Linezolid Overdose

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What is the dose of your medication?

What happens if I overdose Linezolid?

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately.

Proper storage of Linezolid suspension:

Store Linezolid suspension at 77 degrees F (25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep the bottle tightly closed. Discard any unused medicine 21 days after mixing. Keep Linezolid suspension out of the reach of children and away from pets.

Overdose of Linezolid in details

infoWhen a dose is taken in higher dose than the recommended doses, it is called Overdose. Overdose always needs a clinical supervision. Any medicine or drug when consumed in Overdose produces untoward side effects on one or various organs in the body. A medicine is excreted in the kidney or metabolized in the liver most of the times. This process goes without any hurdles when taken in normal dose, but when taken in an overdose, the body is not able to metabolize it or send it out properly which causes the effects of anoverdose.
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In the event of overdosage, supportive care is advised, with maintenance of glomerular filtration. Hemodialysis may facilitate more rapid elimination of Linezolid. In a Phase 1 clinical trial, approximately 30% of a dose of Linezolid was removed during a 3-hour hemodialysis session beginning 3 hours after the dose of Linezolid was administered. Data are not available for removal of Linezolid with peritoneal dialysis or hemoperfusion. Clinical signs of acute toxicity in animals were decreased activity and ataxia in rats and vomiting and tremors in dogs treated with 3000 mg/kg/day and 2000 mg/kg/day, respectively.

What should I avoid while taking Linezolid?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking Linezolid and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Eating tyramine while you are using Linezolid can raise your blood pressure to dangerous levels. Avoid foods that have a high level of tyramine, such as:

  • aged cheeses or meats;

  • pickled or fermented meats, smoked or air-dried meats;

  • sauerkraut;

  • soy sauce;

  • tap beer (alcoholic and nonalcoholic);

  • red wine; or

  • any meat, cheese, or other protein-based food that has been improperly stored.

You should become very familiar with the list of foods you must avoid while you are using Linezolid.

Linezolid warnings

infoWarnings are a mix of Precautions. Contraindications and interactions and serious harmful effects associated with the medicine intake. A diabetic or Hypertensive patient need to be warned about few drug interactions. A known hypersensitivity patient needs to be careful about the reactions or anaphylactic shock. A pregnant woman or a breastfeeding woman should be warned of certain medications. A Hepatitis [liver disease] patient or a cardiac patient should avoid few drugs.
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General

Lactic Acidosis

Lactic acidosis has been reported with the use of Linezolid. In reported cases, patients

experienced repeated episodes of nausea and vomiting. Patients who develop

recurrent nausea or vomiting, unexplained acidosis, or a low bicarbonate level while

receiving Linezolid should receive immediate medical evaluation.

Serotonin Syndrome

Spontaneous reports of serotonin syndrome associated with the co-administration of

Linezolid and serotonergic agents, including antidepressants such as selective serotonin

reuptake inhibitors (SSRIs), have been reported ).

Where administration of Linezolid and concomitant serotonergic agents is clinically

appropriate, patients should be closely observed for signs and symptoms of serotonin

syndrome such as cognitive dysfunction, hyperpyrexia, hyperreflexia and

incoordination. If signs or symptoms occur physicians should consider discontinuation

of either one or both agents. If the concomitant serotonergic agent is withdrawn,

discontinuation symptoms can be observed )

for a description of the associated discontinuation symptoms).

Peripheral and Optic Neuropathy

Peripheral and optic neuropathy have been reported in patients treated with Linezolid,

primarily those patients treated for longer than the maximum recommended duration of 28

days. In cases of optic neuropathy that progressed to loss of vision, patients were treated for

extended periods beyond the maximum recommended duration. Visual blurring has been

reported in some patients treated with Linezolid for less than 28 days.

If patients experience symptoms of visual impairment, such as changes in visual acuity,

changes in color vision, blurred vision, or visual field defect, prompt ophthalmic evaluation

is recommended. Visual function should be monitored in all patients taking Linezolid

for extended periods (? 3 months) and in all patients reporting new visual symptoms

regardless of length of therapy with Linezolid. If peripheral or optic neuropathy occurs,

the continued use of Linezolid in these patients should be weighed against the potential risks.

Convulsions have been reported in patients when treated with Linezolid. In some of these

cases, a history of seizures or risk factors for seizures was reported.

The use of antibiotics may promote the overgrowth of nonsusceptible organisms. Should

superinfection occur during therapy, appropriate measures should be taken.

Linezolid has not been studied in patients with uncontrolled hypertension,

pheochromocytoma, carcinoid syndrome, or untreated hyperthyroidism.

The safety and efficacy of Linezolid formulations given for longer than 28 days have not

been evaluated in controlled clinical trials.

Prescribing Linezolid in the absence of a proven or strongly suspected bacterial infection or

a prophylactic indication is unlikely to provide benefit to the patient and increases the risk

of the development of drug-resistant bacteria.

What should I discuss with my healthcare provider before taking Linezolid?

You should not use Linezolid if you are allergic to Linezolid.

Do not use Linezolid if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, methylene blue injection, phenelzine, rasagiline, selegiline, and tranylcypromine.

Some medicines can interact with Linezolid and should not be used at the same time. Your doctor may need to change your treatment plan if you use any of the following drugs:

  • buspirone, clozapine, cyclobenzaprine, epinephrine (Epi-Pen), meperidine, procarbazine, St. John's wort, tramadol;

  • ADHD medication--Adderall, Ritalin, and others; a diet pill or other stimulant; cold medicine that contains a decongestant; medicine that can raise blood pressure such as dobutamine, dopamine, norephinephrine;

  • an antidepressant--bupropion, citalopram, fluoxetine, imipramine, milnacipran, nefazodone, paroxetine, sertraline, trazodone, venlafaxine, and others; migraine or cluster headache medications-- ("triptans") such as Amerge, Imitrex or Maxalt, Zomig and others;

  • medication to treat Parkinson's disease or restless leg syndrome; glaucoma medicine used in the eyes--apraclonidine, brimonidine.

To make sure Linezolid is safe for you, tell your doctor if you have:

  • a history of high blood pressure;

  • a thyroid disorder;

  • a carcinoid tumor;

  • bone marrow suppression or a weak immune system;

  • kidney or liver disease;

  • pheochromocytoma (adrenal gland tumor);

  • diabetes;

  • epilepsy or a history of seizures; or

  • if you use a catheter.

FDA pregnancy category C. It is not known whether Linezolid will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

It is not known whether Linezolid passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

The liquid form of Linezolid may contain phenylalanine. Talk to your doctor before using this form of Linezolid if you have phenylketonuria (PKU).

Linezolid precautions

infoCertain people who are very sick or very old or who are sensitive show an exacerbation of side effect of the drug which can turn dangerous at times. So, it is very important to remember the precautions while taking the medicine. Pregnancy and Breastfeeding are also special categories wherein extra care or precaution is needed when taking a drug. Few patients may have a hypersensitivity reaction to few medications, and that can be life-threatening rarely. Penicillin hypersensitivity is one example. Diarrhea, rashes are few other symptoms which need a watch. A patient with other co-existing diseases like liver disease, heart disease, kidney disease should take special precautions.
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Reversible myelosuppression (anemia, thrombocytopenia, leukopenia, and pancytopenia) that may be dependent on duration of therapy has been reported in some patients receiving Linezolid. Monitoring of complete blood counts should be considered for patients who are at increased risk for bleeding, who have pre-existing myelosuppression, who receive concomitant medications that may decrease hemoglobin levels or platelet count or function, or who receive Linezolid for more than 2 weeks.

Pseudomembranous colitis has been reported with nearly all antibacterial agents, including Linezolid, and may range in severity from mild to life-threatening.

Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including Linezolid, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.

C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.

Peripheral and optic neuropathy have been reported in patients treated with Linezolid, primarily those patients treated for longer than the maximum recommended duration of 28 days. In cases of optic neuropathy that progressed to loss of vision, patients were treated for extended periods beyond the maximum recommended duration.

If symptoms of visual impairment appear, such as changes in visual acuity, changes in color vision, blurred vision, or visual field defect, prompt ophthalmic evaluation is recommended. Visual function should be monitored in all patients taking Linezolid for extended periods (greater than or equal to 3 months) and in all patients reporting new visual symptoms regardless of length of therapy with Linezolid. If peripheral or optic neuropathy occurs, the continued use of Linezolid in these patients should be weighed against the potential risks.

Lactic acidosis has been reported with the use of Linezolid. Patients who develop recurrent nausea or vomiting, unexplained acidosis, or a low bicarbonate level while receiving Linezolid should receive immediate medical attention.

Convulsions have been reported to occur rarely in patients when treated with Linezolid. In most of these cases, a history of seizures or risk factors for seizures were reported.

Spontaneous reports of serotonin syndrome associated with the co-administration of Linezolid and serotonergic agents, including antidepressants such as selective serotonin reuptake inhibitors (SSRIs) have been reported.

Where administration of Linezolid and concomitant serotonergic agents is clinically appropriate, patients should be closely observed for signs and symptoms of serotonin syndrome such as cognitive dysfunction, hyperpyrexia, hyperreflexia and incoordination. If signs or symptoms occur physicians should consider discontinuation of either one or both agents. If the concomitant serotonergic agent is withdrawn, discontinuation symptoms can be observed.

In healthy volunteers, coadministration of rifampin with Linezolid resulted in a 21% decrease in Linezolid Cmax and a 32% decrease in Linezolid AUC. The clinical significance of this interaction is unknown.

Linezolid has no clinical activity against Gram-negative pathogens and is not indicated for the treatment of gram-negative infections. Specific Gram-negative therapy is required if a concomitant Gram-negative pathogen is documented or suspected. Linezolid should be used with special caution in patients at high risk for life threatening systemic infections, such as those with infections related to central venous catheters in intensive care units. Linezolid is not approved for the treatment of patients with catheter related bloodstream infections.

Clinical Trial in Catheter-Related Gram-Positive Bloodstream Infections: An open-label, randomized clinical trial was conducted in adult patients with catheter related gram-positive bloodstream infections comparing Linezolid (600 mg q12h IV/PO) to vancomycin 1 g IV q12h or oxacillin 2 g IV q6h/dicloxacillin 500 mg PO q6h with a treatment duration of 7 to 28 days. The mortality rates in this study were 78/363 (21.5%) and 58/363 (16.0%) on Linezolid and the comparator, respectively. Based on results from a logistic regression, the estimated odds ratio is 1.426 (95% CI 0.970, 2.098). While causality has not been established, this observed imbalance occurred primarily in Linezolid-treated patients in whom either Gram-negative pathogens, mixed Gram-negative and Gram-positive pathogens, or no pathogen were identified at baseline. Patients randomized to Linezolid who had only a Gram-positive infection at baseline, including the subgroup of patients with Gram-positive bacteremia experienced a survival rate similar to the comparator.

Effects on Ability to Drive and Use Machines: The effect of Linezolid on the ability to drive or operate machinery has not been systematically evaluated.

What happens if I miss a dose of Linezolid?

infoWhen you miss a dose, you should take it as soon as you remember, but you should take care that it should be well spaced from the next dose. You should not take an extra dose at the time of the second dose as it will become a double dose. The double dose can give unwanted side effects, so be careful. In chronic conditions or when you have a serious health issue, if you miss a dose, you should inform your health care provider and ask his suggestion.

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.



References

  1. DailyMed. "LINEZOLID: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
  2. DrugBank. "linezolid". http://www.drugbank.ca/drugs/DB00601 (accessed September 17, 2018).
  3. MeSH. "Anti-Bacterial Agents". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).

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