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Linezolid-associated serotonin toxicity: a systematic review
Fawzy Elbarbry1, Nicholas Moshirian2
1Pacific University School of Pharmacy, Hillsboro, OR, USA. Fawzy.elbarbry@pacificu.edu.
European Journal of Clinical Pharmacology
|May 2, 2023
Summary
Linezolid has a low risk of causing serotonin toxicity, even when used with other serotonergic drugs. Discontinuing linezolid quickly resolves symptoms, with most cases improving within 48 hours.
Area of Science:
- Pharmacology
- Infectious Diseases
- Clinical Toxicology
Background:
- Linezolid is an antibiotic used for serious infections.
- Serotonin toxicity is a potentially serious condition associated with certain medications.
Approach:
- Systematic review of literature and conference abstracts.
- Searched PubMed, IDWeek, ECCMID, and ACCP meetings up to March 2023.
- Included 84 studies evaluating linezolid and serotonin toxicity.
Key Points:
- Incidence of serotonin toxicity: 0.0050% with linezolid monotherapy and 0.0134% with combination therapy.
- Symptom resolution occurred in all cases after discontinuing linezolid and/or serotonergic agents.
- 75% of patients experienced symptom resolution within 24-48 hours of discontinuation.
Conclusions:
- Linezolid therapy should not be delayed due to serotonin syndrome concerns.
- The prevalence of serotonin toxicity with linezolid is low.
- Linezolid can be used safely as monotherapy or with other serotonergic agents.
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