I recently heard presented a tragic story of a patient who died of the serotonin toxicity syndrome. The offending agent was linezolid in combination with mirtazipine (Remiron).

Since I was not previously aware of linezolid causing the serotonin toxicity syndrome, I searched Medscape – Serotonin Toxicity Associated With Linezolid: Postmarketing Data

The use of the antimicrobial agent linezolid in combination with drugs that increase serotonin levels in the central nervous system (CNS), especially selective serotonin reuptake inhibitors (SSRIs), may lead to serotonin toxicity, investigators remind clinicians in a report in the June 1 issue of Clinical Infectious Diseases.

“Serotonin toxicity is a predictable and preventable reaction that occurs as a result of excess serotonin in the CNS,” report co-author, Dr. May Adra, Director of Drug Information/Medication Safety Coordinator at Tufts–New England Medical Center in Boston, told Reuters Health.

“Some drugs are widely recognized as causing serotonin toxicity whereas others, such as linezolid, meperidine, and tramadol are not,” Dr. Adra explained.

A review of the U.S. Food and Drug Administration’s Adverse Event Reporting System database for the period November 1, 1997 to September 25, 2003 revealed a total of 29 patients who developed serotonin toxicity.

Serotonin toxicity was defined as having the following: linezolid as the primary suspect drug; concurrent administration of one or more secondary suspect drug known to raise CNS serotonin levels; and, serotonin toxicity, as defined by the modified Hunter Serotonin Toxicity Criteria or by the case reporter.

Having heard this patient presentation, I have a new question and caution whenever we consider the possibility of using linezolid. If this rant informs at least one other physician then I will be greatly gratified.