Can linezolid be taken with tramadol (Tramadol hydrochloride)?

From the Guidelines

Linezolid should not be taken with tramadol due to the risk of serotonin syndrome, a potentially life-threatening drug interaction. Both medications can increase serotonin levels in the brain, and when taken together, they can cause excessive serotonin accumulation. Linezolid is an antibiotic that also functions as a monoamine oxidase inhibitor (MAOI), while tramadol is a pain medication that affects serotonin reuptake 1.

Key Considerations

• Symptoms of serotonin syndrome include confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, tremors, excessive sweating, diarrhea, and in severe cases, seizures or loss of consciousness.
• The combination of these medications can lead to mental status changes, neuromuscular hyperactivity, and autonomic hyperactivity, which can be fatal if not treated promptly 1.
• Alternative pain management options should be considered if you need to take linezolid.
• If you must take both medications, it would require careful monitoring by healthcare professionals with at least a 14-day washout period between stopping one medication and starting the other.

Recommendations for Healthcare Professionals

• Inform patients about the risks of serotonin syndrome when taking linezolid and tramadol together.
• Monitor patients closely for signs of serotonin syndrome, especially when initiating or adjusting the dose of either medication.
• Consider alternative medications or treatment options to minimize the risk of serotonin syndrome.

From the FDA Drug Label

Caution is advised when tramadol hydrochloride is coadministered with other drugs that may affect the serotonergic neurotransmitter systems, such as SSRIs, MAOIs, triptans, linezolid (an antibiotic which is a reversible non-selective MAOI), lithium, or St. John’s Wort If concomitant treatment of tramadol hydrochloride with a drug affecting the serotonergic neurotransmitter system is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases

Key Considerations:

• Linezolid is a reversible non-selective MAOI.
• Concomitant administration of tramadol with MAOIs, such as linezolid, may increase the risk of serotonin syndrome.
• Caution is advised when coadministering tramadol with linezolid.
• Careful observation of the patient is recommended, particularly during treatment initiation and dose increases 2. Answer: Linezolid can be taken with tramadol, but caution is advised due to the increased risk of serotonin syndrome.

From the Research

Linezolid and Tramadol Interaction

• The interaction between linezolid and tramadol is a concern due to the risk of serotonin syndrome, a potentially life-threatening condition caused by excessive levels of serotonin in the body 3, 4, 5, 6, 7.
• Linezolid is an antibiotic that can increase the risk of serotonin syndrome when used with other serotonergic agents, including tramadol, which is an opioid pain medication that also has serotonergic effects 3, 6.
• Studies have shown that the risk of serotonin syndrome is low when linezolid is used alone, but it may increase when used with other serotonergic agents, including tramadol 3, 6.
• However, a study found that concurrent use of antidepressants, which are also serotonergic agents, did not significantly increase the risk of serotonin syndrome in patients taking linezolid 6.
• Another study analyzed adverse event reports and found that linezolid was one of the top 10 active substances with the highest reporting odds ratio for serotonin syndrome, but the risk was still considered low 7.
• Tramadol has also been associated with serotonin syndrome, particularly when used with other serotonergic agents, and the risk may be higher in older adults and males 4, 5, 7.

Risk Factors and Precautions

• Patients taking linezolid and tramadol should be monitored closely for signs and symptoms of serotonin syndrome, such as agitation, confusion, rapid heart rate, and changes in blood pressure 3, 4, 5, 6, 7.
• The risk of serotonin syndrome may be higher in patients with medical comorbidities, those taking supratherapeutic doses of tramadol, and those using concomitant proconvulsant serotonergic cytochrome P-450 inhibitors 4, 5.
• Prescribers should be vigilant when using linezolid and tramadol together and consider alternative treatments or close monitoring to minimize the risk of serotonin syndrome 6, 7.