Do you prescribe linezolid to patients who are concomitantly on an SSRI?  

Yes, cautiously, especially when LZD is the best or only option. Recent Eur J Clin Pharmacol July 2023 meta-analysis involving 84 publications found an observed rate of < .01%; another study Shi et al., PMID 37301313 found a similar rate (1/1743 persons, 0.06%). Holding an SSRI for a day or two p...

Yes, if there is no other contraindication, but continue to be watchful for the potential of a drug interaction. The data on the risk for serotonin syndrome with linezolid is sparse and linezolid drug trials found no conclusive evidence that it increases the risk for serotonin syndrome. A recent lar...

Yes. I have experience using LZD with one serotonergic agent in young adults. Before discharge, I tend to challenge them, and I have not seen patients experiencing ST (serotonin toxicity). Whether LZD can be given with multiple SAs is unclear.A recent systematic review and meta-analysis by SanFilipp...

I have used Linezolid in ICU patients with MRSA pneumonia and have failed IV Vanco. I do stop SSRIs but have not seen any serotonergic reaction so far irrespective of their half-lives. I chose the option benefits outweigh the risks and have been practicing medicine for 25 plus years.

Yes, in most scenarios. However, I avoid this approach in the frail patient population, where serotonin syndrome could have more devastating consequences.

I find it interesting that all four respondents use Linezolid in patients who take SSRIs. The bulk of our practice consists of inpatients, so outpatient use of Linezolid is not a frequent issue. This question taps into a broader issue of antibiotic-drug interactions. Many of us feel that these inter...

Cautiously, occasionally on inpatients, so I can monitor them (I have had AEs). My preference, when I can get it, is tedizolid, though cost and FDA label are a challenge when treating outpatients.