CriticalOxazolidinone antibiotic×SNRI (serotonin-norepinephrine reuptake inhibitor)
Updated · Methodology
Mechanism
Venlafaxine is a serotonin–norepinephrine reuptake inhibitor (SNRI). Linezolid reversibly inhibits MAO. Combined action raises both serotonin and norepinephrine, risking 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 venlafaxine at least 1 week before linezolid. For acute antibiotic need, use vancomycin or daptomycin. After completing linezolid, venlafaxine may resume 24 hours later.
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.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Zyvox (linezolid) boxed warning - MAO/serotonergic (2010)– ; DailyMed setid 6e70e63b-bfd5-478d-a8ee-8ba22c9efabd
- AEMPS: Ficha técnica: Venlafaxina (nº registro 67542), sección 4.5 (2024)– AEMPS, CIMA, nº registro 67542, revisión 03/2024, sección 4.5