Linezolid Dosage

This dosage information may not include all the information needed to use Linezolid safely and effectively. See additional information for Linezolid.

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for Bacteremia

Vancomycin-resistant Enterococcus faecium infections, including concurrent bacteremia: 600 mg IV or orally every 12 hours
Duration: 14 to 28 days

Usual Adult Dose for Pneumonia

600 mg IV or orally every 12 hours
Duration: 10 to 14 days

Usual Adult Dose for Nosocomial Pneumonia

600 mg IV or orally every 12 hours
Duration: 10 to 14 days

Usual Adult Dose for Skin and Structure Infection

Complicated infections: 600 mg IV or orally every 12 hours
Duration: 10 to 14 days

Uncomplicated infections: 400 mg orally every 12 hours
Duration: 10 to 14 days

Usual Adult Dose for Bacterial Infection

Vancomycin-resistant Enterococcus faecium infections: 600 mg IV or orally every 12 hours
Duration: 14 to 28 days

Usual Pediatric Dose for Bacteremia

Vancomycin-resistant Enterococcus faecium infections, including concurrent bacteremia:
Less than 7 days, gestational age less than 34 weeks: 10 mg/kg IV or orally every 12 hours; may increase to every 8 hours based on clinical response
Less than 7 days, gestational age 34 weeks or more: 10 mg/kg IV or orally every 8 hours
7 days through 11 years: 10 mg/kg IV or orally every 8 hours
12 years or older: 600 mg IV or orally every 12 hours

Duration: 14 to 28 days

Usual Pediatric Dose for Pneumonia

Less than 7 days, gestational age less than 34 weeks: 10 mg/kg IV or orally every 12 hours; may increase to every 8 hours based on clinical response
Less than 7 days, gestational age 34 weeks or more: 10 mg/kg IV or orally every 8 hours
7 days through 11 years: 10 mg/kg IV or orally every 8 hours
12 years or older: 600 mg IV or orally every 12 hours

Duration: 10 to 14 days

Usual Pediatric Dose for Nosocomial Pneumonia

Less than 7 days, gestational age less than 34 weeks: 10 mg/kg IV or orally every 12 hours; may increase to every 8 hours based on clinical response
Less than 7 days, gestational age 34 weeks or more: 10 mg/kg IV or orally every 8 hours
7 days through 11 years: 10 mg/kg IV or orally every 8 hours
12 years or older: 600 mg IV or orally every 12 hours

Duration: 10 to 14 days

Usual Pediatric Dose for Skin and Structure Infection

Complicated infections:
Less than 7 days, gestational age less than 34 weeks: 10 mg/kg IV or orally every 12 hours; may increase to every 8 hours based on clinical response
Less than 7 days, gestational age 34 weeks or more: 10 mg/kg IV or orally every 8 hours
7 days through 11 years: 10 mg/kg IV or orally every 8 hours
12 years or older: 600 mg IV or orally every 12 hours

Duration: 10 to 14 days

Uncomplicated infections:
Less than 7 days, gestational age less than 34 weeks: 10 mg/kg orally every 12 hours; may increase to every 8 hours based on clinical response
Less than 7 days, gestational age 34 weeks or more: 10 mg/kg orally every 8 hours
7 days through 4 years: 10 mg/kg orally every 8 hours
5 through 11 years: 10 mg/kg orally every 12 hours
12 years or older: 600 mg orally every 12 hours

Duration: 10 to 14 days

Usual Pediatric Dose for Bacterial Infection

Vancomycin-resistant Enterococcus faecium infections:
Less than 7 days, gestational age less than 34 weeks: 10 mg/kg IV or orally every 12 hours; may increase to every 8 hours based on clinical response
Less than 7 days, gestational age 34 weeks or more: 10 mg/kg IV or orally every 8 hours
7 days through 11 years: 10 mg/kg IV or orally every 8 hours
12 years or older: 600 mg IV or orally every 12 hours

Duration: 14 to 28 days

Renal Dose Adjustments

Use with caution in patients with severe renal insufficiency (CrCl 30 mL/min or less). Dose adjustments are not recommended.

Liver Dose Adjustments

Mild to moderate hepatic insufficiency (Child-Pugh class A or B): No adjustment recommended.
Severe hepatic impairment: Data not available

Dose Adjustments

Dose adjustments are not necessary when switching from IV to oral linezolid.

Precautions

Linezolid should not be used in patients who have received monoamine oxidase inhibitors within 2 weeks; in patients with uncontrolled hypertension, pheochromocytoma, thyrotoxicosis, and/or taking sympathomimetic, vasopressive, or dopaminergic agents unless they are monitored for elevations in blood pressure; or in patients with carcinoid syndrome and/or taking serotonergic agents (such as SSRI antidepressants) unless they are monitored for signs or symptoms of serotonin syndrome (e.g., fever, hyperreflexia, cognitive dysfunction, incoordination). Discontinuation of linezolid and/or serotonergic agent should be considered if signs or symptoms of serotonin syndrome occur. Linezolid has not been studied in patients with carcinoid syndrome and its use in these patients should be undertaken with caution.

In general, linezolid should not be given to patients receiving serotonergic agents; however, some conditions may be life-threatening or require urgent treatment with linezolid (e.g., vancomycin-resistant Enterococcus faecium infections, nosocomial pneumonia, complicated skin and skin structure infections). In emergency situations, alternative therapy should be considered and the benefit of linezolid treatment should be weighed against the risk of serotonin toxicity. If linezolid must be given to a patient taking a serotonergic agent, that agent must be stopped at once and the patient should be monitored closely for central nervous system toxicity for either 2 weeks (5 weeks if fluoxetine was the agent) or until 24 hours after the last dose of linezolid. When nonurgent linezolid therapy is considered, the serotonergic psychiatric agent should be stopped to allow its activity in the brain to dissipate. Most serotonergic psychiatric agents should be stopped at least 2 weeks prior to linezolid treatment; at least 5 weeks should be allowed for fluoxetine. Treatment with the serotonergic agent may resume 24 hours after the last dose of linezolid.

Linezolid is a reversible, nonselective inhibitor of monoamine oxidase. Foods high in tyramine content should be avoided while taking linezolid. Some foods high in tyramine include aged cheese, fermented or air-dried meats, sauerkraut, soy sauce, tap beer, and red wine. The quantity of tyramine consumed per meal should not exceed 100 mg.

Linezolid has been associated with lactic acidosis. Immediate medical evaluation is recommended if recurrent nausea and vomiting, unexplained acidosis, or low bicarbonate levels develop.

Myelosuppression (including anemia, leukopenia, pancytopenia and thrombocytopenia) has been reported in patients receiving linezolid. Complete blood counts should be monitored weekly in patients who receive linezolid, particularly in those who receive linezolid for longer than two weeks, those with preexisting myelosuppression, those receiving concomitant drugs that produce bone marrow suppression, or those with chronic infection who have received previous or concomitant antibiotic therapy. Discontinuing therapy with linezolid should be considered in patients who develop or have worsening myelosuppression.

Linezolid is not clinically active against gram-negative organisms. It is critical that specific gram-negative therapy be started immediately if a concomitant gram-negative pathogen is proven or suspected.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following linezolid therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Diabetic patients should be warned of possible hypoglycemia with linezolid. A decrease in the dose of insulin or oral hypoglycemic agent, or discontinuation of oral hypoglycemic agent, insulin, or linezolid may be required if hypoglycemia occurs.

Linezolid has been associated with peripheral and optic neuropathy, mainly with courses of therapy longer than 28 days; however, neuropathy has also been reported with shorter courses. Blurred vision has been reported with shorter treatment durations. Visual function should be monitored in patients who are taking with linezolid for more than 3 months and in all patients with new visual symptoms regardless of the treatment duration. Prompt ophthalmologic evaluation is recommended if symptoms of visual impairment occur (changes in visual acuity, changes in color vision, blurred vision, or visual field defect). If peripheral or optic neuropathy occurs, the expected benefit of continuing linezolid versus the potential risks should be carefully evaluated.

Patients with phenylketonuria should be aware that the oral suspension contains 20 mg phenylalanine per 5 mL.

The safety and efficacy of linezolid beyond 28 days have not been established.

Dialysis

Hemodialysis: 30% of a dose is removed during a 3-hour dialysis session beginning 3 hours after administration of linezolid. The dose should be given after dialysis.

Other Comments

Maximum adult dose: 600 mg IV or orally every 12 hours

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