Serotonin toxicity associated with the use of linezolid: A review of postmarketing data
Serotonin toxicity associated with the use of linezolid: A review of postmarketing data
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DOI：
10.1086/503839
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发表时间：
2006-06-01
影响因子：
11.8
通讯作者：
Gillman, PK
中科院分区：
文献类型：
--
作者：
Lawrence, KR;Adra, M;Gillman, PK
背景。利奈唑胺是第一个在美国上市的恶唑烷酮类抗菌药物。它具有 A 型单胺氧化酶 (MAO) 和 B 型单胺氧化酶 (MAO) 抑制作用。非选择性 MAO 抑制剂或 MAO-A 抑制剂与增加血清素浓度的药物同时给药与血清素毒性有关。方法。我们要求美国食品和药物管理局提供有关利奈唑胺的所有上市后不良事件报告，包括血清素毒性或任何描述认知或行为症状以及自主神经和神经肌肉兴奋性的报告。我们评估了从不良事件报告系统数据库获得的病例摘要的血清素毒性。 5-羟色胺中毒病例定义为：（1）利奈唑胺为主要可疑药物； (2) 同时施用>= 1种已知会增加中枢神经系统血清素浓度的次要可疑药物； (3) 血清素毒性，由修改后的亨特血清素毒性标准或报告者定义。结果。 29 例被归类为血清素中毒。患者年龄17-83岁，女性与男性的比例为1:1。与利奈唑胺同时使用的最常见药物类别是选择性血清素再摄取抑制剂（43 名患者中的 26 名）。 13 名患者需要干预以防止永久性损伤或因不良事件而需要住院治疗。结论。利奈唑胺与增加中枢神经系统血清素浓度的药物一起使用可能会导致血清素中毒。处方者必须权衡这种组合的风险和益处。患者和处方者应认识到血清素中毒的体征和症状，如果出现此类症状，应采取适当的措施。
Background. Linezolid is the first oxazolidinone antimicrobial marketed in the United States. It exhibits monoamine oxidase (MAO) type A and MAO type B inhibitory effects. The concomitant administration of nonselective MAO inhibitors or MAO-A inhibitors with drugs that increase serotonin concentrations is associated with serotonin toxicity.Methods. We requested from the US Food and Drug Administration all postmarketing adverse event reports regarding linezolid that included serotonin toxicity or any report describing cognitive or behavioral symptoms and autonomic and neuromuscular excitability. We assessed the case summaries obtained from the Adverse Event Reporting System database for serotonin toxicity. A case of serotonin toxicity was defined as having the following: (1) linezolid as the primary suspect drug; (2) concurrent administration of >= 1 secondary suspect drug known to increase serotonin concentrations in the central nervous system; and (3) serotonin toxicity, as defined by the modified Hunter Serotonin Toxicity Criteria or by the reporter.Results. Twenty-nine cases were classified as serotonin toxicity. Patients' ages ranged from 17-83 years, and the ratio of females to males was 1:1. The most common class of drugs received concurrently with linezolid was selective serotonin reuptake inhibitors (26 of 43 patients). Thirteen patients required an intervention to prevent permanent impairment or required hospitalization for the adverse event.Conclusion. The use of linezolid with medications that increase concentrations of serotonin in the central nervous system may result in serotonin toxicity. Prescribers must weigh risks and benefits of this combination. Patients and prescribers should be cognizant of signs and symptoms of serotonin toxicity and should initiate appropriate measures if such symptoms develop.