linezolid

Type of Medication: Antibiotic

Indications: Treatment of Mycobacterium abscessus infections, MRSA, MSSA

Side Effects: diarrhoea (4%), nausea (3%), vomiting,  headache (2%) , Candidiasis (1%), transient increases in LFTs, lactic acidosis, urticaria, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis,  myelosuppression, peripheral neuropathy, seizure, serotonin syndrome, optic neuropathy (increased risk with prolonged treatment).

Route of administration: Adult (Intravenous)

Dose: 600 mg once a day or twice a day (infusion). Consider reducing to 300 mg once daily if serious adverse effects develop.

Route of administration: Adult (Oral)

Dose: 600 mg once a day o

r twice a day. Consider reducing to 300 mg once daily if serious adverse effects develop.

Monitoring: Target level: 12–24 mg/L (peak) – 2 hours post oral dose or 1 hour post intravenous infusion.

CSM warning (blood disorders) haematopoietic disorders have been reported in patients receiving linezolid. Monitor FBC weekly. Monitor closely patients who: have treatment for more that 10-14 days, have pre-existing myelosuppression, are receiving drugs that may have adr’s on Hb, FBC or platelet function. If significant myelosupression occurs treatment should be stopped. CSM warning (optic neuropathy). Severe optic neuropathy may occur rarely especially if treatment is used for longer than 28 days.

BTS guidelines

Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations

Route of administration: Paediatric (Intravenous)

Dose: children age 1 week to 9 years: 10 mg/kg twice a day (maximum 600 mg/day). Children age >10 years: 10 mg/kg once a day (maximum 600 mg/day). Doses of 300 mg once daily have been used.

Route of administration: Paediatric (Oral)

Dose: children age 1 week to 9 years: 10 mg/kg twice a day (maximum 600 mg/day). Children age >10 years: 10 mg/kg once a day (maximum 600 mg/day). Doses of 300 mg once daily have been used.

Monitoring: Target level: 12–24 mg/L (peak) – 2 hours post oral dose or 1 hour post intravenous infusion.

BTS guidelines

Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations

Examples of some Drug Interactions

Interacting drug: Clarithromycin: increases linezolid serum levels with risk of toxicity (consider drug level monitoring).

Interacting drug: Antidepressants – increased risk of hypertension and excitation. See SPC for individual antidepressants for specific recommendations.

Interacting drug: Dopaminergics – Risk of hypertensive crisis

Interacting drug: opiod analegesics inc Pethidine=- CNS excitation or depression ( hyper or hypotension), avoid concomitant use and for two weeks after stopping MAOI

Interacting drug: Sibutramine – Increased CNS toxicity

Interacting drug: St Johns Wort – Risk of hypertensive crisis.

Interacting drug: Sympathomemetics including pseudoephadine – Risk of hypertensive crisis

Interacting drug: Tyramine rich foods – Hypertensive crisis when given with foods having a high tyramine content i.e mature cheese, yeast extracts, undistilled alcoholic beverages and fermented soya bean products (soya sauce)