Linezolid Paroxetine

Serotonin syndrome was reported in a 56-year-old white woman who received intravenous linezolid shortly after withdrawal of a selective serotonin reuptake inhibitor, paroxetine (115). 

A 56-year-old woman with a postoperative wound infection developed the serotonin syndrome when she was given the antibiotic linezolid intravenously (22). The dose of paroxetine had been tapered and it had been withdrawn 5 days before. 

Linezolid inhibits monoamine oxidase activity and has been reported to cause serotonin toxicity in combination with paroxetine. While some patients have apparently taken the combination of linezolid and an SSRI safely, this report suggests that patients taking combined treatment should be monitored for serotonin toxicity. 

Clinically important, potentially hazardous interactions with amprenavir, clonidine, ephedra, epinephrine, eucalyptus, guanethidine, iobenguane, isocarboxazid, linezolid, MAO inhibitors, paroxetine, phenelzine, quinolones, sparfloxacin, St John s wort, tranylcypromine... 

Morales-Molina JA+, Farm Hosp 29(4), 292 (with paroxetine, and linezolid)... 

Clinically important, potentially hazardous interactions with citalopram, fluoxetine, fluvoxamine, ginkgo biloba, linezolid, lopinavir, nefazodone, paroxetine, sertraline, venlafaxine... 

In an analysis of phase HI studies, changes in vital signs did not differ between patients given linezolid and comparator drugs (i.e. antibiotics) when either were used with drugs known to interact with MAOIs, including unnamed cyclic antidepressants. A case report describes the serotonin syndrome in an elderly patient treated with linezolid 600 mg every 12 hours, 21 days after amitriptyline 10 mg daily, paroxetine 20 mg daily and alprazolam 500 micrograms daily were started. ... 

Not fully understood. Linezolid has weak MAOI effects, and the serotonin syndrome is known to occur when MAOIs are given with SSRIs , (p.l 142), tricyclics , (p.ll49) and venlafaxine , (p.ll56). In the case of the patient taking linezolid with amitriptyline and paroxetine, it is possible that an interaction between amitriptyline and paroxetine contributed to the development of the serotonin syndrome. Consider also Tricyclic and related antidepressants + SSRIs , p.l241. 

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