linezolid
Linezolid (Zyvox) is an oxazolidinone antibiotic that's used to treat adults and children with certain bacterial infections, such as pneumonia and skin infections. This antibiotic can help fight hard-to-treat infections caused by certain bacteria, such as MRSA and VRE. Linezolid (Zyvox) is available as a tablet, powder for suspension, and injection. It's typically taken every 8 or 12 hours. Some side effects include nausea, diarrhea, and headache. This antibiotic also has a rare but serious risk for serotonin syndrome from interactions with medications like antidepressants.
What is Linezolid (Zyvox)?
What is Linezolid (Zyvox) used for?
- Pneumonia
- Skin infections (e.g., cellulitis, foot infection related to diabetes)
- Vancomycin-resistant Enterococcus faecium (VRE) infections
How Linezolid (Zyvox) works
Linezolid (Zyvox) is an oxazolidinone antibiotic. It works by stopping bacteria from being able to make certain proteins. This blocks bacteria from growing, spreading, and being able to survive.
Drug facts
Side effects of Linezolid (Zyvox)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
Adults
- Diarrhea (8%)
- Nausea (7%)
- Headache (6%)
Children
- Diarrhea (11%)
- Vomiting (9%)
- Anemia (low red blood cell count; 6%)
- Low platelets (up to 5%)
Less Common Side Effects
- Stomach pain
- Diarrhea
- Vomiting
- Dizziness
- Rash
- Itching
Linezolid (Zyvox) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Low blood cell counts: fever, pale skin, fast heart rate, lightheadedness, feeling unwell
- Serotonin syndrome: fast heart rate, dizziness, sweating, flushing, tremor (shakiness), muscle stiffness, muscle twitching or spasms, uncoordinated movement, hallucinations
- Infectious diarrhea (C. difficile-related diarrhea): rapid heart rate, fever, nausea, foul-smelling diarrhea, frequent bowel movements (even up to 15 times per day)
- Lactic acidosis: rapid breathing, repeated episodes of nausea and vomiting
- Low sodium levels: weakness, confusion, memory problems, difficulty concentrating
- Serious allergic reaction: hives, rash, blisters, fever, swelling of the lips or tongue, difficulty breathing
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The following Linezolid (Zyvox) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Change in vision
- High lactic acid level—muscle pain or cramps, stomach pain, trouble breathing, general discomfort and fatigue
- Infection—fever, chills, cough, or sore throat
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Low red blood cell level—unusual weakness or fatigue, dizziness, headache, trouble breathing
- Low sodium level—muscle weakness, fatigue, dizziness, headache, confusion
- Muscle injury—unusual weakness or fatigue, muscle pain, dark yellow or brown urine, decrease in amount of urine
- Pain, tingling, or numbness in the hands or feet
- Seizures
- Severe diarrhea, fever
- Unusual bruising or bleeding
- Unusual vaginal discharge, itching, or odor
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
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Pros and cons of Linezolid (Zyvox)
Pros
- Good choice for treating infections caused by resistant bacteria like MRSA and VRE
- Available as a tablet, powder for suspension, and injection
- Can be used in people with kidney or liver problems
Cons
- Need to take every 8 or 12 hours, depending on your age and infection
- Can raise the risk of serotonin syndrome when taken with other medications that affect serotonin levels in the body
- Interacts with some foods, such as aged cheeses, cured meats, and pickled foods
Pharmacist tips for Linezolid (Zyvox)
- You can take linezolid (Zyvox) with or without food. But because nausea and vomiting are common side effects, taking it with food can help lessen or prevent these side effects.
- Take linezolid (Zyvox) exactly as prescribed. Make sure to finish your treatment course, even if you're feeling better. Stopping the medication earlier than prescribed can make your infection come back and become harder to treat.
- Avoid drinking alcohol while you're taking linezolid (Zyvox). This antibiotic can cause side effects like nausea, vomiting, and diarrhea, and alcohol can worsen these side effects. Drinking too much alcohol can also weaken your immune system and make it harder for you to recover from your infection.
- Avoid eating tyramine-rich foods or beverages while you're taking linezolid (Zyvox). Foods and beverages that are high in tyramine are typically aged, fermented, pickled, or smoked to improve flavor. Linezolid (Zyvox) can also raise tyramine levels, and too much tyramine in the body can cause dangerously high blood pressure.
- Be sure to drink plenty of fluids to stay hydrated if you have diarrhea while you're taking linezolid (Zyvox). Get medical help as soon as possible if you have watery or bloody diarrhea, fever, or stomach cramps anytime during treatment or after stopping the antibiotic. These could be signs of C. difficile-related diarrhea, which needs to be treated right away.
- If you have diabetes and you're taking insulin or other diabetes medications, be sure you know how to recognize and treat low blood sugar. It's possible to have low blood sugar if you take linezolid (Zyvox) with these medications.
- Make sure to tell your healthcare team and pharmacist about all of the medications you're taking. Linezolid (Zyvox) interacts with some medications, including many antidepressants. Your prescriber and pharmacist can check for drug interactions and make sure your medications are safe for you to take together.
- Let your healthcare team know if you're pregnant. Discuss with your prescriber about the risks and benefits of taking linezolid (Zyvox) while pregnant. It's not clear whether this antibiotic is safe to take during pregnancy.
- Discuss with your prescriber whether it's okay to breastfeed while you're taking linezolid (Zyvox). Studies suggest that only a small amount of the antibiotic gets into breast milk. It's possible for your breastfed baby to have diarrhea or vomiting if you nurse during treatment with linezolid (Zyvox).
More tips for linezolid (Zyvox) oral suspension:
- You don't need to shake the bottle before you measure out each dose. Make sure to only use an oral dosing syringe from the pharmacy to measure out the medication. Don't use household spoons; they aren't accurate and using them might cause you to take the wrong dose.
- Store the linezolid (Zyvox) suspension at room temperature. Throw the medication away 21 days (3 weeks) after you pick it up from the pharmacy, even if there's still some left. Your pharmacist typically writes this date on the bottle to help remind you when to throw it away.
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Common questions about Linezolid (Zyvox)
A single dose of linezolid (Zyvox) can stay in your system for about a day and a half. This time frame is estimated based on the half-life of linezolid (Zyvox). The half-life is a measure of the time it takes for the medication to leave the body.
How long the side effects of linezolid (Zyvox) last depends on what symptoms you're experiencing. Sometimes, side effects like diarrhea, nausea, or vomiting might get better as you continue to take the medication. But they generally should go away when you stop treatment. Be sure to stay hydrated, avoid greasy and spicy foods, and eat smaller meals more frequently throughout the day to help with these side effects. Other rare but serious side effects, like low blood cell counts or nerve damage, might take longer to recover from. Discuss with your healthcare team if you have a question about any specific linezolid (Zyvox) side effect.
Yes, linezolid (Zyvox) covers (treats) methicillin-resistant Staphylococcus aureus (also known as MRSA). MRSA is a type of bacteria that's typically hard to treat since many antibiotics don't work against it.
No, linezolid (Zyvox) tablets can't be crushed because they have a film coat around them. Crushing the tablet can ruin the film coat, which can damage the medication. Ask your prescriber about switching you to the powder for oral suspension (liquid) form of linezolid (Zyvox) if you're having trouble swallowing the tablets.
Serotonin syndrome is a rare but serious risk with linezolid (Zyvox). This antibiotic raises the levels of a chemical called serotonin in the brain. Too much serotonin can cause serotonin syndrome, which can be life-threatening. Your risk is higher if you take linezolid (Zyvox) with other medications that raise serotonin levels, such as certain antidepressants (e.g., SSRIs, MAOIs), migraine medications called triptans, or some nausea medications like ondansetron (Zofran). Make sure to tell your healthcare team and pharmacist about all the medications you're taking or planning to take. They can check for your risk for serotonin syndrome and make sure your medications are safe to take together.
It might be best to limit the amount of coffee you drink while you're taking linezolid (Zyvox). Ask your prescriber how much coffee you can have while you're taking this antibiotic. Coffee can have tyramine in it. And linezolid (Zyvox) can raise the tyramine levels in your body. There's a risk that you might have too much tyramine in your body if you drink too much coffee while you're taking this antibiotic. Too much tyramine can cause a severe rise in blood pressure, which can be a medical emergency.
Ask a healthcare professional or pharmacist whether it's safe and appropriate for you to take a probiotic with linezolid (Zyvox). A probiotic might help lower your risk of developing a rare, but serious form of diarrhea caused by a Clostridium difficile (C. diff) bacterial infection while you're taking linezolid (Zyvox). Make sure to separate the probiotic from linezolid (Zyvox) by at least 2 hours to prevent the antibiotic from killing the "good" bacteria in the probiotic if you take a probiotic.
It depends on the specific type of bacteria. Linezolid (Zyvox) is bactericidal against most streptococcal strains of bacteria and bacteriostatic against staphylococci and enterococci strains of bacteria. "Bactericidal" means that the antibiotic kills the bacteria. On the other hand, "bacteriostatic" means that the antibiotic stops the bacteria from dividing and growing, but it doesn't kill the bacteria that's already in the body. Some research shows that there are no significant differences in how well bacteriostatic and bactericidical antibiotics work to treat an infection.
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Risks and warnings for Linezolid (Zyvox)
Linezolid (Zyvox) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Low blood cell counts
- Risk factors: Taking linezolid (Zyvox) for longer than 2 weeks | Low blood cell count | Use of other medications that cause bone marrow suppression | Severe kidney or liver problems | Long-lasting infection that's currently or previously treated with antibiotics
Some people who took linezolid (Zyvox) had a drop in the amount of red blood cells, white blood cells, and platelets in the body. Having a lower-than-normal blood cell count can put you at risk for anemia, infections, and easy bruising. But in most cases, blood cell counts go back to usual after you stop taking the antibiotic.
During treatment, your prescriber might order blood draws to check your blood cell counts. Tell your care team if you have symptoms of anemia (e.g., tiredness, headache, pale skin, fast heart rate), infection (e.g., fever, chills, tiredness, cough, body aches, runny nose), or easy bleeding or bruising.
Nerve and eye damage
- Risk factors: Taking linezolid (Zyvox) for more than 4 weeks
Some people who took linezolid (Zyvox) developed nerve damage in the arms, legs, or eyes. Nerve damage might be more likely to happen if you take the antibiotic for longer than 4 weeks. Nerve damage in the eye can sometimes lead to vision loss.
Talk to a healthcare professional (HCP) if you experience any numbness, tingling, or weakness in the arms or legs or if you notice changes in your vision (e.g., blurry vision, changes in color vision). It's best to see an eye specialist to get your eyes checked if you're taking linezolid (Zyvox) for a long period of time.
Serotonin syndrome
- Risk factors: Taking other medications that raise serotonin levels in the brain
Taking linezolid (Zyvox) with other medications that can raise your serotonin levels can lead to a life-threatening condition called serotonin syndrome. This condition happens when there's too much serotonin in the brain.
Examples of medications that can interact with linezolid (Zyvox) in this way include certain antidepressants, mental health medications, opioid medications, and migraine medications. Be sure to tell your healthcare team about all of the medications you're taking before and during treatment with linezolid (Zyvox). Your healthcare team can decide whether you need any adjustments to your medications to lessen the risk for serotonin syndrome.
Get medical help right away if you have any symptoms of serotonin syndrome, like fast heart rate, sweating, muscle stiffness or spasms, fever, and confusion.
Diarrhea from Clostridioides difficile infection
Linezolid (Zyvox) can raise your risk of getting infected with a bacteria called Clostridioides difficile (C. diff). Antibiotics change the amount of normal bacteria in your stomach and intestines. This can cause C. diff to overgrow in your gut and lead to an infection. C. diff infection can cause severe diarrhea.
It's important to recognize the difference between diarrhea as a side effect of linezolid (Zyvox) and C. diff-related diarrhea. This type of infectious diarrhea can cause fever, rapid heart rate, nausea, foul-smelling diarrhea, and frequent bowel movements (even up to 15 times per day). It's a medical emergency, so get medical help right away if you have any of these symptoms. You'll need to get tested for C. diff infection and get appropriate treatment.
Buildup of lactic acid in the blood (lactic acidosis)
Although rare, some people have had lactic acidosis while they were taking linezolid (Zyvox). Lactic acidosis is a medical condition that happens when there's too much lactic acid in the blood. Get medical help right away if you experience any symptoms of lactic acidosis, like rapid breathing and repeated episodes of nausea and vomiting, while you're taking this antibiotic. You'll need to get your blood drawn to check if you have lactic acidosis.
Seizures
- Risk factors: History of seizures | Health conditions that make it easier to have seizures
Some people have had seizures when they were treated with linezolid (Zyvox). Before you start taking this antibiotic, be sure to let the prescriber know if you have a history of seizures or a medical condition that puts you at risk for having seizures.
Low blood sugar
- Risk factors: Diabetes | Using insulin or other diabetes medications
Some people with diabetes who use insulin or take other diabetes medications have had episodes of low blood sugar while they took linezolid (Zyvox). Although it's not clear whether this antibiotic causes low blood sugar, it's important for people with diabetes to be aware of this risk. Check your blood sugar level right away if you have any signs of low blood sugar, such as dizziness, sweating, drowsiness, weakness, and confusion. Treat your low blood sugar and call your primary care provider right away.
Low blood sodium levels
- Risk factors: Older people | Taking diuretic medications (water pills)
Some people developed low sodium levels in the blood when they took linezolid (Zyvox). People at risk, such as older adults and those taking diuretics, might need to get their blood sodium levels checked while they're taking this antibiotic. Get medical help right away if you feel weak or confused or if you have difficulty concentrating, headache, or memory problems. These could be signs of low blood sodium levels, which is a medical emergency.
Caution use in people with phenylketonuria (PKU) - powder for suspension form only
The linezolid (Zyvox) suspension contains phenylalanine, which is a component of the artificial sweetener aspartame. Tell your healthcare team if you have phenylketonuria, a genetic condition that happens when the body has trouble processing phenylalanine. Taking the suspension form of linezolid (Zyvox) might be dangerous for you. Your prescriber might need to switch you to a different form of linezolid (Zyvox) or a different antibiotic.
Linezolid (Zyvox) dosage
Typical dosage for Linezolid (Zyvox)
- Age 12 years and older: The typical dose ranges from 400 mg to 600 mg by mouth every 12 hours, depending on what type of infection you have and how serious it is.
- Age under 12 years: The typical dose is 10 mg/kg of body weight by mouth every 8 or 12 hours. The prescriber will help determine the dose based on your child's age, the type of infection they have, and the seriousness of the infection.
Most of the time, treatment will last 10 to 14 days. Treatment for more serious infections can last up to 4 weeks.
Linezolid (Zyvox) can also be given as an infusion into the vein (IV) by a healthcare professional to treat more serious infections.
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Linezolid (Zyvox) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Linezolid (Zyvox) will not be safe for you to take.
- Currently take or have taken a monoamine oxidase inhibitor (MAOI) in the past 14 days
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