CriticalOxazolidinone antibiotic×Other opioids
Updated · Methodology
Mechanism
Tramadol is an opioid with serotonin–norepinephrine reuptake inhibition. Linezolid reversibly inhibits MAO. Co-administration causes a sharp rise in synaptic serotonin and risk of serotonin syndrome.
Symptoms
Serotonin syndrome: agitation, confusion, tremor, myoclonus, hyperreflexia, dilated pupils. Autonomic features: profuse sweating, tachycardia, hypertension, fever above 38.5 °C. Severe cases progress to seizures, rhabdomyolysis, disseminated intravascular coagulation, and death. First signs appear within hours of concurrent dosing.
Management
The combination is not prescribed. Stop tramadol 24–72 hours before starting linezolid. For analgesia, use paracetamol, NSAIDs (if not contraindicated), or pure opioid agonists such as morphine or oxycodone with no serotonergic activity.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
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Sources
- FDA: Zyvox (linezolid) prescribing information (2020)– ; DailyMed setid 6e70e63b-bfd5-478d-a8ee-8ba22c9efabd
- FDA: Tramadol hydrochloride tablet (Amneal Pharmaceuticals NY LLC) – Prescribing Information (2017)– ; DailyMed setid 8ec4e4e5-a56e-4198-8428-6b770b9bf27d
- AEMPS: Ficha técnica: Linezolid (nº registro 81569), sección 4.4 (2026)– AEMPS, CIMA, nº registro 81569, revisión 05/2026, sección 4.4