Linezolid

Standard dose: 600mg bd po or iv

Drug resistant tuberculosis (see WHO consolidated guidelines on tuberculosis): 600mg po od 

No dose adjustment required.

Renal impairment

• No adjustment required.

• Potential higher risk of thrombocytopenia in patients with renal impairment. Monitor FBCs (See below for monitoring required whilst taking linezolid).

Hepatic impairment

• No adjustment required.

Pregnancy

Very limited human data. After discussion with Micro/ID linezolid can be used when there are no safer alternatives.

Breastfeeding

Discuss with pharmacy.

There are multiple interactions between linezolid and other medications. There are also interactions between linezolid and Tyramine-rich foods. Ensure interactions are checked with the BNF and SPC. Discussion with a pharmacist is advised.

Note: Local OUH guidance has been developed about the interaction between linezolid and serotonergic agents:

Serotonergic agents: CAUTION. Data suggests the risk of serotonin syndrome is extremely low when linezolid is used concomitantly with only one other serotonergic agent. The use of linezolid alongside a single serotonergic agent should not be considered a contraindication. When longer courses of linezolid or multiple serotonergic agents are used the risks and benefits of linezolid should be very carefully considered. Early discussion with a pharmacist or Micro/ID is advised. Patients should be counselled on the risks of serotonin syndrome, including the symptoms and informed consent should be obtained.

Whilst the patient is taking linezolid:

• Monitor weekly U&Es, LFTs and FBC

  • Risk of Myelosuppression – especially when given in longer courses. 

  • Hyponatraemia has been observed in some patients treated with linezolid. It is recommended that serum sodium levels are monitored regularly in patients at risk of hyponatraemia such as elderly patients or patients taking medicines that may lower blood sodium levels.

• Monitor for signs of: 

  • Lactic acidosis

  • Serotonin syndrome

  • Peripheral neuropathy

  • Optic neuropathy. All patients should be advised to report symptoms of visual impairment, such as changes in visual acuity, changes in colour vision, blurred vision, or visual field defect.

Patients that are being discharged with more than 2 weeks of linezolid should be referred to COPAT team.

Linezolid has high oral bioavailability. IV linezolid should only be used if the patient is NBM or there are concerns over absorption (i.e. nausea)

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2. B.Braun Medical. Linezolid 2 mg/ml solution for infusion Summary of product characteristics. Last revision of the text:13/2/17. Accessed via https://www.medicines.org.uk/emc/product/15233/smpc on 12/3/25

3. Joint Formulary Committee.British National Formulary (BNF).  Accessed via https://www.medicinescomplete.com on 12/3/25

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8. Hale TW, Krutsch K. Hale’s Medications & Mothers’ Milk. 2023 ed. Springer Publishing Company; 2023.

9. Bai AD, McKenna S, Wise H, Loeb M, Gill SS. Association of linezolid with risk of serotonin syndrome in patients receiving antidepressants. JAMA Network Open. 2022; 5(12):e2247426.

10. Mitwally H, Saad M, Alkhiyami D, Fahmi A, Mahmoud S, Alhmoud E, et al. Risk of serotonin syndrome in critically ill COVID-19 patients receiving linezolid and opioids concomitantly: A retrospective cohort study. Journal of the American College of Clinical Pharmacy. 2021: 4(12)1660.

11. Kufel WD, Blaine B, Sepiol R, Rubiconti E, Khatsko A, McKnight M, Parsels KA. 741: Evaluation of Serotonin Syndrome with Linezolid and Serotonergic Agents at an Academic Medical Center. Open Forum Infectious Diseases. 2022: 9(2):ofac492.032

12. Stockley IH. Stockley’s Drug Interactions. Available from: https://www.medicinescomplete.com

13. Michigan Medicine. Serotonin syndrome and linezolid. March 2023 [Internet]. 2023 [cited 2024 May 10]. Available from: https://www.med.umich.edu/asp/pdf/adult_guidelines/Serotonin-syndrome.pdf