Linezolid

How it works

It binds the 23S ribosomal RNA of the 50S subunit, preventing formation of the functional 70S initiation complex and thereby inhibiting bacterial protein synthesis.

Prescribing in practice

• It is a reversible, non-selective monoamine oxidase inhibitor and can precipitate serotonin syndrome with serotonergic drugs such as SSRIs, so combinations must be reviewed and tyramine-rich foods limited.
• Reversible myelosuppression, particularly thrombocytopenia, can occur, with greater risk when courses are prolonged.
• Prolonged use beyond the usual duration risks optic and peripheral neuropathy and lactic acidosis, so treatment is generally time-limited.

Monitoring

Monitor full blood count weekly, especially with longer courses, and review for visual symptoms, peripheral neuropathy and signs of serotonin syndrome.

Counselling the patient

• Report any changes in vision, numbness or tingling in the hands or feet promptly.
• Avoid large amounts of tyramine-rich foods such as mature cheese and yeast extracts.
• Tell your team about antidepressants or other medicines that affect serotonin.

Evidence & guidelines

Prescribing reflects the SPC and MHRA advice on monitoring for blood disorders, optic neuropathy and serotonin syndrome.