Can linezolid be taken with ciprofloxacin (Cipro) and metronidazole (Flagyl)?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: March 15, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

From the Guidelines

I strongly advise against taking linezolid with ciprofloxacin (Cipro) and metronidazole (Flagyl) without medical supervision due to potential drug interactions that can increase the risk of serious side effects, including QT interval prolongation and serotonin syndrome. Linezolid is an antibiotic that belongs to a class called oxazolidinones and works as a monoamine oxidase inhibitor (MAOI) 1. When combined with certain medications, including some antibiotics, it can lead to serious interactions. Specifically, taking linezolid with ciprofloxacin may increase the risk of QT interval prolongation (a heart rhythm problem), while the combination of multiple antibiotics can increase the risk of side effects and may not always provide additional benefit.

Key Considerations

  • The combination of linezolid with ciprofloxacin and metronidazole is not explicitly recommended in the provided guidelines 1.
  • Linezolid has food and drug interactions that require careful monitoring, including the risk of serotonin syndrome if combined with certain medications 1.
  • The guidelines suggest that linezolid can be used in the initial course of native vertebral osteomyelitis (NVO) due to oxacillin-resistant staphylococci when first-line agents cannot be used, but it does not provide guidance on combining it with ciprofloxacin and metronidazole 1.
  • Ciprofloxacin is not recommended for use in patients with staphylococcal NVO as monotherapy, but may be used in patients with NVO due to Enterobacteriaceae and other susceptible aerobic gram-negative organisms 1.
  • Metronidazole can be used in the initial course of NVO due to Bacteroides species and other susceptible anaerobes 1.

Recommendations

  • If you've been prescribed these medications or are considering taking them together, please consult with your healthcare provider immediately to discuss the potential risks and benefits.
  • Your healthcare provider should carefully monitor you for side effects and adjust the treatment plan as needed.
  • It is essential to follow the recommended dosages and adjust them based on patients’ renal and hepatic function, as well as consider patient allergies, intolerances, and potential drug interactions or contraindications to a specific antimicrobial 1.

From the Research

Linezolid Interactions with Ciprofloxacin and Metronidazole

  • There is no direct evidence in the provided studies regarding the interaction between linezolid and the combination of ciprofloxacin (Cipro) and metronidazole (Flagyl) 2, 3, 4, 5, 6.
  • The studies primarily focus on the risk of serotonin syndrome associated with linezolid, particularly when used with serotonergic agents 2, 3, 4, 6.
  • One study discusses the use of linezolid combination therapy for serious infections, but it does not specifically address the combination with ciprofloxacin and metronidazole 5.
  • Another study compares the incidence of serotonin syndrome when linezolid is administered alone and in combination with selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs), but it does not provide information on interactions with ciprofloxacin and metronidazole 6.

Potential Considerations

  • Linezolid is a monoamine oxidase inhibitor, which may increase the risk of serotonin syndrome when used with certain medications 2, 3, 4, 6.
  • Ciprofloxacin and metronidazole are antibiotics with different mechanisms of action, and their potential interactions with linezolid are not explicitly addressed in the provided studies.
  • As with any medication combination, it is essential to consider the potential risks and benefits of using linezolid with ciprofloxacin and metronidazole, and to monitor patients closely for any adverse effects.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Linezolid-Associated Serotonin Syndrome. A Report of Two Cases.

Journal of the American Podiatric Medical Association, 2015

4
Research

Linezolid-induced serotonin syndrome.

Industrial psychiatry journal, 2020

5
Research

Role of linezolid combination therapy for serious infections: review of the current evidence.

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2020

Related Questions

Is linezolid contraindicated in patients taking methadone (opioid agonist)?
What is the likelihood of serotonin syndrome with the combination of linezolid and tramadol?
What is the interaction between Amitriptyline (a tricyclic antidepressant) and Linezolid (an antibiotic), specifically regarding their potential pharmacodynamic and pharmacokinetic effects?
Can linezolid (an antibiotic with monoamine oxidase inhibitor (MAOI) properties) cause serotonin syndrome on its own without being combined with other serotonergic medications?
What is the relationship between Linezolid (an antibiotic) and Serotonin Syndrome?
What is the treatment for acne and skin barrier repair in sensitive skin with dermatitis (atopic dermatitis)?
What is the other finding associated with chorioretinitis, microcephaly, and calcification, aside from increased Liver Function Tests (LFTs), increased fibrinogen, or impaired renal function, as indicated by increased Blood Urea Nitrogen (BUN) and creatinine (Cr)?
What is the role of Arachidonic Acid (AA) in the human body?
What is the role of Linoleic Acid (LA), an omega-6 fatty acid, in human health?
Can morphine and Narcan (naloxone) cross-react as cocaine on a drug test?
What is the likely location of the issue in a patient with expressive aphasia and motor symptoms on the right side, specifically in the cerebral cortex or putamen (part of the basal ganglia)?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question