Can a patient take Zyvox (linezolid) IV and lisinopril (PO) together?

Can Zyvox IV and Lisinopril PO Be Taken Together?

Yes, a patient can safely take Zyvox (linezolid) IV and lisinopril PO together, as there is no known drug interaction between these medications. Lisinopril is an ACE inhibitor used for hypertension and heart failure, while linezolid is an oxazolidinone antibiotic with monoamine oxidase inhibitor (MAOI) properties that primarily interacts with serotonergic and adrenergic agents 1, 2.

Key Safety Considerations

No Direct Interaction

• Linezolid's MAOI properties create concerns with serotonergic agents (SSRIs, SNRIs, tricyclic antidepressants) and sympathomimetic drugs, but ACE inhibitors like lisinopril do not fall into these categories 1, 3.
• The pharmacological mechanisms of linezolid (bacterial protein synthesis inhibition and weak MAOI activity) and lisinopril (angiotensin-converting enzyme inhibition) are entirely separate with no overlapping pathways 2, 4.

Critical Drug Interactions to Avoid with Linezolid

Absolute contraindications that do NOT apply to lisinopril include 1, 3:

• Serotonergic agents (SSRIs, SNRIs, MAO inhibitors, meperidine) - risk of serotonin syndrome
• Sympathomimetic agents (pseudoephedrine, phenylpropanolamine) - risk of hypertensive crisis
• Patients with uncontrolled hypertension, pheochromocytoma, or thyrotoxicosis

Important Monitoring for Linezolid Therapy

While safe to combine with lisinopril, linezolid requires vigilant monitoring for its own toxicities 1, 4:

Hematologic monitoring:

• Weekly complete blood counts for the first 2 months, then monthly if stable 1, 4
• Watch for thrombocytopenia (most common), anemia, and neutropenia 4, 5
• Myelosuppression is more common with treatment >2 weeks and doses >600 mg/day 1, 4

Neurological monitoring:

• Monthly visual acuity and color discrimination testing for optic neuritis 1
• Assess for peripheral neuropathy symptoms monthly 1
• These typically occur after 12-20 weeks and may be irreversible 6, 1

Metabolic monitoring:

• Periodic lactate levels to detect lactic acidosis with prolonged use 1

Clinical Management Algorithm

1. Verify no contraindicated medications: Confirm patient is not taking SSRIs, SNRIs, MAO inhibitors, or sympathomimetic agents 1, 3

2. Assess baseline risk factors: Check for uncontrolled hypertension, pheochromocytoma, thyrotoxicosis, bipolar disorder, or schizophrenia 1

3. Initiate standard monitoring:

   • Baseline CBC before starting linezolid 4
   • Weekly CBC for first 8 weeks 1, 4
   • Monthly CBC thereafter if stable 1
   • Monthly visual and neurological assessments 1

4. Continue lisinopril without modification: No dose adjustment or special precautions needed for the ACE inhibitor 2, 4

5. Optimize linezolid dosing: Use 600 mg IV/PO every 12 hours for adults (standard dose for serious infections including MRSA pneumonia, bacteremia, and complicated skin infections) 6

Common Pitfalls to Avoid

• Do not confuse ACE inhibitors with adrenergic agents - lisinopril does not have sympathomimetic properties and will not cause hypertensive reactions with linezolid 2, 3
• Do not discontinue necessary antihypertensive therapy - there is no reason to stop lisinopril when starting linezolid 4, 5
• Do not overlook other medications - carefully review the patient's complete medication list for actual contraindications (serotonergic agents, sympathomimetics) 1, 3