Moderate
Carbamazepine × Linezolid
Antiepileptics. Carboxamide derivatives×Oxazolidinone antibiotic
Mechanism
No direct pharmacokinetic interaction. Mild additive CNS depression and haematologic toxicity: linezolid myelosuppression plus carbamazepine's rare agranulocytosis- and thrombocytopaenia-inducing activity.
Symptoms
Fatigue, confusion, frequent infections (from leukopenia), bleeding (from thrombocytopenia). Symptoms develop with linezolid courses over 14 days.
Management
For short linezolid courses (10–14 days) on stable carbamazepine, no adjustment needed. Check CBC at one week and at course end. For long-term linezolid (over 14 days), weekly CBC. Antibiotic alternative if needed: vancomycin (no myelosuppression).