Critical
Escitalopram × Linezolid
Selective serotonin reuptake inhibitors (SSRIs)×Oxazolidinone antibiotic
Mechanism
Escitalopram (SSRI) raises synaptic serotonin. Linezolid reversibly inhibits MAO. Co-administration sharply amplifies serotonergic transmission. The FDA boxed warning applies to all SSRIs paired with linezolid.
Symptoms
Serotonin syndrome: agitation, confusion, tremor, myoclonus, hyperreflexia, dilated pupils. Autonomic features: profuse sweating, tachycardia, hypertension, fever above 38.5 °C. Severe cases progress to seizures, rhabdomyolysis, disseminated intravascular coagulation, and death. First signs appear within hours of concurrent dosing.
Management
The combination is not prescribed. Stop escitalopram at least 2 weeks before linezolid. If urgent antibiotic therapy is needed, use vancomycin, daptomycin, or ceftaroline based on susceptibility.