Linezolid

A to Z Drug Facts

 Action Prevents the formation of a functional 70S initiation complex, which is essential to the bacterial translation process.

 Indications Treatment of vancomycin-resistant Enterococcus faecium infections; treatment of nosocomial pneumonia, complicated and uncomplicated skin and skin structure infections, and community-acquired pneumonia due to susceptible strains of specific organisms.

 Contraindications Standard considerations.

 Route/Dosage

Vancomycin-Resistant: E. faecium Infections, Including Concomitant Bacteremia Adults: PO or IV 600 mg q 12 hr for 14 to 28 days.

Nosocomial Pneumonia, Complicated Skin And Skin Structure Infections, Community-Acquired Pneumonia, Including Concomitant Bacteremia Adults: PO or IV 600 mg q 12 hr for 10 to 14 days.

Uncomplicated Skin And Skin Structure Infections Adults: PO 400 mg q 12 hr for 10 to 14 days.

 Interactions Adrenergic Agents (eg, dopamine, epinephrine): Effects may be enhanced by linezolid.

Serotonergic Agents (eg, fluoxetine): Possible increased risk of serotonin syndrome.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Hypertension. CNS: Headache; dizziness; insomnia. DERMATOLOGIC: Rash. EENT: Taste alteration; tongue discoloration; oral moniliasis. GI: Diarrhea; nausea; vomiting; constipation; dyspepsia; abdominal pain. GU: Vaginal moniliasis. HEMATOLOGIC: Thrombocytopenia. HEPATIC: Abnormal LFTs. OTHER: Fungal infection; fever; pruritus.

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Safety and efficacy not established. Pseudomembranous colitis: Consider pseudomembranous colitis in patients in whom diarrhea develops. Myelosuppression: Because myelosuppression has been reported, monitor CBC weekly in patients receiving linezolid.

 Administration/Storage

• Do not administer suspension to patient with phenylketonuria without first discussing with health care provider.
• Administer prescribed dose q 12 hr.
• No dose adjustment is needed when switching from IV to oral tablets or suspension.
• Administer tablets and suspension without regard to meals.
• Gently mix suspension by inverting bottle 3 to 5 times before each dose. Do not shake suspension.
• Use suspension for adults who have difficulty swallowing.

IV Administration

• Keep infusion bag in protective overwrap until ready to administer.
• Before administering, check IV bag for minute leaks by firmly squeezing bag, and visually inspect for particulate matter. Do not use if either is noted.
• Solution may exhibit a yellow color, which is normal and does not affect potency.
• Administer IV infusion over 30 to 120 min.
• Do not use IV infusion bag in series connections nor add any other medications to bag.
• If other drugs are being administered through same IV line, flush line before and after infusion of linezolid with 5% Dextrose Injection, 0.9% Sodium Chloride Injection, or Lactated Ringer's Injection.
• Store tablets, suspension, and IV solution at controlled room temperature. Protect infusion bags from freezing. Protect from light. Keep bottles tightly closed. Discard any unused suspension after 21 days.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note history of hypertension, hepatic impairment, myelosuppression or concurrent use of bone marrow suppressive therapy, or phenylketonuria.
• Review results of culture and sensitivity testing as available.
• Ensure that CBC is determined weekly during therapy with linezolid.
• Ensure that patient's diet contains no food with high tyramine content.
• Monitor for signs of infection, especially fever, and for positive response to antibiotic therapy.
• Monitor patient for signs of allergic reaction. Discontinue therapy and immediately notify health care provider if noted.
• Monitor patient for GI, CNS, and general body side effects. Report to health care provider if noted and significant.

 Patient/Family Education

• Explain name, dose, action, and potential side effects of drug.
• Review dosing schedule and prescribed length of therapy with patient. Advise patient that dose and duration of therapy are dependent on site and cause of infection.
• Advise patient that medication may be taken without regard to meals.
• Instruct patient to complete entire course of therapy, even if symptoms of infection have disappeared.
• Instruct patient to avoid foods with high tyramine content. Review common foods known to have high tyramine content (eg, aged cheeses, soy sauce, fermented or air-dried meats, sauerkraut, tap beers, red wines).
• Advise patient that diarrhea, headache, and nausea are the most common side effects, and to inform health care provider if these symptoms occur and are intolerable.
• Advise patient to discontinue therapy and contact health care provider immediately if skin rash, hives, itching, or shortness of breath occurs.
• Advise patient to report the following signs of superinfection to health care provider: black “furry” tongue, white patches in mouth, foul-smelling stools, vaginal itching or discharge.
• Warn patient that diarrhea containing blood or pus may be a sign of a serious disorder and to seek medical care if noted and not to treat at home.
• Caution patient to not take any otc cold products or decongestants containing ephedrine, pseudoephedrine, or phenylpropranolamine.
• Instruct patient to not take any prescription or otc medications or dietary supplements unless advised to do so by health care provider.
• Advise patient that follow-up examinations and lab tests may be required to monitor therapy and to be sure and keep appointments.

Books@Ovid
Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts