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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by David F on April 12, 2008, at 11:55:17
Will combining the following prescribed medications 1) Paroxetine Tab 40MG (Generic for Paxil) & 2) Zyvox Tab 600MG (Generic for Linezolid) cause/induce serotonin syndrome? If yes, what will symptoms, reactions, side effects be & to what severity?
This is an urgent posting & any advice/assistance will be greatly appereciated.
Thanx! David F
Posted by kaleidoscope on April 12, 2008, at 12:39:00
In reply to serotonin syndrome, posted by David F on April 12, 2008, at 11:55:17
Hi
Linezolid is a reversible, non-selective monoamine oxidase inhibitor (MAOI). Linezolid should not be given in combination with SSRIs such as paroxetine unless close medical observation/monitoring is available (in hospital) - even then, it should only be used with paroxetine if no alternative antibiotic is available and paroxetine cannot be stopped. Serotonin syndrome is indeed possible.
Is linezolid being used to treat MRSA? If so, there are normally alternative antibiotics (some oral, some IV) which can be used.... depending on the site of infection and the results of sensitivity testing. In some places, such as the UK, community-acquired MRSA infections are normally sensitive to quite a variety of antibiotics. The situation is worse in the US, where antibiotic resistance is more widespread.
K
Posted by kaleidoscope on April 12, 2008, at 12:48:31
In reply to serotonin syndrome, posted by David F on April 12, 2008, at 11:55:17
>If yes, what will symptoms, reactions, side effects be & to what severity?
Here is some info RE the symptoms.....
http://www.psychotropical.com/Serotonin_Syndrome_Symptoms.shtml
There is very little information available from drug interaction studies on the safety of linezolid when administered in combination with SSRI antidepressants. Cases of Serotonin Syndrome have been reported. To make the situation even more confusing, the severity of serotonin syndrome is extremely variable even with drug combinations which are well know to interact.
Posted by bleauberry on April 12, 2008, at 13:36:27
In reply to serotonin syndrome, posted by David F on April 12, 2008, at 11:55:17
Drugs.com is a site that provides patients information on their medications. Here is an excerpt of interest:
"While you are using Zyvox, avoid taking an "SSRI" antidepressant without telling your doctor. This includes Celexa, Lexapro, Prozac, Luvox, Paxil, or Zoloft. Taking an SSRI antidepressant together with Zyvox can cause symptoms such as anxiety, high fever, sweating, chills or goosebumps, memory problems, trouble concentrating, loss of coordination, or muscle spasms."
The symptoms described above are consistent with serotonin syndrome. While extremely uncomfortable in mild stages, it should end up in the emergency room immediately, and it can end up in a coffin.
Even serotonin medications all by themselves can cause serotonin syndrome. 40mg is already a high dose and warrants caution and respect.
You deserve a lot of credit for learning more before swallowing a new med.
Posted by Phillipa on April 12, 2008, at 14:30:46
In reply to Serotonin syndrome, posted by kaleidoscope on April 12, 2008, at 12:39:00
Vancomyicin? Love PJ XO
Posted by kaleidoscope on April 12, 2008, at 15:21:21
In reply to Re: Serotonin syndrome » kaleidoscope, posted by Phillipa on April 12, 2008, at 14:30:46
Hi PJ
You are right, MRSA is virtually always sensitive to vancomycin. Vancomycin is often used to treat serious infections due to MRSA and other resistant gram-positive bacteria. Unfortunately, vancomycin has to be given by injection (unless it's being used to remove C. difficile from the bowel) - vancomycin is not absorbed from capsules.
In the UK, MRSA is *usually* sensitive to clindamycin, fusidic acid, minocycline, doxycycline and rifampicin (rifampin). It is virtually always sensitive to vancomycin, daptomycin, teicoplanin, linezolid, Synercid and tigecycline.
In the US antibiotic resistance tends to be worse. Sensitivity to doxycycline may be much less than in England and I don't think you have fusidic acid or teicoplanin.
Posted by kaleidoscope on April 12, 2008, at 15:38:40
In reply to Re: Serotonin syndrome » kaleidoscope, posted by Phillipa on April 12, 2008, at 14:30:46
Hi again PJ,
Infections due to MRSA can be very serious but they can also be relatively minor eg. impetigo can be caused by MRSA. Vancomycin tends to be used for serious infections such as pneumonia.
Vancomycin should not be used to treat S. aureus infections unless they are resistant to anti-staphylococcal penicillins because it is less active and more toxic than these drugs eg. flucloxacillin, dicloxacillin. A small percentage of S. aureus (probably about 10% in the UK but less elsewhere) are still sensitive to penicillin G - the original penicillin. Penicillin G is exceptionally active and non-toxic so anyone whose S. aureus infection is sensitive to penicillin G is quite lucky!
Bearing in mind that only around 10% of patients who claim to be allergic to penicillins actually are allergic on further testing, vancomycin is sometimes overused in patients who believe they are allergic to penicillins.... and who would otherwise be treated with flucloxacillin or a related drug NB. Most penicillin side effects have nothing to do with allergy and people who get a late-onset (after a few days) macular/papular rash on amoxicillin are not allergic but usually have mononucleosis.
Posted by kaleidoscope on April 12, 2008, at 15:41:20
In reply to serotonin syndrome, posted by David F on April 12, 2008, at 11:55:17
Having said all this, linezolid (Zyvox) is sometimes used to treat other infections apart from MRSA eg. due to multiply-resistant enterococci.
I don't know what sort of infection is being treated so I'm basically just waffling on.
Posted by Phillipa on April 12, 2008, at 19:42:54
In reply to Re: Serotonin syndrome » Phillipa, posted by kaleidoscope on April 12, 2008, at 15:21:21
K no we don't and MSRA is now rampant in the communities. Used to be solely hospital aquired. Now seems that bathrooms and playgrounds are breading grounds. Scarey. Yes I did know the V was IV only. True or not if it doesn't work leads to the flesh eating bacteria? Love PJXXXXX
Posted by Phillipa on April 12, 2008, at 19:45:27
In reply to Re: Serotonin syndrome » Phillipa, posted by kaleidoscope on April 12, 2008, at 15:38:40
K thanks as both my Daughters had that happen to them and the docs said allergy so glad you told me. Have I said I miss you lately? Love PJXX
Posted by Jeroen on April 12, 2008, at 20:37:30
In reply to Serotonin syndrome, posted by kaleidoscope on April 12, 2008, at 12:39:00
hi there, i wont recommend this i seen bad things on SSRI meds combos
Posted by undopaminergic on April 12, 2008, at 20:40:50
In reply to serotonin syndrome, posted by David F on April 12, 2008, at 11:55:17
Serotonin toxicity can be treated with cyproheptadine tablets (about 12 mg), and in emergencies, with intravenous chlorpromazine (12-25 mg). Antagonism of 5-HT2A receptors is the relevant mechanism of action for this purpose.
The antidote should be administered without delay upon emergence of symptoms, as progression is sometimes rapid and unpredictable.
Posted by undopaminergic on April 12, 2008, at 20:54:32
In reply to Re: serotonin syndrome, posted by bleauberry on April 12, 2008, at 13:36:27
>
> Even serotonin medications all by themselves can cause serotonin syndrome. 40mg is already a high dose and warrants caution and respect.
>Life-threatening serotonin toxicity doesn't occur with a SSRI alone, even in overdose. Symptoms can still be unpleasant, however.
This is the end of the thread.
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