Divya Periasamy and Sachidanand Peteru
Introduction: Linezolid (Zyvox) is an antibiotic, which belongs to the class of oxazolidinone. FDA approved it in 1998 to treat gram-positive drug-resistant enterococcus, staphylococcus, and pneumococcus infections in adults (MRSA and VRE). Bupropion (Welbutrin) is a medication primarily used as an antidepressant and smoking cessation aid. FDA first approved it in 1985. Both these medications are well known for causing serotonin syndrome when combined with serotonergic agents or administered along with tyramine-rich foods. Case: A 50-year old male patient was admitted to the hospital with right leg cellulitis and was treated with linezolid. The patient also had a history of depression and anxiety and was stable on bupropion for the past two years. Our C and L team was consulted for medication reconciliation and possible drug-drug interaction. On an extensive literature search, we came across just one case of hypertensive crisis when treated with linezolid and bupropion simultaneously. Hypertensive crisis from other confounding factors is unknown. We recommended continuing the prescribed bupropion on the patient along with his linezolid medication after explaining the risks and benefits. The patient completed his treatment and there were no symptoms suggestive of serotonin syndrome or hypertensive crisis. Conclusion: Bupropion was continued in a patient who was simultaneously treated with linezolid and pt completed the treatment without any symptoms of serotonin syndrome or hypertensive crisis. However, clinicians should be vigilant about drug-drug interactions and should make decisions on a case by case basis.
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