Zyvox (Linezolid)

Zyvox (linezolid) is an oxazolidinone antibiotic used to treat certain serious infections caused by susceptible Gram-positive bacteria. In Canada, it may be prescribed in hospital or specialist care when this type of antibiotic is clinically appropriate.

Drug class

Linezolid belongs to the oxazolidinone class of antibiotics.

How it works

Linezolid blocks bacterial protein synthesis at an early stage by preventing formation of the 70S initiation complex.

What Zyvox tablets treat (and what they do not)

Limitations of use (Canada): Zyvox is not indicated for the treatment of Gram-negative infections. If a Gram-negative pathogen is suspected or confirmed, appropriate treatment should be started.

Indications (US labeling)

Zyvox tablets are used for certain infections caused by susceptible Gram-positive bacteria, including pneumonia (hospital-acquired and community-acquired), skin and skin structure infections (complicated and uncomplicated), and vancomycin-resistant Enterococcus faecium (VRE) infections, including cases with concurrent bacteremia.

Tablet strength

• Tablet: 600 mg (film-coated).

Can you split the tablet?

Zyvox 600 mg tablets are film-coated and are not described as scored in Canadian product information. Because of this, splitting or crushing them is generally not recommended unless a clinician specifically tells you to do so.

Why is Zyvox expensive? Are there alternatives?

Cost can be affected by brand pricing, manufacturing and supply chain factors, and market conditions. Depending on the infection and culture/susceptibility results, clinicians may choose alternatives. Health Canada-authorized generic linezolid tablets are available in Canada and may cost less than the brand product in some settings.

What medicines is it used with?

Zyvox may be used on its own for confirmed susceptible Gram-positive infections. If an infection is mixed or a Gram-negative pathogen is suspected, clinicians may prescribe Zyvox together with other antibiotics that cover Gram-negative organisms and, when needed, anaerobes. The exact combination depends on the site of infection, its severity, and local resistance patterns.

Drug interactions

Linezolid is a reversible, nonselective MAO inhibitor (MAOI). It can interact with adrenergic drugs, which may raise blood pressure, and serotonergic drugs, which may increase the risk of serotonin syndrome. Tell your clinician about all prescription, over-the-counter, and herbal products you use.

Contraindications

Tyramine (food interaction)

Because linezolid has MAOI activity, avoid consuming large amounts of tyramine-rich foods and drinks during treatment. Examples include aged cheeses, cured, aged, or improperly stored meats, fermented foods (including some soy and yeast products), and certain alcoholic drinks (such as some beers and red wine). Seek medical help if you develop a severe headache, flushing, or a marked rise in blood pressure.

Side effects and key precautions

Common side effects include diarrhea, nausea/vomiting, and headache.

Important warnings and precautions include myelosuppression (including thrombocytopenia; complete blood counts are commonly monitored weekly), peripheral and optic neuropathy (reported mainly with treatment longer than 28 days), lactic acidosis, seizures, and C. difficile-associated diarrhea. Report unusual bruising or bleeding, severe or persistent diarrhea, or new vision symptoms right away, including blurred vision or changes in visual acuity or colour vision.

Storage

Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F).