Linézolide
antibiotic
Third-party optionBy the Layer Nutrition editorial team · How the atlas classifies the 664 molecules
What this medicine is for
Pharmacologically, Linezolid relates to the category “antibiotic”. Antibiotics treat infections caused by bacteria. They are taken as a course, over a set duration, until the end of the prescription.
For Linezolid, in practice: Treats a bacterial infection. Its use is generally limited in time, adjusted to the situation.
Under which brands it is found
Linezolid is part of the composition of about 8 presentations listed in France. It is available under various trade names and as generics.
- Linezolide Accord
- Linezolide Arrow
- Linezolide Eg
- Linezolide Hikma
- Linezolide Kabi
- Linezolide Panpharma
- Linezolide Stragen
- Zyvoxid
Original brand-name products and generics deliver the same active substance; the choice between them is made with your doctor or pharmacist.
On your plate: limiting tyramine
Linezolid slows down monoamine oxidase, the enzyme that breaks down the tyramine supplied by certain foods. When this tyramine builds up, blood pressure can rise. Diet then serves to spot and limit the foods richest in tyramine, alongside your treatment.
Tyramine forms when foods age, ferment or are stored for a long time. It is found most in aged cheeses, cured meats and dried meats, smoked or salted fish, and fermented foods. A clear blood pressure response has been observed from 100 mg of tyramine per meal, a load these foods can reach when eaten in quantity.
The simple reflex is to favour fresh products. A fresh cheese or a yoghurt provides little tyramine, unlike a long-aged cheese. Likewise, fresh meat or fish, cooked and eaten promptly, or an egg, remain safe choices. Choosing recent products rather than fermented or aged ones limits tyramine intake without complicating meals.
How linezolid works
Linezolid belongs to the oxazolidinone family, a class of synthetic antibiotics. It acts on the bacterial ribosome, the machine that builds the bacterium's proteins. It binds to the 23S ribosomal RNA of the 50S subunit and prevents the assembly of the functional 70S initiation complex. Deprived of this starting point, the bacterium can no longer begin the synthesis of its proteins, and its multiplication stops.
This action does not always destroy the bacterium directly. Against staphylococci and enterococci, linezolid is bacteriostatic: it blocks growth without killing and lets the body's defences finish the work. Against most streptococci, it is bactericidal, meaning it destroys the bacterium. This original mode of action explains why it remains active where other antibiotics have lost ground.
Why linezolid is prescribed
Linezolid is reserved for specific situations: infections caused by bacteria that have become resistant to the usual treatments. It targets in particular Enterococcus faecium enterococci resistant to vancomycin, often noted as VRE, against which few options remain. It also treats pneumonia due to methicillin-resistant Staphylococcus aureus, MRSA, whether contracted in hospital or in the community.
It is finally used in skin and soft tissue infections due to MRSA, both complicated and uncomplicated. This role as a fallback explains why it is not prescribed as a first choice for a common infection. The decision rests on identifying the organism and on its resistance profile, established by the doctor and the laboratory.
How to take it day to day
Linezolid comes as a tablet and in an injectable form. Its oral bioavailability approaches 100%, which means the tablet delivers the same amount of medicine as the infusion: the oral dose and the intravenous dose are identical, with no adjustment. Switching from the infusion to the tablet therefore happens without loss of effectiveness, an advantage for continuing treatment at home.
The medicine's half-life is between 4.3 and 5.4 hours at steady state, which corresponds to two doses a day, twelve hours apart. It can be swallowed with or without food: food slows the rate of absorption but does not reduce the amount absorbed. You should keep to the schedule, follow the prescribed duration and not stop the treatment on your own, even when symptoms improve.
The effects on the blood to be aware of
The most closely watched side effect involves the blood. Linezolid can slow the production of blood cells by the bone marrow, a phenomenon called myelosuppression: a fall in platelets (thrombocytopenia), red blood cells (anaemia), white blood cells (leukopenia), sometimes all three at once (pancytopenia). In adult trials, a marked fall in platelets affected 2.4% of patients; in hospitalised children, this figure reaches 12.9%.
This toxicity is partly due to the kinship between the bacterial ribosome and that of the mitochondria, the energy factories of our cells. By blocking the synthesis of mitochondrial proteins, linezolid hampers very active cells such as those of the marrow. This is why a full blood count is checked each week during treatment, in order to spot a fall early and adjust the course of action.
Neuropathies and lactic acidosis
Two other effects appear above all during prolonged treatments. Neuropathies, damage to the peripheral nerves and the optic nerve, have been reported mainly beyond the maximum recommended duration of 28 days. They can show up as tingling, a loss of sensation or a decline in vision, and they do not always resolve: some damage is irreversible.
Lactic acidosis, that is, a build-up of lactic acid in the blood, has also been described. It stems from the same mitochondrial mechanism. Nausea, recurrent vomiting or a fall in bicarbonates should raise concern: if suspected, stopping the treatment is recommended and a medical assessment is required. These signs justify seeking care without delay.
Interactions and monitoring
Linezolid is a reversible and non-selective inhibitor of monoamine oxidase, the enzyme (MAO-A and MAO-B) that breaks down certain chemical messengers. Combined with medicines that increase serotonin, such as SSRI antidepressants, tricyclics, certain opioids and other serotonergic agents, it can trigger serotonin syndrome. Any combination of this kind must be known to the doctor, who decides on the course of action.
The same effect on MAO, in the gut and the liver, explains the caution towards foods rich in tyramine, detailed further down. On the nutrient side, the protective role of vitamin B6, pyridoxine, against blood toxicity remains debated: a prospective study showed no effect of pyridoxine on the frequency of myelosuppression during prolonged treatment. Monitoring rests above all on weekly surveillance of the blood count.
Sources
Related molecules
To explore in the « Anti-infectives » family and its neighbours.
See the whole « Anti-infectives » family · Back to the atlas
Supplements to consider
Beyond the plate, a single isolated nutrient can be worth discussing, to confirm with your doctor or pharmacist. Here is which one and in which form.
Probiotics
Probiotics are live micro-organisms, mainly lactobacilli and bifidobacteria. The CFU count and the number of strains are among the selection criteria; gastro-resistant capsules protect the bacteria from stomach acidity.
Preferred form gastro-resistant capsules, several strains, CFU count stated
Frequently asked questions
What is linezolid used for?
Linezolid is an antibiotic in the oxazolidinone family, prescribed for certain Gram-positive bacterial infections, particularly when they are resistant to other treatments. The exact indication and duration are decided by the doctor: refer to the package leaflet and to your prescriber or pharmacist.
What are the side effects of linezolid?
The package leaflet mainly lists headaches, nausea and diarrhoea. With prolonged use, blood-related effects (a drop in platelets or blood cells) or nerve disorders can occur, which warrant monitoring. Report any unusual symptom to your doctor or pharmacist and read the package leaflet.
Why should you avoid certain foods such as aged cheese while taking linezolid?
Linezolid acts as a weak monoamine oxidase inhibitor, so foods very high in tyramine (aged cheeses, cured meats, some fermented drinks) can be a problem. The list and precautions are set out in the package leaflet: follow the instructions of your doctor or pharmacist.
Can linezolid interact with antidepressants?
Yes, combining linezolid with certain antidepressants (SSRIs, SNRIs) or other serotonergic medicines can increase the risk of serotonin syndrome. Never change a treatment on your own: tell your doctor or pharmacist about all the medicines you take and refer to the package leaflet.
Can you take linezolid during pregnancy or breastfeeding?
The package leaflet states that linezolid is used during pregnancy or breastfeeding only if the doctor considers it necessary. This decision is theirs to make on a case-by-case basis: discuss it with your doctor or pharmacist and read the package leaflet.
Can an antibiotic like linezolid upset the gut flora, and what should you consider nutrition-wise?
Studies link antibiotic use to a temporary imbalance of the gut flora, sometimes accompanied by digestive upset. On the nutrition side, probiotics are often mentioned to support the flora: documented strains such as Saccharomyces boulardii or Lactobacillus rhamnosus are worth considering, in capsule or sachet form. Ask your doctor or pharmacist for advice before combining them with an antibiotic.
Ces réponses portent sur le volet nutritionnel. Pour toute question sur votre médicament, la notice et votre médecin ou pharmacien font foi.