Journal of Pharmacy Practice (JPP)A Case Series on Serotonin Syndrome from Concomitant Use of Linezolid with Methadone, Buprenorphine, and/or Dextroamphetamine

Are you underestimating the potential risk of serotonin syndrome when combining linezolid with these other drugs?

Uncovering the risk associated with combining linezolid and drugs like methadone, buprenorphine, and dextroamphetamine is crucial for tailoring antimicrobial therapy options. These researchers explored these implications further.

Key Points:

• This study analyzed adult patient encounters using linezolid with methadone, buprenorphine, and/or dextroamphetamine from April 2016 to June 2022.
• Of 194 encounters, 16.5%, 17.8%, and 7.1% were on high dose methadone, buprenorphine, and dextroamphetamine, respectively.
• One confirmed and two possible cases of serotonin syndrome were identified.

Additional Points:

• The average duration of overlap with linezolid was 4.6 days for methadone, 3.3 days for buprenorphine, and 7 days for dextroamphetamine.
• Confirmed and possible cases of serotonin syndrome were diagnosed using ICD-10 codes, cyproheptadine administration, and the Hunter Serotonin Toxicity Criteria.

Conclusion:

• Linezolid can be considered for patients concurrently on methadone, buprenorphine, and/or dextroamphetamine, but real-world studies are needed to clarify the potential risk for serotonin syndrome.

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Did You Know?
Despite its potential severity, serotonin syndrome is often underdiagnosed due to its wide range of symptoms. The American Association of Poison Control Centers reports approximately 7,000 cases annually, but the true prevalence may be significantly higher due to lack of awareness and recognition.