Names and pronunciation
(line-zoe′lide) Zyvox, Zyvoxam
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Individual generic drug information
Extracted information for linezolid only.
(line-zoe′lide) Zyvox, Zyvoxam
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Func. class.: Broad-spectrum antiinfective
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Chem. class.: Oxazolidinone
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Do not confuse: Zyvox/Vioxx/Zovirax
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ACTION: Inhibits protein synthesis by interfering with translation; binds to bac- terial 23S ribosomal RNA of the 50S subunit, thus preventing formation of the bacterial translation process in primarily gram-positive organisms
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USES: Vancomycin-resistant Enterococ- cus faecium infections, hospital-acquired pneumonia caused by Staphylococcus aureus or Streptococcus pneumoniae, uncomplicated or complicated skin and skin-structure infections, community- acquired pneumonia, Pasteurella multo- cida, viridans streptococci, E. faecium infections, S. aureus, S. pyogenes; can be used for MSSA/MRSA/MDRSP strains
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Extracted information for linezolid only.
CONTRAINDICATIONS: Hyper- sensitivity Precautions: Pregnancy, breastfeeding, children, thrombocytopenia, bone mar- row suppression, hypertension, hyper- thyroidism, pheochromocytoma, seizure disorder, ulcerative colitis, MI, PKU, renal/GI disease
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SIDE EFFECTS CNS: Headache, dizziness, insomnia GI: Nausea, diarrhea, CDAD, increased ALT/AST, vomiting, taste change, tongue- color change EENT: Optic neuropathy HEMA: Myelosuppression MISC: Vaginal moniliasis, fungal infec- tion, oral moniliasis, lactic acidosis, ana phylaxis, angioedema, Stevens-Johnson syndrome, serotonin syndrome
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INTERACTIONS Do not use with MAOIs (or within 2 wk) or with products that possess MAOI-like action (furazolidone, isoniazid, INH, pro carbazine); hypertensive crisis may occur Increase: hypertensive crisis, seizures, coma—amoxapine, maprotiline, mirtaza pine, traZODone, cyclobenzaprine, tricy clics, methyldopa Increase: serotonin syndrome—bupropi on, cyclobenzaprine, tramadol, trazadone, SSRIs, SNRIs, serotonin receptor agonists; notify prescriber immediately Increase: effects of adrenergic agents (DOPamine, EPINEPHrine, pseudoephed- rine); monitor B/P Drug/Herb • Avoid use with green tea, valerian, ginseng, yohimbine, kava, guarana, St. John’s wort Drug/Food • Tyramine foods: avoid; increased pres- sor response Drug/Lab Test Increase: LFTs, alkaline phosphatase, amylase, lipase, BUN Decrease: WBC, platelets, blood glucose
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Extracted information for linezolid only.
DOSAGE AND ROUTES Vancomycin-resistant Enterococcus faecium infections • Adult/adolescent/child ≥12 yr: IV/PO 600 mg q12hr × 14-28 days; max 1200 mg/day • Child <12 yr/infant/term neonate: IV/ PO 10 mg/kg q8hr × 14-28 days Pneumonia/complicated skin infections • Adult: IV/PO 600 mg q12hr × 10-14 days; max 1200 mg/day • Child birth-11 yr: PO/IV 10 mg/kg q8hr × 10-14 days Uncomplicated skin infections caused by S. aureus (MSSA only) or S. pyogenes • Adult: PO 400 mg q12hr × 10-14 days; max 1200 mg/day • Adolescent: PO 600 mg q12hr × 10- 14 days; max 1200 mg/day • Child 5-11 yr: PO 10 mg/kg q12hr × 10-14 days • Neonate ≥7 days old/infant/child <5 yr: PO 10 mg/kg q8hr × 10-14 days • Infant preterm <7 days old: PO 10 mg/kg q12hr × 10-14 days
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Available forms: Tabs 600 mg; oral susp 100 mg/5 mL; premixed infusion 200 mg/100 mL, 400 mg/200 mL, 600 mg/mL (2 mg/mL)
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Administer: • Obtain culture and sensitivity before starting treatment, may give before re- sults are received PO route • With/without food • Store reconstituted oral susp at room temperature; use within 3 wk Intermittent IV INFUSION route • Do not use if particulate is present, yellow color is normal • Premixed sol ready to use (2 mg/mL), give over 30-120 min; do not use IV infu- sion bag in series connections; do not use with additives in sol; do not use with another product, administer separately, flush line before and after use • Store at room temperature in original packaging Y-site compatibilities: Acyclovir, alfentanil, amikacin, aminophylline, ampicillin, aztre- onam, buprenorphine, butorphanol, cal- cium gluconate, CARBOplatin, ceFAZolin, cefoTEtan, cefOXitin, cefTAZidime, ceftizox- ime, cefuroxime, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, cytara- bine, digoxin, furosemide, ganciclovir, gemcitabine, gentamicin, heparin, HYDRO- morphone, ifosfamide, labetalol, leucovo- rin, levofloxacin, lidocaine, LORazepam, magnesium sulfate, mannitol, meperidine, meropenem, mesna, methotrexate, methyl- PREDNISolone, metoclopramide, metro NIDAZOLE, midazolam, minocycline, mito XANtrone, morphine, nalbuphine, naloxone, nitroglycerin, ofloxacin, ondan- setron, PACLitaxel, PENTobarbital, PHENo- barbital, piperacillin, potassium chloride, prochlorperazine, promethazine, propran- olol, ranitidine, remifentanil, SUFentanil, theophylline, ticarcillin, tobramycin, vanco- mycin, vecuronium, verapamil, vinCRIS- tine, zidovudine Solution compatibilities: D5W, 0.9% NaCl, LR
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Extracted information for linezolid only.
Assess: • Infection: VS, characteristics of spu- tum, wounds, stool, emesis; WBC base- line, periodically • Vision change, optic neuritis may occur • CBC with differential weekly, assess for myelosuppression (anemias, leuko- penia, pancytopenia, thrombocytope- nia) L • Serotonin syndrome: at least 2 wk should elapse between discontinuing li nezolid and starting serotonergic agents; assess for increased heart rate, shivering, sweating, dilated pupils, tremor, high B/P, hyperthermia, head ache, confusion; if these occur, stop li nezolid, administer a serotonin antago nist if needed • Lactic acidosis: repeated nausea/ vomiting, unexplained acidosis, low bicar bonate level; notify prescriber immedi ately • Anaphylaxis/angioedema/Stevens- Johnson syndrome: rash, pruritus, diffi culty breathing, fever; have emergency equipment nearby • CNS symptoms: headache, dizziness • Hepatic studies: AST, ALT • Diabetes mellitus: monitor those re- ceiving insulin or oral antidiabetics for increased hypoglycemia • CDAD: diarrhea, abdominal pain, fe ver, fatigue, anorexia, possible anemia, elevated WBC, low serum albumin; stop product, usually either vancomycin or IV metroNIDAZOLE given • Pregnancy/breastfeeding: avoid use in pregnancy and breastfeeding
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Evaluate: • Therapeutic response: decreased symptoms of infection, blood cultures negative
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • If dizziness occurs, to ambulate, per- form activities with assistance • To complete full course of product therapy, use as directed, not to skip or double dose when remembered, unless close to next dose • Serotonin syndrome: to notify pre scriber immediately of fever, sweating, diarrhea, confusion • To contact prescriber if adverse reac- tion occurs • To inform prescriber if SSRIs or cold products, decongestants being used • To avoid large amounts of high-tyramine foods (aged cheeses, red wine), drinks; provide list • To report diarrhea, signs/symptoms of superinfection • To notify health care professional of vision change • To discuss with health care professional all Rx, OTC, herbals, supplements used • Pregnancy/breastfeeding: Identify if pregnancy is planned or suspected or if breastfeeding
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Extracted information for linezolid only.
PHARMACOKINETICS Peak 1-2 hr, terminal half-life 4-5 hr, rapidly and extensively absorbed, protein binding 31%, metabolized by oxidation of the morpholine ring
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Filter the extracted dose blocks for this individual drug.
Vancomycin-resistant Enterococcus faecium infections
• Adult/adolescent/child ≥12 yr: IV/PO 600 mg q12hr × 14-28 days; max 1200 mg/day
Candidate age grouping · source page 792
Vancomycin-resistant Enterococcus faecium infections
• Adolescent: PO 600 mg q12hr × 10- 14 days; max 1200 mg/day
Candidate age grouping · source page 792