FDA Update: Linezolid is Toxic when Taken with SSRIs
In the most recent FDA update, regulators have updated their statement made about the harmful effects linked with combining the antibacterial agent linezolid (Zyvox) with seretonergic psychiatric drugs like Paxil. The updated statement shows that there is the potential for serious central nervous system toxicity.
The cases of serotonin syndrome that have been reported to the FDA seem to be caused by an adverse reaction to patients taking SSRIs or SNRIs in combination with linezolid. In these reports, the drugs specifically mentioned include paroxetine (Paxil), fluvoxamine (Luvox), fluoxetine (Prozac, Symbyax), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), vilazodone (Viibryd), venlafaxine (Effexor), desvenlafaxine (Pristiq) and duloxetine (Cymbalta).
So far, it is not fully understood just what it is that causes the adverse reactions when linezolid interacts with these medications. However, some believe that it is caused from inhibition of monoamine oxidase A. This is the enzyme that the body uses to help metabolize serotonin in the brain. When this is prevented or slowed, it causes a toxic buildup that can even cause death, though only one person was reported as dying from it.
In a statement, the FDA said "Healthcare professionals and patients may not realize that linezolid has monoamine oxidase inhibitor properties."
Linezolid is most commonly used to treat “vancomycin-resistant Enterococcus faecium infections, pneumonia and skin and soft-tissue infections — including those caused by methicillin-resistant Staphylococcus aureus.” Linezolid is generally not mixed with SSRIs and other psychiatric drugs unless it is an emergency where the linezolid is necessary in treating a patient. It is currently recommended that healthcare professionals fully weigh the risk-to-benefit ratio when thinking of using this harmful combination of medication. In addition, regulators are also suggesting that doctors first use something else when possible. The regulators are also advising doctors to immediately stop giving patients the serotonergic drug and keep a close watch for any adverse side effects if they decide to use the linezolid.
