Preexisting myelosuppression, renal impairment (CrCl < 30ml/min), uncontrolled hypertension, phaeochromocytoma, carcinoid syndrome, untreated hyperthyroidism, chronic infection, history of seizures, bipolar depression, schizophrenia or acute confusional states. Pregnancy and lactation. Monitor complete blood counts weekly. Give after haemodialysis. Not known if linezolid or metabolites removed during peritoneal dialysis.
Lactation: Unknown; use caution
Indication
Community-acquired pneumonia, Skin and skin structure infections, Nosocomial pneumonia
Contra Indication
Linzolid formulations are contraindicated for use in patients who have known hypersensitivity to Linzolid or any of the other product components. Linzolid should not be used in patients taking any medicinal product which inhibits monoamine oxidases A or B (e.g. phenelzine, isocarboxazid) or within two weeks of taking any such medicinal product. Linzolid should not be administered to patients with uncontrolled hypertension, pheochromocytoma, thyrotoxicosis, carcinoid syndrome and/or patients taking directly and indirectly acting sympathomimetic agents (e.g. pseudoephedrine), vasopressive agents (e.g. epinephrine, norepinephrine), dopaminergic agents (e.g. dopamine, dobutamine), serotonin re-uptake inhibitors, tricyclic antidepressants, serotonin 5-HT1 receptor agonists (triptans), meperidine or buspirone.
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks
Mode of Action
Linezolid is a bacteriostatic oxazolidinone which acts by inhibiting ribosomal protein synthesis. It is active against gm+ve bacteria including vancomycin-resistant enterococci and MRSA. It has limited in vitro activity against gm-ve bacteria.
Interaction
May reduce serum levels w/ rifampicin and phenytoin. May cause hypoglycaemia w/ insulin or oral antidiabetics. May increase risk of seizures w/ tramadol.
Potentially Fatal: Increased risk of serotonin syndrome w/ MAOIs, TCAs, SNRIs, or other serotonergic drugs (e.g. bupropion, vilazodone, mirtazapine, amoxapine, buspirone, maprotiline, meperidine, trazodone, nefazodone). Significant increase in BP w/ vasopressive agents (e.g. epinephrine, norepinephrine), sympathomimetic agents (e.g. pseudoephedrine) and dopaminergic agents (e.g. dopamine, dobutamine).
Pregnancy Category Note
Pregnancy category: C
Lactation: Unknown; use caution
Adult Dose
Oral
Uncomplicated skin and skin structure infections
Adult: 400 mg 12 hrly for 10-14 days.
Vancomycin-resistant Enterococcus faecium
Adult: 600 mg 12 hrly for 14-28 days.
Methicillin-resistant Staphylococcus aureus infections
Adult: 600 mg bid for 7-21 days.
Community-acquired pneumonia; Nosocomial pneumonia; Complicated skin and skin structure infections
Adult: 600 mg 12 hrly for 10-14 days.
Elderly: No dosage adjustment needed.
Hepatic impairment: Mild to moderate: No dosage adjustment needed.
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