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 prio...

This is the paper I routinely cite when challenged by Pharmacy. Thanks to all for some newer citations. (Of course, the conclusion remains the same)

Bai et al., PMID 36534400

Key Points

Question: Are patients who take antidepressants at increased risk for serotonin syndrome when receiving linezolid tre...

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

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.

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.