Linez

Indications

Linezolid is a strong antibiotic kept for serious infections caused by bacteria that do not respond to other antibiotics, such as MRSA and VRE. It is used for:

• Pneumonia, including pneumonia caught in hospital
• Complicated skin and soft tissue infections, such as diabetic foot infections
• Infections caused by resistant Enterococcus
• Some forms of drug-resistant tuberculosis, under specialist care

How It Works

It stops bacteria from making the proteins they need to live and multiply. It works in a different way from other antibiotics, so it often works when others have failed.

Dosage and Administration

Adults: usually 600 mg every 12 hours, by mouth or as a drip into a vein, as prescribed. Treatment usually lasts 10 to 14 days and generally no longer than 28 days, except under specialist care. Children and tuberculosis treatment: as prescribed. Tablets can be taken with or without food. Finish the full course.

Interactions

Linezolid has important interactions. Tell the doctor about all medicines you take, especially:

• Antidepressants such as Sertraline, Fluoxetine, Escitalopram and Amitriptyline, and other medicines such as Tramadol, Pethidine and triptans: risk of serotonin syndrome (see Side Effects)
• Cold and flu medicines with Pseudoephedrine or Phenylephrine, and medicines such as Adrenaline or Dopamine: blood pressure can rise sharply
• Other MAO inhibitor medicines: must not be taken together
• Rifampicin: can lower Linezolid levels

Avoid large amounts of foods rich in tyramine, such as aged cheese, fermented soy sauce, yeast extracts, cured or smoked meat and fish, and draught beer, as they can raise blood pressure.

Contraindications

• Allergy to Linezolid
• Taking an MAO inhibitor medicine, or having taken one in the last 2 weeks
• Unless closely monitored in hospital: uncontrolled high blood pressure, phaeochromocytoma, carcinoid tumour, overactive thyroid, bipolar disorder, or taking the interacting medicines listed above

Side Effects

Common: diarrhoea, nausea, headache, taste changes, and fungal infections such as thrush. Linezolid can lower blood counts, so weekly blood tests are usually done.

Get urgent medical help if you have:

• Blurred or reduced vision, or changes in colour vision
• Numbness, tingling or pain in the hands or feet
• Agitation, confusion, fever, sweating, shaking, muscle twitching and fast heartbeat (possible serotonin syndrome)
• Unusual bleeding or bruising, or frequent infections
• Repeated vomiting, fast breathing and severe weakness (possible lactic acidosis)
• Severe or bloody diarrhoea, fits, or a serious allergic reaction

Pregnancy and Lactation

There is limited information. It is used in pregnancy only when the doctor feels the benefit outweighs the risk. It may pass into breast milk; ask the doctor before breastfeeding.

Precautions and Warnings

• Weekly blood counts are advised, especially with treatment over 2 weeks or existing blood problems.
• Use over 28 days raises the risk of nerve and eye damage; vision should be checked if treatment is long.
• People with diabetes on insulin or tablets may get low blood sugar.
• Tell the doctor about epilepsy, high blood pressure, kidney or liver disease.

Overdose

Contact a doctor or hospital urgently. Treatment is supportive, and dialysis can remove some of the medicine.

Therapeutic Class

Antibiotic: oxazolidinone.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children. Infusion bags should be kept in their outer wrapping and not frozen.