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UTA and Zyvox (Linezolid Tablets)

Determining the interaction of UTA and Zyvox (Linezolid Tablets) and the possibility of their joint administration.

Check result:
UTA <> Zyvox (Linezolid Tablets)
Relevance: 16.05.2023 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

If you are currently being treated with linezolid, let your doctor know before you receive methylene blue. Combining these medications can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. Depending on your condition, your doctor may want you to discontinue linezolid for at least two weeks before you start treatment with methylene blue, or prescribe an alternative medication. Otherwise, you will need to be closely monitored by your doctor during treatment. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

CONTRAINDICATED: Coadministration of methylene blue with serotonergic agents may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Current research suggests that methylene blue has structural properties similar to monoamine oxidase inhibitors (MAOIs). As such, it may enhance serotonergic effects by inhibiting serotonin metabolism. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucination, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea. Serotonin syndrome has been reported when methylene blue was administered intravenously at dosages ranging from 1 to 8 mg/kg to patients exposed to drugs that interfere with serotonin reuptake. Several cases required admission to the intensive care unit. The risk of administering methylene blue intravenously at dosages less than 1 mg/kg or by non-intravenous routes (e.g., orally or by local injection) is unclear, although the potential for interaction with serotonergic agents should be considered.

MANAGEMENT: Serotonergic agents should not be used in patients receiving methylene blue intravenously. Most serotonergic psychiatric drugs should be stopped 1 to 2 weeks (i.e., 4 to 5 half-lives) prior to treatment with methylene blue if possible, while others such as fluoxetine may require discontinuation up to 5 weeks in advance due to its prolonged half-life. Treatment with serotonergic medications may be resumed 24 hours after the last dose of methylene blue. In patients receiving methylene blue who require urgent treatment of a psychiatric condition, other interventions including hospitalization should be considered. Conversely, when urgent treatment with methylene blue is required (e.g., methemoglobinemia, ifosfamide-induced encephalopathy, cyanide poisoning) in patients receiving serotonergic agents, the benefit of methylene blue treatment should be weighed against the risk of serotonin toxicity. If a decision is made to use methylene blue, the serotonergic drug must be immediately stopped, and the patient closely monitored for emergent symptoms of CNS toxicity for two weeks (five weeks if fluoxetine was taken; three weeks if vortioxetine was taken) or until 24 hours after the last dose of methylene blue, whichever comes first. Patients and/or their caregivers should be advised to seek medical attention if potential symptoms of serotonin syndrome develop.

References
  • Khavandi A, Whitaker J, Gonna H "Serotonin toxicity precipitated by concomitant use of citalopram and methylene blue." Med J Aust 189 (2008): 534-5
  • Ng BK, Cameron AJ "The role of methylene blue in serotonin syndrome: a systematic review." Psychosomatics 51 (2010): 194-200
  • Gillman PK "Methylene blue is a potent monoamine oxidase inhibitor." Can J Anaesth 55 (2008): 311-2; author reply 312
  • FDA. U.S. Food and Drug Administration "FDA Drug Safety Communication: serious CNS reactions possible when methylene blue is given to patients taking certain psychiatric medications. Available from: URL: http://www.fda.gov/Drugs/DrugSafety/ucm263190.htm." ([2011 July 26]):
  • Health Canada "Association of serotonin toxicity with methylene blue injectable in combination with serotonin reuptake inhibitors. Available from: URL: http://www.hc-sc.gc.ca/dhp-mps/alt_formats/pdf/medeff/advisories-avis/prof/2011/methylene_blue-bleu_nth-aah-eng.pdf." ([2011 Feb 16]):
  • Boyer EW, Shannon M "The serotonin syndrome." N Engl J Med 352 (2005): 1112-20
  • Ng BK, Cameron AJ, Liang R, Rahman H "[Serotonin syndrome following methylene blue infusion during parathyroidectomy: a case report and literature review]" Can J Anaesth 55 (2008): 36-41
  • Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  • Heritier Barras AC, Walder B, Seeck M "Serotonin syndrome following Methylene Blue infusion: a rare complication of antidepressant therapy." J Neurol Neurosurg Psychiatry 81 (2010): 1412-3
  • Gillman PK "Methylene blue and serotonin toxicity: definite causal link." Psychosomatics 51 (2010): 448-9
UTA

Generic Name: hyoscyamine / methenamine / methylene blue / sodium biphosphate

Brand name: Urogesic-Blue, UTA, Uro-BLUE, Urolet MB, Indiomin MB, ME/NaPhos/MB/Hyo1, UTA

Synonyms: n.a.

Zyvox (Linezolid Tablets)

Generic Name: linezolid

Brand name: Zyvox

Synonyms: Zyvox

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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