Linezolid is well absorbed orally, which makes it useful for early switch, but its toxicity is duration-related. Myelosuppression, especially thrombocytopenia, becomes more likely beyond about two weeks and in kidney impairment. Peripheral and optic neuropathy appear with prolonged courses, as in drug-resistant tuberculosis.
Linezolid is a weak monoamine oxidase inhibitor. Combined with SSRIs, SNRIs or other serotonergic drugs it can cause serotonin syndrome, and with large amounts of tyramine-rich food it can raise blood pressure. Lactic acidosis is uncommon but reported.
- Check a full blood count weekly, particularly beyond two weeks of therapy or in kidney impairment.
- Review serotonergic drugs — SSRIs, SNRIs, tramadol, methylene blue — before starting.
- Ask about visual change or numbness on longer courses.
- Consider lactate if a patient on linezolid develops unexplained nausea or acidosis.
Why it matters
Its oral convenience makes long courses easy to start and its toxicities easy to miss.
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