Infectious Disease Compendium

Linezolid (Zyvox®)

Dosing

CrCl Formula

CrCl > 80: 600 mg po or iv q 12 h.

If it can be given po, it should be given po.

CrCl 80-50:

CrCl 50-10:

CrCl < 10:

Hemodialysis:

Peritoneal dialysis:

Obesity dosing

Important side effects

Cytopenias (especially thrombocytopenia) and more common in dialysis patients.

Cannot have a high tyrosine diet (smoked sausage and red wines, usually not an issue in my hospital).

Optic and peripheral neuropathy (rare but not reversible).

Rare: rhabdomyolysis.

The serotonin syndrome is always worried about but rarely seen (Pubmed); I am awaiting my first case.

My take is the longer the patient is on the drug, the more likely a toxicity, but on a 10-day course or so toxicities are rare.  If I have to go longer than 10 days I look for another option.

Important drug interactions

Citalopram, clovoxamine, dopamine, epinephrine, escitalopram, femoxetine, flesinoxan, fluoxetine, fluvoxamine, nefazodone, paroxetine, phenylpropanolamine, pseudoephedrine, sertraline, trazodone, venlafaxine, zimeldine. They get a serotonin syndrome) PubMed) (altered MS, agitation, fevers) with concomitant SSRI's but in most patients, the drug can be continued without stopping the SSRI as long as they are watched closely (PubMed).

Rants and Screeds

Waaaaayyyyyyyy expensive ($1500 American dollars for a 10-day course), but, hey, someone needs to pay for that pizza at lunch conference.  Now generic and around $50 a course but the patient may need to shop around.

Pearls

Do you want to really be irritated? Some Staphylococci require linezolid for growth (CDC).

Treatment of choice

Use for

Gram-positives for the most part. MRSA and VRE if you can't use vancomycin.

Cellulitis, some Mycobacterium infections, Pneumonia.

Probably should not be used to bactermia, espcially if no definitice source control.

Maybe the better therapy for MRSA Pneumonia; the data keeps going back and forth, but to my mind, anything is better than vancomycin.

Clostridium difficile is susceptible in the test tube.

Don't use for

Class

Oxazolidinone.

Last update 11/28/19