil
  • Alogliptin
  • Alogliptin; Metformin
  • Alogliptin; Pioglitazone
  • Amitriptyline
  • Amitriptyline; Chlordiazepoxide
  • Amoxapine
  • Amphetamines
  • Arformoterol
  • Armodafinil
  • Articaine; Epinephrine
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Oxycodone
  • Atenolol
  • Atenolol; Chlorthalidone
  • Atomoxetine
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Atropine; Difenoxin
  • Atropine; Diphenoxylate
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Bendroflumethiazide; Nadolol
  • Benzhydrocodone; Acetaminophen
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Beta-adrenergic blockers
  • Beta-agonists
  • Betaxolol
  • Bisoprolol
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • Brimonidine
  • Brimonidine; Brinzolamide
  • Brimonidine; Timolol
  • Bromocriptine
  • Brompheniramine; Carbetapentane; Phenylephrine
  • Brompheniramine; Dextromethorphan; Guaifenesin
  • Brompheniramine; Dextromethorphan; Phenylephrine
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
  • Budesonide; Formoterol
  • Buprenorphine
  • Buprenorphine; Naloxone
  • Bupropion
  • Bupropion; Naltrexone
  • Buspirone
  • Caffeine
  • Caffeine; Ergotamine
  • Canagliflozin; Metformin
  • Carbamazepine
  • Carbetapentane; Chlorpheniramine
  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbetapentane; Pyrilamine
  • Carbidopa; Levodopa
  • Carbidopa; Levodopa; Entacapone
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Phenylephrine
  • Carbinoxamine; Pseudoephedrine
  • Carteolol
  • Carvedilol
  • Cetirizine; Pseudoephedrine
  • Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
  • Chlophedianol; Guaifenesin; Phenylephrine
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dextromethorphan
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Chlorpropamide
  • Citalopram
  • Clomipramine
  • Cocaine
  • Codeine
  • Codeine; Guaifenesin
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • COMT inhibitors
  • Cyclobenzaprine
  • Dapagliflozin; Metformin
  • Dapagliflozin; Saxagliptin
  • Desipramine
  • Desloratadine; Pseudoephedrine
  • Desvenlafaxine
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dexmethylphenidate
  • Dextromethorphan
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Guaifenesin
  • Dextromethorphan; Guaifenesin; Phenylephrine
  • Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
  • Dextromethorphan; Guaifenesin; Pseudoephedrine
  • Dextromethorphan; Promethazine
  • Dextromethorphan; Quinidine
  • Dienogest; Estradiol valerate
  • Diethylpropion
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Dihydroergotamine
  • Dipeptidyl Peptidase-4 Inhibitors
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Phenylephrine
  • Dobutamine
  • Dolasetron
  • Dopamine
  • Dorzolamide; Timolol
  • Doxepin
  • Drospirenone
  • Drospirenone; Estradiol
  • Drospirenone; Ethinyl Estradiol
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Droxidopa
  • Dulaglutide
  • Duloxetine
  • Elagolix; Estradiol; Norethindrone acetate
  • Empagliflozin; Linagliptin
  • Empagliflozin; Linagliptin; Metformin
  • Empagliflozin; Metformin
  • Entacapone
  • Ephedrine
  • Epinephrine
  • Ergoloid Mesylates
  • Ergonovine
  • Ergot alkaloids
  • Ergotamine
  • Ertugliflozin; Metformin
  • Ertugliflozin; Sitagliptin
  • Escitalopram
  • Esmolol
  • Estradiol; Levonorgestrel
  • Estradiol; Norethindrone
  • Estradiol; Norgestimate
  • Ethanol
  • Ethinyl Estradiol
  • Ethinyl Estradiol; Desogestrel
  • Ethinyl Estradiol; Ethynodiol Diacetate
  • Ethinyl Estradiol; Etonogestrel
  • Ethinyl Estradiol; Levonorgestrel
  • Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
  • Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
  • Ethinyl Estradiol; Norelgestromin
  • Ethinyl Estradiol; Norethindrone
  • Ethinyl Estradiol; Norethindrone Acetate
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Ethinyl Estradiol; Norgestimate
  • Ethinyl Estradiol; Norgestrel
  • Exenatide
  • Fenfluramine
  • Fentanyl
  • Fexofenadine; Pseudoephedrine
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Fluvoxamine
  • food
  • Formoterol
  • Formoterol; Mometasone
  • Fosphenytoin
  • Ginseng, Panax ginseng
  • Glimepiride
  • Glimepiride; Pioglitazone
  • Glimepiride; Rosiglitazone
  • Glipizide
  • Glipizide; Metformin
  • Glyburide
  • Glyburide; Metformin
  • Glycopyrrolate; Formoterol
  • Granisetron
  • Green Tea
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Guaifenesin; Phenylephrine
  • Guaifenesin; Pseudoephedrine
  • Guanabenz
  • Homatropine; Hydrocodone
  • Hydrochlorothiazide, HCTZ; Methyldopa
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydromorphone
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Imipramine
  • Incretin Mimetics
  • Indacaterol
  • Indacaterol; Glycopyrrolate
  • Insulin Degludec; Liraglutide
  • Insulin Glargine; Lixisenatide
  • Insulins
  • Iobenguane I 131
  • Isoniazid, INH
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Isoproterenol
  • Labetalol
  • Lasmiditan
  • Leuprolide; Norethindrone
  • Levalbuterol
  • Levobetaxolol
  • Levobunolol
  • Levodopa
  • Levomilnacipran
  • Levonorgestrel
  • Levorphanol
  • Linagliptin
  • Linagliptin; Metformin
  • Liraglutide
  • Lithium
  • Lixisenatide
  • Loratadine; Pseudoephedrine
  • Lorcaserin
  • Maprotiline
  • Meglitinides
  • Meperidine
  • Meperidine; Promethazine
  • Mestranol; Norethindrone
  • Metaproterenol
  • Metformin
  • Metformin; Pioglitazone
  • Metformin; Repaglinide
  • Metformin; Rosiglitazone
  • Metformin; Saxagliptin
  • Metformin; Sitagliptin
  • Methadone
  • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
  • Methyldopa
  • Methylene Blue
  • Methylergonovine
  • Methylphenidate
  • Methysergide
  • Metoclopramide
  • Metoprolol
  • Midodrine
  • Milnacipran
  • Mirtazapine
  • Modafinil
  • Morphine
  • Morphine; Naltrexone
  • Nadolol
  • Nalbuphine
  • Naproxen; Pseudoephedrine
  • Nateglinide
  • Nebivolol
  • Nebivolol; Valsartan
  • Nefazodone
  • Netupitant, Fosnetupitant; Palonosetron
  • Norepinephrine
  • Norethindrone
  • Norgestrel
  • Nortriptyline
  • Olodaterol
  • Ondansetron
  • Oral Contraceptives
  • Oxycodone
  • Oxymorphone
  • Ozanimod
  • Palonosetron
  • Paroxetine
  • Penbutolol
  • Pentazocine
  • Pentazocine; Naloxone
  • Pergolide
  • Perphenazine; Amitriptyline
  • Phendimetrazine
  • Phenobarbital
  • Phentermine
  • Phentermine; Topiramate
  • Phenylephrine
  • Phenylephrine; Promethazine
  • Phenytoin
  • Pindolol
  • Pioglitazone
  • Pirbuterol
  • Pramlintide
  • Prilocaine; Epinephrine
  • Primidone
  • Procarbazine
  • Propranolol
  • Protriptyline
  • Pseudoephedrine
  • Racepinephrine
  • Rasagiline
  • Remifentanil
  • Repaglinide
  • Reserpine
  • Rifampin
  • Ritodrine
  • Rosiglitazone
  • Safinamide
  • Salmeterol
  • Saxagliptin
  • Segesterone Acetate; Ethinyl Estradiol
  • Semaglutide
  • Serotonin-Receptor Agonists
  • Sertraline
  • Sibutramine
  • Simvastatin; Sitagliptin
  • Sitagliptin
  • Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
  • St. John’s Wort, Hypericum perforatum
  • Sufentanil
  • Sulfonylureas
  • Tapentadol
  • Terbutaline
  • Tetrahydrozoline
  • Thiazolidinediones
  • Timolol
  • Tiotropium; Olodaterol
  • Tolazamide
  • Tolbutamide
  • Tolcapone
  • Tramadol
  • Trazodone
  • Trimipramine
  • Umeclidinium; Vilanterol
  • Valerian, Valeriana officinalis
  • Venlafaxine
  • Vilazodone
  • Vortioxetine
  • Yohimbine
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