Linezolid (Intravenous)

Administered intravenously, Linezolid is used to treat gram-positive bacterial infections which have not responded to other forms of treatment.

Overview

As an antibiotic, Linezolid can be used to treat infections affecting various parts of the body. Although Linezolid is primarily used to treat pneumonia or skin infections, it can also be prescribed to treat methicillin-resistant staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), streptococci and/or drug-resistant tuberculosis. However, Linezolid will only work against infections which are bacterial in nature and cannot be used to treat fungal or viral infections.

Like many antibiotics, Linezolid is a protein synthesis inhibitor. By affecting the bacteria cells and preventing them from producing protein, Linezolid causes cell death and prevents the bacteria cells from growing or spreading. As a result, the patient's infection cannot worsen and should be resolved.

However, Linezolid blocks the bacteria cells from producing protein at a relatively early stage, whereas other antibiotics tend to inhibit protein production at a later stage of the cycle. Due to this, Linezolid is often effective in treating bacterial infections which have not responded to other medications.

Although Linezolid can be taken orally, it is often delivered via intravenous injection. When patients have a severe infection, they may be unable to take medication orally and they may struggle to keep the medication in their system if the symptoms of the infection include vomiting or diarrhea. By administering Linezolid directly into the patient's vein, physicians can overcome these issues and ensure that the patient is given the appropriate amount of medication.

In addition to this, Linezolid can be delivered at a faster rate when it is administered intravenously. If the patient's condition is deteriorating, it may be necessary to treat the infection aggressively, with high doses of antibiotics. As Linezolid can be administered via intravenous injection, it can take effect more quickly than some other medications and can, therefore, relieve the patient's symptoms and treat the infection at a faster rate.

Conditions Treated

Bacterial infections

Type Of Medicine

Antibiotic

Side Effects

When patients are treated with Linezolid, they may experience some adverse effects. Although it's not particularly uncommon to experience side-effects during antibiotic treatment, some side-effects are more concerning than others.

The following side-effects may be more pronounced when patients are first treated with Linezolid but should diminish over time:

  • Stomach or abdominal pain
  • Unpleasant, unusual or bad (after) taste
  • Inability to sleep
  • Change in taste
  • Trouble sleeping
  • Discoloration of the tongue
  • Sore tongue or mouth
  • Itching of the vagina or outside genitals
  • Sleeplessness
  • Loose stools
  • Pain during sexual intercourse
  • Discoloration of the tooth
  • Pain in the legs or arms
  • Thick, white curd-like vaginal discharge, may be without odor or with mild odor

If the above side-effects are fairly mild, patients may not require additional medical treatment for them. However, if they are severe or continuous, patients should obtain medical advice.

Furthermore, patients should notify a doctor or nurse immediately if they develop any of the following side-effects whilst being treated with Linezolid:

  • Chills
  • Headache
  • Confusion
  • Ear congestion
  • Dizziness
  • Soreness or dryness of the throat
  • Fainting
  • Dry mouth
  • Labored or difficult breathing
  • Fast heartbeat
  • Cough
  • Fever
  • Convulsions
  • Lightheadedness
  • Constipation
  • Pale skin
  • Decreased urinary output
  • Shallow, rapid breathing
  • Congestion
  • Rash on the skin
  • Chest pain
  • Troubled breathing with exertion
  • Body pains or aches
  • Unusual bruising or bleeding
  • Bluish skin or lips
  • Unusual weakness or tiredness
  • Tarry, black stools
  • Blood in the stools or urine
  • Sneezing
  • Bleeding gums
  • Shortness of breath
  • Hoarseness
  • Severe stomach pain
  • Increased thirst
  • Runny nose
  • Irregular heartbeat
  • Red pinpoint spots on the skin
  • Loss of appetite
  • Difficult or painful urination
  • Loss of voice
  • Tightness in the chest
  • Mood changes
  • Hives
  • Muscle cramps or pain
  • Eye pain
  • Nasal congestion
  • Diarrhea
  • Nausea or vomiting
  • Decreased vision
  • Not breathing
  • Tingling or numbness in the feet, lips or hands
  • White spots, ulcers or sores in the mouth or on the lips
  • Decreased appetite
  • Swollen glands
  • Painful, tingling, numbness or burning sensations
  • Swollen, tender glands in the neck
  • Wheezing
  • Trouble with swallowing
  • Blurred vision
  • Voice changes
  • Loosening, peeling or blistering of the skin
  • Vomiting material that looks like coffee grounds
  • Stomach or abdominal discomfort
  • Vomiting of blood
  • Blindness
  • General feeling of discomfort
  • Sleepiness
  • High fever
  • Muscle or joint pain
  • Hives
  • Muscle cramping or pain
  • Itching
  • Swelling or puffiness around the face, lips, tongue, eyes or of the eyelids
  • Irritated, red eyes
  • Large, hive-like swelling on the eyelids, tongue, face, lips, throat, feet, legs, hands or sex organs
  • Swollen glands
  • Red skin lesions, sometimes with a purple center
  • Unexplained bruising or bleeding
  • Awkwardness or unsteadiness
  • Weakness in the hands, arms, hands, feet or legs

If patients experience any other side-effects during or following treatment with Linezolid, they should inform their doctor or nurse and obtain medical advice.

Dosage

When patients are prescribed intravenous Linezolid, their dose of medication will depend on their condition, the nature of their infection, their age, weight and medical history. If adult patients are being treated for complicated skin infections, for example, they may be given 600mg of Linezolid every twelve hours. Although this treatment could continue for ten to fourteen days, patients are usually switched to an oral antibiotic once their symptoms begin to improve.

Similarly, community-acquired pneumonia, nosocomial pneumonia and MRSA infections in adult patients can be treated with 600mg of Linezolid, given every twelve hours.

When Linezolid is prescribed via intravenous injection, a trained healthcare professional will administer the medication. Usually, Linezolid is delivered over a period of 30-120 minutes, but patients may need additional doses. As the medication is administered by a medical professional in a clinical setting, patients will not have to calculate or manage their own dose of Linezolid.

Potential Drug Interactions

Due to the risk of an interaction occurring, Linezolid is not used in conjunction with the following medications:

  • Almotriptan
  • Dobutamine
  • Amitriptyline
  • Dextroamphetamine
  • Amoxapine
  • Dexmethylphenidate
  • Amphetamine
  • Desvenlafaxine
  • Apraclonidine
  • Desipramine
  • Atomoxetine
  • Epinephrine
  • Benzphetamine
  • Escitalopram
  • Brimonidine
  • Entacapone
  • Bupropion
  • Femoxetine
  • Buspirone
  • Carbamazepine
  • Imipramine
  • Duloxetine
  • Carbidopa
  • Isocarboxazid
  • Eletriptan
  • Carbinoxamine
  • Milnacipran
  • Citalopram
  • Methadone
  • Clomipramine
  • Methylphenidate
  • Clovoxamine
  • Methyldopa
  • Cyclobenzaprine
  • Methylene Blue
  • Cyproheptadine
  • Mirtazapine
  • Diethylpropion
  • Nefazodone
  • Dopamine
  • Mazindol
  • Doxepin
  • Naratriptan
  • Doxylamine
  • Meperidine
  • Flesinoxan
  • Phenylalanine
  • Fluoxetine
  • Phenmetrazine
  • Fluvoxamine
  • Phentermine
  • Frovatriptan
  • Guanadrel
  • Phenelzine
  • Guanethidine
  • Protriptyline
  • Hydroxytryptophan
  • Procarbazine
  • Levodopa
  • Phendimetrazine
  • Levomethadyl
  • Phenylephrine
  • Levomilnacipran
  • Paroxetine
  • Linezolid
  • Opipramol
  • Lisdexamfetamine
  • Sibutramine
  • Maprotiline
  • Reserpine
  • Methamphetamine
  • Trazodone
  • Nefopam
  • Tapentadol
  • Norepinephrine
  • Zolmitriptan
  • Venlafaxine
  • Sumatriptan
  • Nortriptyline
  • Tetrabenazine
  • Sertraline
  • Opicapone
  • Tranylcypromine
  • Phenylpropanolamine
  • Selegiline
  • Pseudoephedrine
  • Vilazodone
  • Rizatriptan
  • Tryptophan
  • Rasagiline
  • Zimeldine
  • Trimipramine
  • Safinamide
  • Vortioxetine

In addition to this, using Linezolid alongside any of the following medicines is not usually advisable:

  • Altretamine
  • Oxycodone
  • Atropine
  • Morphine Sulfate Liposome
  • Buprenorphine
  • Morphine
  • Cholera Vaccine, Live
  • Oxymetazoline
  • Dextromethorphan
  • Metoclopramide
  • Difenoxin
  • Palonosetron
  • Diphenhydramine
  • Tolcapone
  • Diphenoxylate
  • Reboxetine
  • Dolasetron
  • St John's Wort
  • Droperidol
  • Ma Huang
  • Ethchlorvynol
  • Risperidone
  • Fentanyl
  • Mate
  • Granisetron
  • Tyrosine
  • Licorice
  • Guarana
  • Lithium
  • Hydrocodone
  • Lorcaserin
  • Tramadol
  • Hydromorphone
  • Warfarin
  • Iobenguane I 123
  • Ziprasidone
  • Kava

In some cases, however, it may be in the patient's best interests to treat them with Linezolid and one of the medications listed above. If so, the patient's dose of Linezolid may be modified in order to try and prevent an interaction taking place.

Furthermore, if patients are given Linezolid in conjunction with any of the following substances, it may increase their risk of experiencing side-effects:

  • Glimepiride
  • Acarbose
  • Insulin Glargine, Recombinant
  • Nateglinide
  • Glipizide
  • Chlorpropamide
  • Insulin Aspart, Recombinant
  • Glyburide
  • Clarithromycin
  • Insulin Bovine
  • Metformin
  • Insulin Degludec
  • Repaglinide
  • Insulin Detemir
  • Rifampin
  • Insulin
  • Tolazamide
  • Insulin Glulisine
  • Ginseng
  • Tolbutamide
  • Insulin Lispro, Recombinant

As some medications can also interact with certain food and drink, patients will need to be aware of what they can and cannot consume when they are being treated with Linezolid. For example, consuming either of the following it not recommended when patients are being treated with Linezolid:

  • Bitter orange
  • Avocado

In addition to this, patients may suffer from increased side-effects if they consume the following during or following treatment with Linezolid:

  • Foods containing tyramine

Before receiving treatment with Linezolid, patients should tell their doctor if they have been taking or using any other medicines. This includes over-the-counter medications, supplements and/or vitamins. Patients should also obtain medical advice before using any new medicines, supplements or vitamins once treatment with Linezolid has begun.

Warnings

If patients have any other existing medical conditions, they should notify their physician before they are treated with Linezolid. Similarly, patients should discuss their medical condition with their doctor before they are given Linezolid. There are some conditions which can affect the use of this medication and they may include:

Linezolid should not be prescribed if the patient is currently taking a monoamine oxidase (MAO) inhibitor or if the patient has taken an MAO inhibitor within the fourteen days before treatment.

Whilst patients are being treated with Linezolid, they should be closely monitored by their medical team. This will ensure that Linezolid is being given in appropriate doses and that the medication isn't having any unwanted effects.

Patients should notify their physician if they do not notice an improvement in their symptoms within a few days of treatment commencing or if their symptoms worsen.

Treatment with Linezolid can temporarily lower the number of platelets and/or white blood cells in the patient's blood. Due to this, patients may be susceptible to infections and have a limited blood clotting abilities. Patients should avoid other people who are unwell or have an infection and should inform their doctor immediately if they begin to feel unwell or exhibit the following symptoms:

  • Hoarseness
  • Fever
  • Chills
  • Cough
  • Pain in the side or lower back
  • Difficult or painful urination

Patients should also inform their physician if they suffer any unusual bruising or bleeding during or following treatment with Linezolid. In order to prevent bleeding, patients should take extra care when using nail clippers, razors and/or dental floss. In some cases, patients may need to temporarily modify their oral hygiene routine to prevent their gums from bleeding.

Linezolid can cause patients to experience severe diarrhea and this is a side effect which can continue for two months or longer after treatment has been discontinued. If affected in this way, patients should contact their physician for advice. Patients should not take or use any diarrhea remedies or medications unless advised to do so by their doctor.

When patients are treated with Linezolid, they may experience periods of low blood sugar. This can cause the following symptoms to occur:

  • Headache, may be continuing
  • Anxiety
  • Drowsiness
  • Weakness
  • Confusion
  • Increased hunger
  • Changes to vision

If patients experience low blood sugar as a result of treatment with Linezolid, they should contact their doctor for advice.

In some cases, Linezolid may cause acid to build up in the patient's blood. This is a serious reaction, known as lactic acidosis. If patients develop the following symptoms, they should obtain immediate medical assistance:

  • Weakness
  • Extreme fatigue
  • Nausea
  • Difficulty breathing
  • Lightheadedness
  • Faintness
  • Vomiting

If Linezolid is taken with certain other medications, patients could develop serotonin syndrome. Patients should consult their doctor before taking any medicines following treatment with Linezolid and should obtain urgent medical help if they experience the following symptoms:

  • Fainting
  • Nausea or vomiting
  • Tiredness
  • Weakness
  • Trouble breathing
  • Lightheadedness

If patients experience vision changes when they are treated with Linezolid, they should inform their physician. These changes may include, blurred vision, difficulty reading and/or double vision.

If patients consume certain foods and drinks whilst being treated with Linezolid, they could suffer an increase in blood pressure. To avoid this happening, patients should not consume foods or drinks with a high tyramine content. These may include, cheese, smoked or dried fish, poultry or meats, soy sauce, sauerkraut, red wine and/or beer. Patients should ask their physician for a list of foods and drinks that they should avoid following treatment with Linezolid.

If Linezolid is prescribed to patients who are pregnant, there is a risk that it could cause harm to the unborn fetus. Due to this, Linezolid should only be used to treat pregnant patients if a safer alternative is not available and if the benefits greatly outweigh the risks.

If patients become pregnant immediately following treatment with Linezolid, they should notify their doctor straight away.

It is not known if Linezolid can be excreted in breast milk and whether it could cause harm to an infant if it was transferred in this way. Due to this, patients are generally advised not to breastfeed during or immediately following treatment with Linezolid. Patients should consult their doctor in order to determine when it is safe for them to resume breastfeeding following treatment with Linezolid.

Before being given Linezolid, patients should tell their doctor if they have any allergies or if they have ever exhibited an allergic reaction to any substances. In rare cases, patients may develop an allergic reaction during treatment with Linezolid. If so, a healthcare practitioner must be notified immediately as the patient will require emergency medical treatment. An allergic reaction may include the following symptoms:

  • Difficulty breathing
  • Wheezing
  • Shortness of breath
  • Difficulty swallowing
  • Hives
  • Tightness in the chest
  • Hoarseness
  • Swelling of the face, lips, mouth, tongue, throat or hands
  • Itching
  • Rash on the skin

Storage

In order to protect Linezolid, the medication should be stored in accordance with the manufacturer's instructions. Typically, Linezolid is supplied in single-use infusion bags which should be stored at 25?C (77?F). In addition to this, Linezolid infusion bags should be kept in overwrap prior to use and should be protected from light.

However, when Linezolid is administered intravenously, it is given in a clinical setting, such as a treatment center or hospital. Due to this, healthcare practitioners will deal with the storage and preparation of Linezolid and patients will not be required to keep this type of medication at home.

Summary

If patients are exhibiting signs of an infection, they will be assessed by a physician and specific tests will be carried out. This enables doctors to determine whether the infection has been caused by bacteria, fungus or a virus. Following this, further tests will be done to confirm what type of bacteria, fungus or virus is causing the patient's condition.

If the patient is diagnosed with a gram-positive bacterial infection, Linezolid may be used to destroy existing bacteria cells and to prevent the infection from spreading. However, Linezolid is not always the first-choice treatment for bacterial infections and may only be used when other antibiotics have failed to treat the infection.

When administered intravenously, Linezolid is given in a clinical setting and patients are usually treated as a hospital inpatient. As bacterial infections can quickly worsen without effective treatment, the physician will monitor the patient during their treatment with Linezolid to ensure that the medication is working.

Once intravenous Linezolid has begun to treat the infection, the patient may be given Linezolid orally or be switched to another type of oral antibiotic. For serious or drug-resistant infections, however, intravenous Linezolid can be extremely effective. As Linezolid begins to destroy the infection itself, the patient's symptoms should begin to diminish and the risk of further complications will be lowered.

Although Linezolid is associated with some side-effects, the benefits of treatment with this medication often outweigh the risk of developing adverse effects. For infections which require fast-acting treatment, intravenous Linezolid can be used to target the bacteria in the patient's body and to rid them of the infection.