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Linezolid-associated serotonin toxicity: a systematic review

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Abstract

Purpose

This systematic review aims to evaluate the existing evidence associating linezolid to serotonin toxicity when used as monotherapy or when co-administered with other serotonergic agents.

Methods

A systematic literature search using PubMed (till March 2023), IDWeek meetings (2003–2023), the European Congress of Clinical Microbiology and Infectious Disease Annual Meetings (2001–2023), and the American College of Clinical Pharmacy (1999–2023) identified studies and abstracts related to linezolid and serotonin toxicity.

Results

A total of 84 studies were included. The data collected in retrospective/observational studies compared the incidence of serotonin toxicity with linezolid monotherapy at 0.0050% and linezolid combination therapy at 0.0134%. All cases which discontinued linezolid and serotonergic agent/s at signs and symptoms of toxicity found symptom resolution; 75% of cases reported serotonin toxicity resolution within 24–48 h after discontinuation.

Conclusion

Linezolid therapy when optimal should not be deferred due to the risk of serotonin syndrome. The data collected reveals a low prevalence of serotonin toxicity in both linezolid monotherapy and linezolid concurrent with other serotonergic agents.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors of this review would like to thank Brig Turner for their initial help with study design and abstract screening.

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Authors and Affiliations

  1. Pacific University School of Pharmacy, Hillsboro, OR, USA

    Fawzy Elbarbry

  2. VA Southern Oregon Rehabilitation Center and Clinics, Medford, USA

    Nicholas Moshirian

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Contributions

Both authors have made equal and substantial contributions to all of the following: (1) the conception and design of the study, acquisition of data, analysis, and interpretation of data; (2) drafting the article and revising it critically for important intellectual content; and (3) final approval of the version to be submitted.

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Correspondence to Fawzy Elbarbry.

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Elbarbry, F., Moshirian, N. Linezolid-associated serotonin toxicity: a systematic review. Eur J Clin Pharmacol 79, 875–883 (2023). https://doi.org/10.1007/s00228-023-03500-9

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