Discontinuation of Mirtazapine While Taking Zyvox (Linezolid)
Mirtazapine must be stopped at least 14 days before starting Zyvox (linezolid) due to the risk of serotonin syndrome, and linezolid should not be started until this washout period is complete. 1, 2
Critical Drug Interaction
Mirtazapine is absolutely contraindicated with linezolid because linezolid acts as a monoamine oxidase inhibitor (MAOI), and concurrent use with serotonergic antidepressants like mirtazapine can cause life-threatening serotonin syndrome 1, 2
The FDA drug label explicitly states that patients taking linezolid should not receive mirtazapine or any other serotonergic agents, and that linezolid is contraindicated in patients taking MAOIs or within 14 days of stopping such medications 1, 2
Required Washout Period
Stop mirtazapine at least 14 days before initiating linezolid to allow adequate clearance and prevent serotonin syndrome 1
After stopping linezolid, wait at least 14 days before restarting mirtazapine or any other serotonergic antidepressant 1
One case report documented serotonin syndrome occurring 17 days after stopping mirtazapine when linezolid was started, demonstrating that even extended washout periods may not completely eliminate risk in some patients 3
Clinical Monitoring During Linezolid Therapy
Monitor closely for serotonin syndrome symptoms including cognitive dysfunction, hyperpyrexia (fever), hyperreflexia, incoordination, agitation, confusion, diaphoresis, tachycardia, and elevated blood pressure 2, 3, 4
Serotonin syndrome can occur at any time during linezolid therapy, with onset ranging from less than 1 day to 20 days after starting treatment, though it typically appears within 24 hours 3, 4
If serotonin syndrome develops, immediately discontinue linezolid and provide supportive care; symptoms typically resolve within 1-5 days after stopping the offending agents 4
Additional Safety Considerations
Linezolid requires multiple monitoring parameters including weekly complete blood counts for the first 2 months (then monthly if stable), monthly visual acuity and color discrimination testing, and assessment for peripheral neuropathy 5
The maximum recommended duration of linezolid is 28 days for most indications, though tuberculosis treatment may require longer courses with careful toxicity monitoring 6
Avoid tyramine-rich foods (aged cheeses, fermented meats, tap beers) during linezolid therapy, limiting tyramine intake to less than 100 mg per meal 2
Regarding "Trampoline"
There is no specific contraindication to physical activity or trampoline use while taking linezolid from a pharmacological standpoint 5, 6
However, if linezolid causes dizziness, peripheral neuropathy, or visual disturbances, activities requiring balance and coordination (including trampoline use) should be avoided until these symptoms resolve 5, 2
Monitor for neurological adverse effects including peripheral neuropathy, optic neuropathy, and seizures, which could impair safe participation in physical activities 5, 6, 2