Drug Interaction Report

The linezolid in Zyvox has a moderate potential interaction with Acidosis.

Cases of lactic acidosis have been reported with the use of linezolid. Patients who develop recurrent nausea or vomiting, unexplained acidosis, or a low bicarbonate level while receiving linezolid should receive immediate medical evaluation.

dilTIAZem has a major potential interaction with Aortic Stenosis.

The use of some calcium channel blockers (CCBs) is contraindicated in patients with advanced aortic stenosis. CCBs whose pharmacologic effect is partially dependent on their ability to reduce afterload (e.g., diltiazem, nicardipine, nifedipine, verapamil) may be of less benefit in these patients due to a fixed impedance to flow across the aortic valve and may, in fact, worsen rather than improve myocardial oxygen balance. Rarely, heart failure has developed following the initiation of these CCBs, particularly in patients receiving concomitant beta-blocker therapy.

The linezolid in Zyvox has a major potential interaction with Bone Marrow Depression/Low Blood Counts.

Reversible myelosuppression, including anemia, leukopenia, pancytopenia and thrombocytopenia, has been reported during postmarketing use of linezolid, although a causal relationship has not been established. Thrombocytopenia was also reported in phase 3 comparator-controlled trials at dosages up to and including 600 mg every 12 hours for up to 28 days, and bleeding events were identified in thrombocytopenic patients in a compassionate use program for linezolid. Therapy with linezolid should be administered cautiously in patients with preexisting blood dyscrasias and in patients receiving concomitant medications that may produce myelosuppression. Complete blood counts should be monitored weekly, particularly if linezolid is administered for longer than 2 weeks. Discontinuation of therapy should be considered in patients who develop or have worsening myelosuppression.

The linezolid in Zyvox has a moderate potential interaction with Carcinoid Syndrome.

Linezolid is a weak, reversible, nonselective monoamine oxidase inhibitor (MAOI). Nonspecific MAOIs inhibit the breakdown of pressor amines, including serotonin, and may exacerbate symptoms of the carcinoid syndrome. While adverse effects related to MAOI activity have not been reported with linezolid, the potential for excessive serotonergic effects should be considered. Therapy with linezolid should be administered cautiously in patients with carcinoid syndrome and in patients receiving serotonergic agents. Clinical data are not available concerning the use of linezolid in these populations.

dilTIAZem has a major potential interaction with Cardiogenic Shock.

In general, calcium channel blockers (CCBs) should not be used in patients with hypotension (systolic pressure < 90 mm Hg) or cardiogenic shock. Due to potential negative inotropic and peripheral vasodilating effects, the use of CCBs may further depress cardiac output and blood pressure, which can be detrimental in these patients. The use of verapamil and diltiazem is specifically contraindicated under these circumstances.

The linezolid in Zyvox has a moderate potential interaction with Cardiovascular Conditions and Disorders.

Linezolid is a weak, reversible, nonselective monoamine oxidase inhibitor (MAOI). Nonspecific MAOIs inhibit the breakdown of pressor amines, the accumulation of which can precipitate hypertensive crises. Intracranial hemorrhage and death have been reported with MAOI antidepressants. While adverse effects related to MAOI activity have not been reported with linezolid, the potential for severe hypertension should be considered. Therapy with linezolid should be administered cautiously in patients with cerebro- or cardiovascular disease, pheochromocytoma, or untreated hyperthyroidism. Clinical data are not available concerning the use of linezolid in this population. As a precaution, patients should have their blood pressure monitored during therapy and observed for signs and symptoms of a hypertensive reaction (e.g., occipital headache which may radiate frontally; palpitation; neck stiffness or soreness; nausea or vomiting; perspiration associated with fever or cold, clammy skin; mydriasis; photophobia; constricting chest pain).

The linezolid in Zyvox has a moderate potential interaction with Cerebral Vascular Disorder.

Linezolid is a weak, reversible, nonselective monoamine oxidase inhibitor (MAOI). Nonspecific MAOIs inhibit the breakdown of pressor amines, the accumulation of which can precipitate hypertensive crises. Intracranial hemorrhage and death have been reported with MAOI antidepressants. While adverse effects related to MAOI activity have not been reported with linezolid, the potential for severe hypertension should be considered. Therapy with linezolid should be administered cautiously in patients with cerebro- or cardiovascular disease, pheochromocytoma, or untreated hyperthyroidism. Clinical data are not available concerning the use of linezolid in this population. As a precaution, patients should have their blood pressure monitored during therapy and observed for signs and symptoms of a hypertensive reaction (e.g., occipital headache which may radiate frontally; palpitation; neck stiffness or soreness; nausea or vomiting; perspiration associated with fever or cold, clammy skin; mydriasis; photophobia; constricting chest pain).

The linezolid in Zyvox has a moderate potential interaction with Diabetes Mellitus.

Cases of symptomatic hypoglycemia have been reported in diabetic patients receiving insulin or oral hypoglycemic agents when treated with linezolid. Caution and close monitoring are recommended when prescribing this agent to a patient with diabetes mellitus.

The linezolid in Zyvox has a moderate potential interaction with Head Injury.

Caution is recommended when prescribing linezolid to patients with a history of seizures or risk factors for seizures as convulsions have been reported with the use of this agent. Close monitoring is recommended.

dilTIAZem has a major potential interaction with Heart Attack.

Diltiazem has demonstrated a negative inotropic effect in isolated animal tissue preparations but rarely in clinical situations. Hemodynamic studies in humans with normal ventricular function and in patients with a compromised myocardium have not shown a reduction in cardiac index nor consistent negative effects on contractility. However, worsening of congestive heart failure has been reported in patients with preexisting impairment of ventricular function. Therapy with diltiazem should be administered cautiously, if at all, in patients with severe left ventricular dysfunction (e.g., ejection fraction < 30%) or moderate to severe symptoms of cardiac failure and in patients with any degree of ventricular dysfunction if they are receiving a beta-adrenergic blocker. Likewise, diltiazem should not be given to patients with acute myocardial infarction and pulmonary congestion documented by X-ray on admission, since associated heart failure may be acutely worsened. Mild symptoms of cardiac failure should be under control, if possible, prior to initiating diltiazem therapy.

dilTIAZem has a major potential interaction with Heart Block.

The use of some calcium channel blockers (CCBs) is contraindicated in patients with severe bradyarrhythmia, sick sinus syndrome (unless a functioning pacemaker is present), or heart block greater than the first degree (unless a functioning pacemaker is present). CCBs like bepridil, diltiazem and verapamil have a negative effect on AV conduction and the SA node and may exacerbate these conditions.

dilTIAZem has a major potential interaction with Heart Failure.

Diltiazem has demonstrated a negative inotropic effect in isolated animal tissue preparations but rarely in clinical situations. Hemodynamic studies in humans with normal ventricular function and in patients with a compromised myocardium have not shown a reduction in cardiac index nor consistent negative effects on contractility. However, worsening of congestive heart failure has been reported in patients with preexisting impairment of ventricular function. Therapy with diltiazem should be administered cautiously, if at all, in patients with severe left ventricular dysfunction (e.g., ejection fraction < 30%) or moderate to severe symptoms of cardiac failure and in patients with any degree of ventricular dysfunction if they are receiving a beta-adrenergic blocker. Likewise, diltiazem should not be given to patients with acute myocardial infarction and pulmonary congestion documented by X-ray on admission, since associated heart failure may be acutely worsened. Mild symptoms of cardiac failure should be under control, if possible, prior to initiating diltiazem therapy.

The linezolid in Zyvox has a moderate potential interaction with Hemodialysis.

Linezolid is partially removed by hemodialysis and should be administered after dialysis.

The linezolid in Zyvox has a moderate potential interaction with High Blood Pressure.

Linezolid should not be administered to patients with uncontrolled hypertension, pheochromocytoma, thyrotoxicosis and/or patients taking any medication that could affect the pressor response unless patients are being monitored for potential increases in blood pressure. Caution and close monitoring are recommended when prescribing this agent to these patients.

The linezolid in Zyvox has a moderate potential interaction with Hyperthyroidism.

Linezolid is a weak, reversible, nonselective monoamine oxidase inhibitor (MAOI). Nonspecific MAOIs inhibit the breakdown of pressor amines, the accumulation of which can precipitate hypertensive crises. Intracranial hemorrhage and death have been reported with MAOI antidepressants. While adverse effects related to MAOI activity have not been reported with linezolid, the potential for severe hypertension should be considered. Therapy with linezolid should be administered cautiously in patients with cerebro- or cardiovascular disease, pheochromocytoma, or untreated hyperthyroidism. Clinical data are not available concerning the use of linezolid in this population. As a precaution, patients should have their blood pressure monitored during therapy and observed for signs and symptoms of a hypertensive reaction (e.g., occipital headache which may radiate frontally; palpitation; neck stiffness or soreness; nausea or vomiting; perspiration associated with fever or cold, clammy skin; mydriasis; photophobia; constricting chest pain).

dilTIAZem has a major potential interaction with Hypotension.

In general, calcium channel blockers (CCBs) should not be used in patients with hypotension (systolic pressure < 90 mm Hg) or cardiogenic shock. Due to potential negative inotropic and peripheral vasodilating effects, the use of CCBs may further depress cardiac output and blood pressure, which can be detrimental in these patients. The use of verapamil and diltiazem is specifically contraindicated under these circumstances.

dilTIAZem has a major potential interaction with Ischemic Heart Disease.

Increased frequency, duration, and/or severity of angina, as well as acute myocardial infarction, have rarely developed during initiation or dosage increase of calcium channel blockers (CCBs), particularly in patients with severe obstructive coronary artery disease and those treated with immediate-release formulations. The mechanism of this effect is not established. Therapy with CCBs should be administered cautiously in patients with significant coronary artery disease.

dilTIAZem has a major potential interaction with Liver Disease.

Calcium channel blockers (CCBs) are extensively metabolized by the liver. The half-lives of CCBs may be prolonged substantially in patients with severe hepatic impairment, with the potential for significant drug accumulation. In addition, the use of some CCBs has been associated with elevations in serum transaminases, both with and without concomitant elevations in alkaline phosphatase and bilirubin. While these effects may be transient and reversible, some patients have developed cholestasis or hepatocellular injury. Therapy with CCBs should be administered cautiously and often at reduced dosages in patients with significantly impaired hepatic function. Periodic monitoring of liver function is advised.

The linezolid in Zyvox has a moderate potential interaction with Liver Disease.

Linezolid is primarily metabolized by the liver. The pharmacokinetics of linezolid are not altered in patients with mild to moderate hepatic impairment (Child-Pugh class A or B) and, therefore, no dosage adjustments are necessary. Pharmacokinetic data are not available for patients with severe hepatic impairment. Therapy with linezolid should be administered cautiously in such patients.

The linezolid in Zyvox has a major potential interaction with Noninfectious Colitis.

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

The linezolid in Zyvox has a moderate potential interaction with Optic Nerve Disorder.

Peripheral and optic neuropathies have been reported in patients treated with linezolid. If patients experience symptoms of visual impairment, such as changes in visual acuity, changes in color vision, blurred vision, or visual field defect, prompt ophthalmic evaluation is recommended. Visual function should be monitored in all patients taking linezolid for extended periods and in all patients reporting new visual symptoms regardless of length of therapy with linezolid. If peripheral or optic neuropathy occurs, the continued use of linezolid in these patients should be weighed against the potential risks.

The linezolid in Zyvox has a moderate potential interaction with Peripheral Neuropathy.

Peripheral and optic neuropathies have been reported in patients treated with linezolid. If patients experience symptoms of visual impairment, such as changes in visual acuity, changes in color vision, blurred vision, or visual field defect, prompt ophthalmic evaluation is recommended. Visual function should be monitored in all patients taking linezolid for extended periods and in all patients reporting new visual symptoms regardless of length of therapy with linezolid. If peripheral or optic neuropathy occurs, the continued use of linezolid in these patients should be weighed against the potential risks.

The linezolid in Zyvox has a moderate potential interaction with Pheochromocytoma.

Linezolid should not be administered to patients with uncontrolled hypertension, pheochromocytoma, thyrotoxicosis and/or patients taking any medication that could affect the pressor response unless patients are being monitored for potential increases in blood pressure. Caution and close monitoring are recommended when prescribing this agent to these patients.

The linezolid in Zyvox has a moderate potential interaction with Pheochromocytoma.

Linezolid is a weak, reversible, nonselective monoamine oxidase inhibitor (MAOI). Nonspecific MAOIs inhibit the breakdown of pressor amines, the accumulation of which can precipitate hypertensive crises. Intracranial hemorrhage and death have been reported with MAOI antidepressants. While adverse effects related to MAOI activity have not been reported with linezolid, the potential for severe hypertension should be considered. Therapy with linezolid should be administered cautiously in patients with cerebro- or cardiovascular disease, pheochromocytoma, or untreated hyperthyroidism. Clinical data are not available concerning the use of linezolid in this population. As a precaution, patients should have their blood pressure monitored during therapy and observed for signs and symptoms of a hypertensive reaction (e.g., occipital headache which may radiate frontally; palpitation; neck stiffness or soreness; nausea or vomiting; perspiration associated with fever or cold, clammy skin; mydriasis; photophobia; constricting chest pain).

dilTIAZem has a major potential interaction with Preexcitation Syndrome.

The use of intravenous diltiazem is contraindicated for the management of atrial flutter or fibrillation in patients with an accessory AV tract (e.g., those with Wolff-Parkinson-White or Lown-Ganong-Levine syndrome). Diltiazem can cause ventricular fibrillation and cardiac arrest in such patients, the mechanism of which is related to the drug's ability to shorten the refractory period and accelerate antegrade conduction within the accessory pathway.

dilTIAZem has a moderate potential interaction with Renal Dysfunction.

Diltiazem is extensively metabolized by the liver and subsequently excreted in the urine, primarily as metabolites. Limited data suggest that the pharmacokinetic disposition of diltiazem is not altered in the presence of renal insufficiency or even end-stage renal disease. However, the effects of possible metabolite accumulation have not been studied. The manufacturers recommend that therapy with diltiazem be administered cautiously in patients with impaired renal function. Laboratory parameters of renal function should be monitored at regular intervals.

The linezolid in Zyvox has a moderate potential interaction with Renal Dysfunction.

Linezolid is primarily metabolized by the liver and subsequently eliminated by the kidney. The pharmacokinetics of the parent drug are not altered in patients with impaired renal function and, therefore, no dosage adjustments are necessary. However, accumulation of the two primary metabolites may occur in such patients, the amount of which increases with the degree of renal impairment. The clinical significance of metabolite accumulation has not been determined. Therapy with linezolid should be administered cautiously in patients with renal impairment and only if benefits outweigh the potential risks.

The linezolid in Zyvox has a moderate potential interaction with Seizures.

Caution is recommended when prescribing linezolid to patients with a history of seizures or risk factors for seizures as convulsions have been reported with the use of this agent. Close monitoring is recommended.

dilTIAZem has a major potential interaction with Sinus Node Dysfunction.

The use of some calcium channel blockers (CCBs) is contraindicated in patients with severe bradyarrhythmia, sick sinus syndrome (unless a functioning pacemaker is present), or heart block greater than the first degree (unless a functioning pacemaker is present). CCBs like bepridil, diltiazem and verapamil have a negative effect on AV conduction and the SA node and may exacerbate these conditions.

The linezolid in Zyvox has a major potential interaction with Thrombocytopathy.

Reversible myelosuppression, including anemia, leukopenia, pancytopenia and thrombocytopenia, has been reported during postmarketing use of linezolid, although a causal relationship has not been established. Thrombocytopenia was also reported in phase 3 comparator-controlled trials at dosages up to and including 600 mg every 12 hours for up to 28 days, and bleeding events were identified in thrombocytopenic patients in a compassionate use program for linezolid. Therapy with linezolid should be administered cautiously in patients with preexisting blood dyscrasias and in patients receiving concomitant medications that may produce myelosuppression. Complete blood counts should be monitored weekly, particularly if linezolid is administered for longer than 2 weeks. Discontinuation of therapy should be considered in patients who develop or have worsening myelosuppression.

The linezolid in Zyvox has a moderate potential interaction with Thyrotoxicosis.

Linezolid should not be administered to patients with uncontrolled hypertension, pheochromocytoma, thyrotoxicosis and/or patients taking any medication that could affect the pressor response unless patients are being monitored for potential increases in blood pressure. Caution and close monitoring are recommended when prescribing this agent to these patients.

dilTIAZem has a major potential interaction with Ventricular Arrhythmia.

The use of intravenous diltiazem or verapamil is contraindicated in patients with ventricular tachycardia. IV administration of a calcium channel blocker can precipitate cardiac arrest in such patients. Marked hemodynamic deterioration and ventricular fibrillation have occurred in patients with wide-complex ventricular tachycardia (QRS >= 0.12 seconds) treated with IV verapamil.

The linezolid in Zyvox has a moderate potential interaction with Vomiting.

Cases of lactic acidosis have been reported with the use of linezolid. Patients who develop recurrent nausea or vomiting, unexplained acidosis, or a low bicarbonate level while receiving linezolid should receive immediate medical evaluation.