Tips for prescribing insulin therapy and diabetes supplies

There are many different insulin preparations and supplies available in order to create individualized regimens for patients.  Here are some tips and a checklist to help avoid getting future calls from pharmacies.

Interaction between linezolid (Zyvox®) and SSRIs

Linezolid is an oxazolidinone antibiotic (see more about its mechanism here) that is active against many gram-positive organisms including those that are resistant to multiple other agents such as methicillin-resistant staphylococci, penicillin-resistant streptococci, and vancomycin-resistant enterococci.  Linezolid is also a weak, reversible, inhibitor of monoamine oxidase (MAO), predominantly MAO-A, which is responsible for the metabolism of neurotransmitters such as serotonin, in the brain.  This effect has led to an increased risk of serotonin syndrome in patients taking other medications that increase serotonergic tone.  SSRIs fall in this category as they increase synaptic serotonin concentrations by preventing transport into the presynaptic neuron.  They are commonly prescribed for numerous psychiatric conditions. Due to the high prevalence of both depressive disorders and nosocomial infections in patients with chronic medical illnesses, this medication combination may be encountered in the hospital setting.  Though case reports are few, deaths have been reported due to serotonin syndrome and a Food and Drug Administration Safety Alert was issued in 2011 specifically warning about the linezolid-SSRI interaction.