Linezolid

About Linezolid

Linezolid belongs to the oxazolidinone class and stops bacteria making protein. The label approves it, in adults and children from birth, for nosocomial (hospital-acquired) pneumonia, community-acquired pneumonia, complicated skin and skin structure infections including diabetic foot infections without bone infection, uncomplicated skin infections, and infections with vancomycin-resistant Enterococcus faecium. It is not for Gram-negative infections, and it is not approved for, and should not be used for, catheter-related bloodstream infections. Adults and children 12 and older take 600 mg every 12 hours, by mouth or by vein, for 10 to 14 days for most infections and 14 to 28 days for vancomycin-resistant Enterococcus; younger children are dosed by weight every eight hours. The tablet and suspension can be taken with or without food, and a patient often goes home on tablets after starting the injection in hospital.

There is no boxed warning, but the label carries several serious ones. Linezolid can suppress the bone marrow, lowering platelets and other blood counts, so a complete blood count is checked weekly, especially beyond two weeks of treatment. Numbness or weakness in the hands and feet and loss of vision have occurred, mostly with courses longer than 28 days, and any change in vision needs a prompt eye examination. It is contraindicated with monoamine oxidase inhibitors, or within two weeks of stopping one, and it can cause serotonin syndrome with SSRIs, SNRIs, tricyclics, buspirone, triptans and some opioids. Other warnings cover lactic acidosis, seizures, low blood sugar in people with diabetes taking insulin or oral diabetes medicines, low sodium, Clostridioides difficile diarrhea, and raised blood pressure with decongestants such as pseudoephedrine and phenylephrine. Diarrhea, vomiting, headache, nausea and anemia are the most common side effects.

What is distinctive is the diet: because linezolid is a reversible, nonselective inhibitor of monoamine oxidase, MedlinePlus advises avoiding large amounts of tyramine-rich foods and drinks, such as aged or smoked cheeses, meats and fish, pickled or fermented foods, beer and red wine, while taking it. The oral suspension contains phenylalanine, a concern in phenylketonuria, and it is mixed by gently turning the bottle rather than shaking; once made up it is kept at room temperature and used within 21 days. Treatment beyond 28 days has not been studied in controlled trials. Linezolid is not a controlled substance.

Taking Linezolid

How to take it

Take it by mouth with or without food, usually every 12 hours, at the same times each day, and finish the whole prescription even if you feel better. Mix the suspension by gently turning the bottle over three to five times; do not shake it.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose. Do not take a double dose.

Storage

Tablets at room temperature in the original container, away from light, heat and moisture. The made-up suspension is kept at room temperature and thrown away after 21 days. Keep both out of reach of children.

Interactions to know about

Never with an MAO inhibitor such as phenelzine, tranylcypromine, selegiline or rasagiline, or within two weeks of one. SSRIs, SNRIs, tricyclics, buspirone, triptans and some opioids raise the risk of serotonin syndrome; pseudoephedrine, phenylephrine and other decongestants can raise blood pressure; insulin and oral diabetes medicines can cause low blood sugar. Avoid large amounts of tyramine-rich foods and drinks.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Linezolid differs from pharmacy to pharmacy

A course of linezolid tablets is short, usually 20 to 28 tablets, so the quote reflects a single fill: which generic maker the pharmacy buys from, whether it stocks the drug or orders it in, and whether it is on a flat-price generic list. Linezolid is an antibiotic for resistant infections that many pharmacies fill rarely, so stocking differs more than for everyday antibiotics.

The suspension, used mainly for children, is made up by the pharmacy and is quoted separately, and a prescription for the brand without substitution is priced as a brand.

Ways to pay less for Linezolid without insurance

• Ask the prescriber to write linezolid generically and allow substitution; the brand costs far more than the generics.
• Call ahead or ask more than one pharmacy, since a course usually starts the same day and not every pharmacy keeps linezolid in stock.
• Ask whether the pharmacy has linezolid on a flat-price generic list, and ask for a quote on the exact count your course needs.
• If a child is prescribed the suspension, ask the prescriber whether the tablet would suit an older child, since the tablet is more widely stocked.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Linezolid

1. 1.Which of my medicines, such as an antidepressant, a migraine medicine or a cold remedy, could cause a problem with linezolid?
2. 2.Which foods and drinks should I avoid while I take linezolid?
3. 3.Do I need a blood test during my course, and who arranges it?
4. 4.What symptoms, such as vision changes, numbness or confusion, mean I should call my doctor right away?

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