linezolid and sertraline

Linezolid is a reversible inhibitor of monoamine oxidase, particularly MAO-A. Sertraline is a selective serotonin reuptake inhibitor that increases synaptic serotonin. Co-administration results in additive serotonergic effects through reduced serotonin metabolism and increased serotonin release, leading to excessive serotonergic activity in the central nervous system.

Combined use can precipitate serotonin syndrome, characterised by agitation, confusion, hyperthermia, autonomic instability, myoclonus, and potentially fatal outcomes. The risk is highest with full therapeutic doses, but serious reactions have occurred even with short courses of linezolid in patients taking SSRIs.

Do not co-prescribe linezolid and sertraline. If linezolid is essential, withhold sertraline for at least 5 half-lives before starting linezolid, and resume at least 24 hours after the last dose of linezolid (or longer for long-acting formulations). If urgent concomitant use is unavoidable, closely monitor for signs of serotonin syndrome and consider alternative antibiotics when clinically feasible.

Well-established interaction based on pharmacological principles and numerous case reports of serotonin syndrome. Regulatory guidelines and product labelling recommend avoiding concurrent use with MAOIs, including linezolid.