What foods should be avoided when taking linezolid?

Foods to Avoid When Taking Linezolid

Patients taking linezolid should avoid consuming large amounts of foods or beverages with high tyramine content due to linezolid's activity as a weak, reversible monoamine oxidase inhibitor. 1

Understanding the Tyramine Restriction

Linezolid is a weak, reversible monoamine oxidase inhibitor (MAOI) that can potentially interact with tyramine-rich foods. This interaction could lead to a significant pressor response (increased blood pressure), particularly when consuming foods with high tyramine content.

Foods High in Tyramine to Limit:

• Aged, fermented, cured, smoked, and pickled foods 2, including:
  • Aged cheeses (particularly aged cheddar, blue-veined cheeses, feta, Brie, Camembert, and Mexican queso fresco) 3
  • Fermented alcoholic beverages (unpasteurized craft beer, spontaneously fermented beer, wine) 3
  • Soy sauce 3
  • Cured meats
  • Smoked or pickled fish
  • Fermented soybean products

Important Considerations:

1. Quantity matters: The concern is primarily with large amounts (more than 150 mg) of tyramine 3. Moderate consumption of most tyramine-containing foods appears safe.

2. Hospital vs. outpatient setting: For hospitalized patients, dietary tyramine restriction is generally not required, as hospital meals typically do not contain large amounts of high-tyramine foods 4.

3. Blood pressure monitoring: Patients with pre-existing hypertension should be particularly cautious and monitor their blood pressure regularly.

Additional Precautions

Contraindications:

Linezolid is contraindicated in patients with:

• Uncontrolled hypertension
• Pheochromocytoma
• Carcinoid tumor
• Thyrotoxicosis
• Bipolar depression
• Schizophrenia
• Acute confusional states 3

Medication Interactions:

• Avoid concomitant use with other monoamine oxidase inhibitors (MAOIs) or within 2 weeks of taking such medications 3
• Use caution with serotonergic agents due to risk of serotonin syndrome 2

Monitoring Recommendations

• Blood counts: Weekly complete blood count monitoring for the first 2 months of therapy, then monthly if stable 3
• Visual monitoring: Consider monthly visual acuity and color discrimination testing for patients on prolonged therapy 3
• Blood pressure: Regular monitoring, especially after consuming foods with moderate tyramine content

Patient Education

Patients should be instructed to:

• Report any unusual headaches, neck stiffness, palpitations, or rapid increase in blood pressure
• Seek immediate medical attention if experiencing severe headache, confusion, blurred vision, or other symptoms of hypertensive crisis
• Understand that moderate consumption of most foods is likely safe, but large quantities of high-tyramine foods should be avoided

While the risk of a clinically significant interaction between linezolid and tyramine from food is relatively low with moderate consumption 3, caution is still warranted, especially for outpatients who have more dietary variety than hospitalized patients.