Linezolid is a weak, reversible monoamine oxidase inhibitor. Combined with SSRIs, SNRIs, tramadol or other serotonergic drugs it can cause serotonin syndrome, so review the drug list before starting it.
Myelosuppression, particularly thrombocytopenia, becomes more likely with courses beyond about two weeks, so check a full blood count weekly on longer courses. Prolonged use also carries a risk of peripheral and optic neuropathy and lactic acidosis.
- Review for serotonergic co-medication before the first dose.
- Check a full blood count weekly when a course goes beyond two weeks.
- Ask about visual change and numbness on prolonged therapy.
- Consider lactic acidosis in a patient on linezolid with unexplained nausea and acidosis.
Why it matters
Linezolid is increasingly used for resistant infections and long courses, where its toxicities accumulate.
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