How commonly does serotonin syndrome occur with linezolid combined with antidepressants?
Bai et al. studied older adults (>/= 66 y) in the ICES database in Ontario, Canada who received oral linezolid between 1 Oct 2014 and 1 Jan 2021. The authors looked for SS, altered mental status/confusion, hospitalization, or death within 30 days of starting linezolid. Out of 1134 patients prescribed linezolid, 215 (19.8%) were on a serotonergic antidepressant. Half were on an SSRI, and one in six were on an SNRI. No patients were on an MAO-Inhibitor. They identified SS in 6 patients (<0.5%). There was no difference in SS or other outcomes between patients with an antidepressant and those without. No patients were taking an MAO-I, so the study does not exclude a higher risk of SS with linezolid + MAO-I. The database also could neither verify patients’ adherence to prescribed medications nor exclude any dose adjustments in antidepressants during linezolid therapy.
Bai AD, McKenna S, Wise H, Loeb M, Gill SS. Association of Linezolid With Risk of Serotonin Syndrome in Patients Receiving Antidepressants. JAMA Netw Open. 2022 Dec 1;5(12):e2247426. doi: 10.1001/jamanetworkopen.2022.47426. PMID: 36534400; PMCID: PMC9856528.
Contributed by: Michael Mullins, MD