UMEM Educational Pearls

Category: Critical Care

Title: Linezolid and Serotonin Syndrome

Keywords: Antibiotics, linezolid, serotonin syndrome, delirium, critical care (PubMed Search)

Posted: 12/7/2010 by Haney Mallemat, MD
Click here to contact Haney Mallemat, MD


Linezolid is used for gram-positive infections resistant to conventional therapy (e.g., Vancomycin-resistant enterococcus and Methicillin Resistant Staph Aureus). Linezolid is an oxazolidinone, but more importantly it is a weak monoamine oxidase inhibitor (MAOI) and serotonin syndrome (e.g., altered mental status, neuromuscular abnormalities, autonomic instability) may occur when combined with selective serotonin re-uptake inhibitors (SSRIs) or with recent discontinuation of SSRI. 


Be aware that the following drugs can precipitate serotonin syndrome when combined with Linezolid:


Mirtazpine       Buproprion       Fentanyl

Trazodone       Buspirone         Bromocryptine

Levodopa        Lithium               Amphetamines

Cocaine           Codeine            Reserpine

Ergots               MAOI's






Narita, M. Linezolid-Associated Peripheral and Optic Neuropathy, Lactic Acidosis, and Serotonin Syndrome Pharmacotherapy (2007) vol. 27 (8) pp. 1189-97