Summary

Sertraline and linezolid have a significant drug interaction that can lead to serotonin syndrome, a potentially life-threatening condition. This interaction occurs because linezolid has monoamine oxidase inhibitor (MAOI) properties that can dangerously increase serotonin levels when combined with sertraline.

Introduction

Sertraline is a selective serotonin reuptake inhibitor (SSRI) antidepressant commonly prescribed for depression, anxiety disorders, and obsessive-compulsive disorder. It works by increasing serotonin levels in the brain. Linezolid is an oxazolidinone antibiotic used to treat serious gram-positive bacterial infections, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). While primarily an antibiotic, linezolid also possesses weak monoamine oxidase inhibitor properties.

Mechanism of Interaction

The interaction between sertraline and linezolid occurs through complementary mechanisms that both increase serotonin availability. Sertraline blocks the reuptake of serotonin at nerve terminals, while linezolid inhibits monoamine oxidase A and B enzymes that normally break down serotonin. When used together, these mechanisms can cause excessive accumulation of serotonin in the central nervous system, leading to serotonin syndrome. This pharmacodynamic interaction is dose-independent and can occur even with standard therapeutic doses of both medications.

Risks and Symptoms

The primary risk of combining sertraline and linezolid is serotonin syndrome, which can range from mild to life-threatening. Early symptoms include agitation, confusion, rapid heart rate, dilated pupils, muscle rigidity, and hyperthermia. Severe cases can progress to seizures, coma, and death. The risk is particularly high in patients taking higher doses of sertraline or those with compromised kidney function. Additional risks include hypertensive crisis and increased bleeding risk due to platelet dysfunction. The interaction is considered contraindicated by most clinical guidelines due to the severity of potential outcomes.

Management and Precautions

The combination of sertraline and linezolid should generally be avoided. If linezolid treatment is absolutely necessary in a patient taking sertraline, the antidepressant should typically be discontinued at least 2 weeks before starting linezolid (allowing for sertraline washout). Alternative antibiotics should be considered first. If no alternatives exist and the infection is life-threatening, sertraline may need to be stopped and the patient closely monitored for serotonin syndrome symptoms during linezolid therapy. After completing linezolid treatment, wait at least 24 hours before restarting sertraline. Patients should be educated about serotonin syndrome symptoms and advised to seek immediate medical attention if they occur.

Sertraline interactions with food and lifestyle

Alcohol: Sertraline may increase the effects of alcohol and impair mental and motor skills. Patients should avoid or limit alcohol consumption while taking sertraline as recommended by major clinical guidelines and drug databases. The combination can increase sedation, dizziness, and impair cognitive function.

Linezolid interactions with food and lifestyle

Linezolid has significant interactions with tyramine-rich foods that require careful dietary restrictions. Patients taking linezolid should avoid or limit foods high in tyramine including aged cheeses, cured meats, fermented foods, red wine, beer, and certain vegetables like sauerkraut. Consuming large amounts of tyramine while on linezolid can lead to dangerous increases in blood pressure (hypertensive crisis). Additionally, linezolid can interact with foods and beverages containing high amounts of caffeine, potentially causing increased blood pressure and heart rate. Patients should limit caffeine intake from coffee, tea, energy drinks, and chocolate while taking this medication. Alcohol should be avoided or used with extreme caution as it may increase the risk of side effects and can interact with linezolid's mechanism of action.