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Serious CNS Reactions Prompt FDA Warning About Mixing Certain MAOIs, Serotonergic Psychiatric Drugs
Potentially Life-threatening Interaction Involves More Than Two Dozen Drugs
By News Staff
According to the FDA, more than two dozen medications can interact with linezolid and methylene blue, including selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricylic antidepressants, other MAOIs and a number of other psychiatric medications. Both safety documents contain a complete list of these agents.
- The FDA is alerting physicians and patients that concomitant administration of serotonergic psychiatric medications and either linezolid or methylene blue can lead to serotonin syndrome.
- The agency said serotonergic psychiatric medications should not be prescribed to patients taking linezolid or methylene blue except in certain life-threatening or urgent situations.
- to treat vancomycin-resistant Enterococcus faecium infections; and
- to treat infections such as nosocomial pneumonia and complicated skin and skin structure infections, including cases caused by methicillin-resistant Staphylococcus aureus.
- to treat methemoglobinemia;
- to treat ifosfamide-induced encephalopathy; and
- to treat cyanide poisoning.
The FDA issued the following information for physicians contemplating the use of linezolid or methylene blue in nonurgent situations for patients taking serotonergic psychiatric medications:
- the serotonergic psychiatric medication should be stopped at least two weeks in advance, and at least five weeks in advance with fluoxetine, to allow the antidepressant's activity in the brain to dissipate;
- treatment with the serotonergic psychiatric medication may be resumed 24 hours after the last dose of the MAOI;
- serotonergic psychiatric medications should not be started in a patient receiving linezolidor or methylene blue. Wait until 24 hours after the last dose of the MAOI before starting the antidepressant; and
- educate patients to recognize the symptoms of toxicity and advise them to contact a health care professional immediately if they experience any such symptoms while taking serotonergic psychiatric medications, linezolid or methylene blue.