Linezolid

By Medically reviewed by hellodoktor

Generic Name: Linezolid Brand Name(s): Linezolid and Linezolid.

Uses

What is Linezolid used for?

Linezolid is an antibiotic used to treat certain serious bacterial infections. It works by stopping the growth of bacteria.

This antibiotic treats only bacterial infections. It will not work for viral infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.

Linezolid also belongs to a class of drugs known as MAO inhibitors. It can increase the levels of certain natural substances in the body (such as dopamine, norepinephrine, serotonin) which can increase the chance of certain side effects and food and drug interactions.

How should I take Linezolid?

Use exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Before taking the oral suspension (liquid), gently mix it by turning the bottle upside down 3 to 5 times. Do not shake. Measure the liquid with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Intravenous linezolid is injected into a vein through an IV. This medicine must be given slowly, and the IV infusion can take up to 2 hours to complete. You may be shown how to use an IV at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles, IV tubing, and other items used to inject the medicine.

To be sure this medication is not causing harmful effects, your blood cells and blood pressure will need to be tested often. You may also need eye exams. Visit your doctor regularly.

Use this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Linezolid will not treat a viral infection such as the common cold or flu.

How do I store Linezolid?

Linezolid is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Linezolid in the bathroom or the freezer. There may be different brands of Linezolid that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Linezolid down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Linezolid?

Before using this medication, tell your doctor or pharmacist your medical history, especially of: high blood pressure, blood/bone marrow problems (such as low red/white blood cells and platelets), certain tumor conditions (such as pheochromocytoma, carcinoid syndrome), overactive thyroid, seizures.

This drug may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages.

If you have diabetes, linezolid may lower your blood sugar. Check your blood sugar regularly as directed and share the results with your doctor. Tell your doctor right away if you have symptoms of low blood sugar such as sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet. Your doctor may need to adjust your diabetes medication, exercise program, or diet.

Linezolid may cause live bacterial vaccines (such as typhoid vaccine) to not work as well. Do not have any immunizations/vaccinations while using this medication unless your doctor tells you to.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Linezolid during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Linezolid. Linezolid is pregnancy risk category C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Linezolid?

Diarrhea, headache, nausea, vomiting, or dizziness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: deep/fast breathing, unusual drowsiness, nausea/vomiting that doesn’t stop, numbness/tingling of the hands/feet, unusual tiredness, easy bruising/bleeding.

Get medical help right away if you have any very serious side effects, including: muscle stiffness, increased sweating, vision changes (such as blurred vision, change in color vision, loss of vision), mental/mood changes (such as agitation, confusion), seizure.

This medication may rarely cause a severe intestinal condition (Clostridium difficile-associated diarrhea) due to a type of resistant bacteria. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn’t stop, abdominal or stomach pain/cramping, blood/mucus in your stool.

Do not use anti-diarrhea products or narcotic pain medications if you have any of these symptoms because these products may make them worse.

Use of this medication for prolonged or repeated periods may result in oral thrush or a new yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.

This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take. Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, unexplained fever, severe nausea/vomiting/diarrhea, twitching muscles, unusual agitation/restlessness.

This drug may rarely cause an attack of extremely high blood pressure (hypertensive crisis), which may be fatal. Many drug and food interactions can increase this risk (see How to Use and Drug Interactions sections). Get medical help right away if any of these serious side effects occur: severe headache, fast/slow/irregular/pounding heartbeat, chest pain, neck stiffness/soreness, severe nausea/vomiting, sweating/clammy skin (sometimes with fever), widened pupils, vision changes (such as double/blurred vision), sudden sensitivity to light (photophobia).

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Linezolid?

Some products that may interact with this drug include: diet pills/appetite suppressants (such as diethylpropion), drugs for attention deficit disorder (such as atomoxetine, methylphenidate), apraclonidine, bupropion, buspirone, carbamazepine, cyclobenzaprine, deutetrabenazine, a certain combination product (dextromethorphan/quinidine), levodopa, maprotiline, methyldopa, certain narcotic pain relievers (such as fentanyl, meperidine, methadone, tapentadol), certain drugs for Parkinson’s disease (such as entacapone, tolcapone), certain supplements (such as tryptophan, tyramine), tetrabenazine, tricyclic antidepressants (such as amitriptyline, doxepin), valbenazine.

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/”ecstasy,” St. John’s wort, certain antidepressants (including mirtazapine, SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), tramadol, certain “triptans” used to treat migraine headaches (such as rizatriptan, sumatriptan, zolmitriptan), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.

Some products can interact with linezolid if you take them together, or even if you take them weeks before or after taking linezolid. Tell your doctor or pharmacist if you take anything in the list of products that may interact with this drug, or any of the products that increase serotonin, within 2 weeks before or after taking linezolid. Also tell them if you have taken fluoxetine within 5 weeks before starting linezolid. Ask your doctor how much time to wait between starting or stopping any of these drugs and starting linezolid.

Taking other MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Do not take any other MAO inhibitors (isocarboxazid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.

Before using linezolid, report the use of drugs that may increase the risk of extremely high blood pressure (hypertensive crisis) when combined with linezolid, including herbal products (such as ephedra/ma huang), allergy and cold products (including decongestants such as phenylephrine/pseudoephedrine), and stimulants (such as amphetamines, ephedrine, epinephrine). Linezolid should not be used with any of these medications. Talk to your doctor or pharmacist for more details.

Although most antibiotics are unlikely to affect hormonal birth control such as pills, patch, or ring, a few antibiotics (such as rifampin, rifabutin) can decrease their effectiveness. This could result in pregnancy. If you use hormonal birth control, ask your doctor or pharmacist for more details.

Linezolid may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Linezolid?

Eating tyramine while you are using linezolid can raise your blood pressure to dangerous levels. Avoid foods that have a high level of tyramine, such as:

  • Aged cheeses or meats;
  • Pickled or fermented meats, smoked or air-dried meats;
  • Sauerkraut;
  • Soy sauce;
  • Tap beer (alcoholic and nonalcoholic);
  • Red wine; or
  • Any meat, cheese, or other protein-based food that has been improperly stored.

You should become very familiar with the list of foods you must avoid while you are using linezolid.

Linezolid may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Linezolid?

Linezolid may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Linezolid.

What is the dose of Linezolid for an adult?

Usual Adult Dose for Bacteremia

600 mg IV or orally every 12 hours

Duration of therapy:

-Pneumonia: 10 to 14 consecutive days

-Vancomycin-resistant Enterococcus faecium infections: 14 to 28 consecutive days

Uses: For the treatment of community-acquired pneumonia due to Streptococcus pneumoniae (including cases with concurrent bacteremia) or Staphylococcus aureus (methicillin-susceptible isolates only); for the treatment of nosocomial pneumonia due to S aureus (methicillin-susceptible and -resistant isolates) or S pneumoniae; for the treatment of vancomycin-resistant E faecium infections (including cases with concurrent bacteremia)

Usual Adult Dose for Pneumonia

600 mg IV or orally every 12 hours

Duration of therapy:

-Pneumonia: 10 to 14 consecutive days

-Vancomycin-resistant Enterococcus faecium infections: 14 to 28 consecutive days

Uses: For the treatment of community-acquired pneumonia due to Streptococcus pneumoniae (including cases with concurrent bacteremia) or Staphylococcus aureus (methicillin-susceptible isolates only); for the treatment of nosocomial pneumonia due to S aureus (methicillin-susceptible and -resistant isolates) or S pneumoniae; for the treatment of vancomycin-resistant E faecium infections (including cases with concurrent bacteremia)

Usual Adult Dose for Bacterial Infection

600 mg IV or orally every 12 hours

Duration of therapy:

-Pneumonia: 10 to 14 consecutive days

-Vancomycin-resistant Enterococcus faecium infections: 14 to 28 consecutive days

Uses: For the treatment of community-acquired pneumonia due to Streptococcus pneumoniae (including cases with concurrent bacteremia) or Staphylococcus aureus (methicillin-susceptible isolates only); for the treatment of nosocomial pneumonia due to S aureus (methicillin-susceptible and -resistant isolates) or S pneumoniae; for the treatment of vancomycin-resistant E faecium infections (including cases with concurrent bacteremia)

Usual Adult Dose for Nosocomial Pneumonia

600 mg IV or orally every 12 hours

Duration of therapy:

-Pneumonia: 10 to 14 consecutive days

-Vancomycin-resistant Enterococcus faecium infections: 14 to 28 consecutive days

Uses: For the treatment of community-acquired pneumonia due to Streptococcus pneumoniae (including cases with concurrent bacteremia) or Staphylococcus aureus (methicillin-susceptible isolates only); for the treatment of nosocomial pneumonia due to S aureus (methicillin-susceptible and -resistant isolates) or S pneumoniae; for the treatment of vancomycin-resistant E faecium infections (including cases with concurrent bacteremia)

Usual Adult Dose for Skin and Structure Infection

Complicated infections: 600 mg IV or orally every 12 hours

Uncomplicated infections: 400 mg orally every 12 hours

Duration of therapy: 10 to 14 consecutive days

Uses: For the treatment of complicated skin and skin structure infections (including diabetic foot infections, without concomitant osteomyelitis) due to S aureus (methicillin-susceptible and -resistant isolates), S pyogenes, or S agalactiae; for the treatment of uncomplicated skin and skin structure infections due to S aureus (methicillin-susceptible isolates only) or S pyogenes

Dialysis

Hemodialysis: Dose should be administered after dialysis.

Peritoneal dialysis: Data not available

Comments:

-About 30% of dose removed in 3-hour hemodialysis session beginning 3 hours after dose administered.

Other Comments

Administration advice:

-IV injection: Administer via IV infusion over 30 to 120 minutes; do not use this IV infusion bag in series connections.

-IV injection: When using concomitantly with another drug, administer each drug separately (as appropriate for each drug); if the same IV line is used for sequential infusion of several drugs, flush the line with a compatible infusion solution before and after infusion of this drug.

-Do not adjust dose when switching from IV to oral administration (no adjustments needed).

-Oral: May administer without regard to food

-Oral suspension: Before use, gently mix by inverting the bottle 3 to 5 times; do not shake.

-Do not use this drug for the treatment of gram-negative infections; if concomitant gram-negative pathogen verified/suspected, it is crucial that specific gram-negative therapy is started immediately.

Storage requirements:

-Store at 25C (77F) and protect from light.

-Keep bottles closed tightly to protect from moisture.

-Keep infusion bags in overwrap until ready to use; protect from freezing.

-Discard the oral suspension 21 days after constitution.

Reconstitution/preparation techniques:

-The manufacturer product information should be consulted.

IV compatibility:

-Compatible IV solutions: 0.9% Sodium Chloride Injection, USP; 5% Dextrose Injection, USP; Lactated Ringer’s Injection, USP

-Chemically incompatible: Ceftriaxone sodium

-Physically incompatible: Amphotericin B, chlorpromazine hydrochloride, diazepam, pentamidine isethionate, erythromycin lactobionate, phenytoin sodium, sulfamethoxazole-trimethoprim

-Additives should not be added to this IV solution.

General:

-To reduce the development of drug-resistant organisms and maintain effective therapy, this drug should be used only to treat or prevent infections proven or strongly suspected to be caused by susceptible bacteria. This drug has no clinical activity against gram-negative organisms.

-Culture and susceptibility information should be considered when selecting/modifying antibacterial therapy or, if no data are available, local epidemiology and susceptibility patterns may be considered when selecting empiric therapy.

-The safety and efficacy of this drug beyond 28 days have not been established.

Monitoring:

-Cardiovascular: For potential blood pressure increases (the manufacturer product information should be consulted regarding patient population)

-Hematologic: CBC (weekly)

-Nervous System: For signs/symptoms of serotonin syndrome or neuroleptic malignant syndrome-like reactions (the manufacturer product information should be consulted regarding patient population and monitoring duration)

-Ocular: Visual function (the manufacturer product information should be consulted for further guidance)

Patient advice:

-Avoid missing doses and complete the entire course of therapy.

-Avoid ingesting large amounts of foods or beverages with high tyramine content (e.g., aged cheese, fermented or air-dried meats, sauerkraut, soy sauce, tap beer, red wines) while using this drug.

-Consult physician if changes in vision occur.

-If you have phenylketonuria, be aware that the oral suspension contains 20 mg phenylalanine/5 mL; consult your healthcare provider.

-Consult physician at once if watery and bloody stools (with or without stomach cramps and fever) develop.

-Consult healthcare provider if hypoglycemic reactions occur during therapy.

What is the dose of Linezolid for a child?

Usual Pediatric Dose for Bacteremia

Less than 7 days, gestational age less than 34 weeks: 10 mg/kg IV or orally every 12 hours

Less than 7 days, gestational age at least 34 weeks: 10 mg/kg IV or orally every 8 hours

7 days through 11 years: 10 mg/kg IV or orally every 8 hours

12 years or older: 600 mg IV or orally every 12 hours

Duration of therapy:

-Pneumonia: 10 to 14 consecutive days

-Vancomycin-resistant E faecium infections: 14 to 28 consecutive days

Comments:

-In preterm neonates younger than 7 days (gestational age less than 34 weeks) with suboptimal clinical response, may consider using 10 mg/kg every 8 hours

Uses: For the treatment of community-acquired pneumonia due to S pneumoniae (including cases with concurrent bacteremia) or S aureus (methicillin-susceptible isolates only); for the treatment of nosocomial pneumonia due to S aureus (methicillin-susceptible and -resistant isolates) or S pneumoniae; for the treatment of vancomycin-resistant E faecium infections (including cases with concurrent bacteremia)

Usual Pediatric Dose for Pneumonia

Less than 7 days, gestational age less than 34 weeks: 10 mg/kg IV or orally every 12 hours

Less than 7 days, gestational age at least 34 weeks: 10 mg/kg IV or orally every 8 hours

7 days through 11 years: 10 mg/kg IV or orally every 8 hours

12 years or older: 600 mg IV or orally every 12 hours

Duration of therapy:

-Pneumonia: 10 to 14 consecutive days

-Vancomycin-resistant E faecium infections: 14 to 28 consecutive days

Comments:

-In preterm neonates younger than 7 days (gestational age less than 34 weeks) with suboptimal clinical response, may consider using 10 mg/kg every 8 hours

Uses: For the treatment of community-acquired pneumonia due to S pneumoniae (including cases with concurrent bacteremia) or S aureus (methicillin-susceptible isolates only); for the treatment of nosocomial pneumonia due to S aureus (methicillin-susceptible and -resistant isolates) or S pneumoniae; for the treatment of vancomycin-resistant E faecium infections (including cases with concurrent bacteremia)

Usual Pediatric Dose for Bacterial Infection

Less than 7 days, gestational age less than 34 weeks: 10 mg/kg IV or orally every 12 hours

Less than 7 days, gestational age at least 34 weeks: 10 mg/kg IV or orally every 8 hours

7 days through 11 years: 10 mg/kg IV or orally every 8 hours

12 years or older: 600 mg IV or orally every 12 hours

Duration of therapy:

-Pneumonia: 10 to 14 consecutive days

-Vancomycin-resistant E faecium infections: 14 to 28 consecutive days

Comments:

-In preterm neonates younger than 7 days (gestational age less than 34 weeks) with suboptimal clinical response, may consider using 10 mg/kg every 8 hours

Uses: For the treatment of community-acquired pneumonia due to S pneumoniae (including cases with concurrent bacteremia) or S aureus (methicillin-susceptible isolates only); for the treatment of nosocomial pneumonia due to S aureus (methicillin-susceptible and -resistant isolates) or S pneumoniae; for the treatment of vancomycin-resistant E faecium infections (including cases with concurrent bacteremia)

Usual Pediatric Dose for Nosocomial Pneumonia

Less than 7 days, gestational age less than 34 weeks: 10 mg/kg IV or orally every 12 hours

Less than 7 days, gestational age at least 34 weeks: 10 mg/kg IV or orally every 8 hours

7 days through 11 years: 10 mg/kg IV or orally every 8 hours

12 years or older: 600 mg IV or orally every 12 hours

Duration of therapy:

-Pneumonia: 10 to 14 consecutive days

-Vancomycin-resistant E faecium infections: 14 to 28 consecutive days

Comments:

-In preterm neonates younger than 7 days (gestational age less than 34 weeks) with suboptimal clinical response, may consider using 10 mg/kg every 8 hours

Uses: For the treatment of community-acquired pneumonia due to S pneumoniae (including cases with concurrent bacteremia) or S aureus (methicillin-susceptible isolates only); for the treatment of nosocomial pneumonia due to S aureus (methicillin-susceptible and -resistant isolates) or S pneumoniae; for the treatment of vancomycin-resistant E faecium infections (including cases with concurrent bacteremia)

Usual Pediatric Dose for Skin and Structure Infection

Complicated infections:

Less than 7 days, gestational age less than 34 weeks: 10 mg/kg IV or orally every 12 hours

Less than 7 days, gestational age at least 34 weeks: 10 mg/kg IV or orally every 8 hours

7 days through 11 years: 10 mg/kg IV or orally every 8 hours

12 years or older: 600 mg IV or orally every 12 hours

Uncomplicated infections:

Less than 7 days, gestational age less than 34 weeks: 10 mg/kg orally every 12 hours

Less than 7 days, gestational age at least 34 weeks: 10 mg/kg orally every 8 hours

7 days to less than 5 years: 10 mg/kg orally every 8 hours

5 through 11 years: 10 mg/kg orally every 12 hours

12 years or older: 600 mg orally every 12 hours

Duration of therapy: 10 to 14 consecutive days

Comments:

-In preterm neonates younger than 7 days (gestational age less than 34 weeks) with suboptimal clinical response, may consider using 10 mg/kg every 8 hours

Uses: For the treatment of complicated skin and skin structure infections (including diabetic foot infections, without concomitant osteomyelitis) due to S aureus (methicillin-susceptible and -resistant isolates), S pyogenes, or S agalactiae; for the treatment of uncomplicated skin and skin structure infections due to S aureus (methicillin-susceptible isolates only) or S pyogenes

How is Linezolid available?

Linezolid is available in the following dosage forms and strengths:

  • Intravenous solution,
  • Oral tablet,
  • Oral powder for reconstitution

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Linezolid, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: March 17, 2018 | Last Modified: September 12, 2019

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