Linezolid-associated peripheral and optic neuropathy, lactic acidosis, and serotonin syndrome

Pharmacotherapy. 2007 Aug;27(8):1189-97. doi: 10.1592/phco.27.8.1189.

Abstract

Linezolid is an oxazolidinone antibacterial agent indicated for serious gram-positive infections. Only minor adverse effects were seen in phase III trials. However, more serious adverse effects were reported after commercial release, including cases of lactic acidosis, peripheral and optic neuropathy, and serotonin syndrome. Peripheral and optic neuropathy was usually seen after several months of linezolid therapy (median 5 mo), lactic acidosis after several weeks (median 6 wks), and serotonin syndrome after several days (median 4 days). Death occurred in two of seven reported cases of lactic acidosis, and three of 15 reported cases of serotonin syndrome. Improvement or complete recovery occurred in all cases of optic neuropathy, whereas complete recovery failed to occur in any patient with peripheral neuropathy. Linezolid should be discontinued immediately in patients experiencing these adverse effects. Patients receiving linezolid for more than 28 days should be monitored for signs of peripheral and optic neuropathy.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Acetamides / administration & dosage
  • Acetamides / adverse effects*
  • Acidosis, Lactic / chemically induced*
  • Acidosis, Lactic / physiopathology
  • Anti-Infective Agents / administration & dosage
  • Anti-Infective Agents / adverse effects*
  • Drug Interactions
  • Female
  • Humans
  • Linezolid
  • Male
  • Optic Nerve Diseases / chemically induced*
  • Optic Nerve Diseases / physiopathology
  • Oxazolidinones / administration & dosage
  • Oxazolidinones / adverse effects*
  • Peripheral Nervous System Diseases / chemically induced*
  • Peripheral Nervous System Diseases / physiopathology
  • Risk Factors
  • Selective Serotonin Reuptake Inhibitors / adverse effects
  • Serotonin Syndrome / chemically induced
  • Serotonin Syndrome / physiopathology

Substances

  • Acetamides
  • Anti-Infective Agents
  • Oxazolidinones
  • Serotonin Uptake Inhibitors
  • Linezolid