antibioticsbooks

114 PART 2 Antibacterial Drugs
Adverse Effects
Linezolid is generally well tolerated, but it can
cause bone marrow suppression, most commonly
thrombocytopenia. Bone marrow suppression tends
to occur after two or more weeks of therapy and
warrants monitoring. Peripheral neuropathy or
lactic acidosis may occur after even more prolonged
therapy (months) because of toxicity to
mitochondria.
■ Important Facts
• Linezolid has bioavailability approaching
100%, and its oral formulation greatly increases
its utility.
• Linezolid is also an inhibitor of monoamine oxidase
and can cause serotonin syndrome when
given concurrently with serotonergic agents
such as selective serotonin reuptake inhibitors
(SSRIs)—avoid concurrent use if possible.
Recent evidence has shown this reaction to be
uncommon, but it does occur. The interaction is
listed as a contraindication in linezolid’s package
insert.
• Linezolid has dual hepatic and renal elimination,
and doses do not need to be adjusted in
cases of renal or hepatic dysfunction.
• Both oral and IV formulations are expensive,
but the oral formulation is less expensive and
more convenient than home-infusion vancomycin
and a nurse.