Antimicrobials
Linezolid (Zyvoxam)

Linezolid (Zyvoxam)

Restricted
C difficile risk
Low
Oral Bioavailability
Excellent
Cost
IV ~$22.00/day; PO ~$54.00/day

Dosing

600mg PO/IV q12h

Severe impairment (Child-Pugh class C)There are no dosage adjustments provided in the manufacturer's labeling

Linezolid concentrations may be increased in patients with cirrhosis and risk of thrombocytopenia may be increased

Use with caution and monitor for thrombocytopenia; consider therapeutic drug monitoring when feasible

In clinically stable patients with an anticipated treatment course >10 days, some experts suggest reducing dose to 300mg twice daily after 72 hours with therapeutic drug monitoring to reduce the risk of thrombocytopenia

CrCl greater than or equal to 40 mL/minCrCl less than 40 mL/minNo dosing adjustment necessaryNo dosage adjustment necessary but use with caution

No dosage adjustment necessary

Administer 2nd dose after dialysis on dialysis days

Note: increased risk of myelosuppression; more frequent monitoring of CBC should be considered

No dosage adjustment necessary

Note: increased risk of myelosuppression; more frequent monitoring of CBC should be considered

General Information

Targeted or empiric therapy for gram positive infections including skin and soft tissue, and pneumonia.

Covers MRSA and VRE.

CBC at least once/week.

Visual testing for therapy >3 months or if symptoms develop on therapy.

  • Serotonin syndrome
  • Rash
  • Elevated liver enzymes
  • Lactic acidosis
  • Myelosuppression (usually with >2 weeks therapy) - reversible
  • Peripheral/optic neuropathy with prolonged courses

SSRI and other serotonergics/MAOIs - Increased risk of serotonin syndrome.

Rifampin decreases linezolid levels.

Antimicrobial class: Oxazolidinone

Pregnancy category: C

Average serum half life: 5 hours

CSF penetration: Therapeutic

Lung penetration: Therapeutic

Urine penetration: Therapeutic