This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo

Linezolid oral

Updated 2 Feb 2023 | Oxazolidinones


Granules for oral suspension containing linezolid 100mg/5ml.

Film coated tablets containing 600mg linezolid.

Drugs List

  • linezolid 100mg/5ml oral suspension
  • linezolid 600mg tablets
  • ZYVOX 100mg/5ml oral suspension
  • ZYVOX 600mg tablets
  • Therapeutic Indications


    Community acquired pneumonia
    Complicated skin and soft tissue infections
    Nosocomial pneumonia

    Nosocomial pneumonia or community acquired pneumonia

    Treatment of nosocomial pneumonia or community acquired pneumonia when known or suspected to be caused by susceptible Gram positive bacteria.

    Microbiological tests and the prevalence of antibacterial resistance in Gram positive bacteria should be considered before linezolid treatment.

    Combination therapy will be necessary if a concomitant Gram negative pathogen is documented or suspected.

    Complicated skin and soft tissue infections

    Treatment of complicated skin and soft tissue infections when known to be caused by susceptible Gram positive bacteria.

    Linezolid is not effective against Gram negative pathogens. If co-infection with Gram negative pathogens is known or suspected, linezolid should only be used if no other alternative treatment options are appropriate. Treatment against Gram negative organisms must be initiated concurrently.


    Therapy with linezolid should only be initiated in a hospital environment and after consultation with a relevant specialist.


    600mg twice daily for 10 to 14 days.

    Duration of therapy
    The duration of treatment is dependent on the pathogen, the site of infection and its severity, and on the patient's clinical response.

    The maximum treatment duration is 28 days; safety and efficacy beyond this period have not been established.

    Shorter treatment regimens may be suitable for some types of infection but have not been evaluated in clinical trials.

    No increase in the recommended dosage or duration of treatment is required for infections associated with concurrent bacteraemia.


    Children aged 12 to 18 years (unlicensed)
    600mg every 12 hours.

    Children aged 1 month to 12 years (unlicensed)
    10mg/kg (up to 600mg per dose) every 8 hours.


    Neonates aged 7 to 28 days old (unlicensed)
    10mg/kg every 8 hours.

    Neonates under 7 days old (unlicensed)
    10mg/kg every 12 hours. This may be increased to 10mg/kg every 8 hours if necessary.

    Additional Dosage Information

    Linezolid solution for infusion, film-coated tablets or oral suspension may be used as initial therapy. Switching from parenteral formulation oral formulations is permitted without dose adjustment due to 100% oral bioavailability.


    Within 2 weeks of discontinuing other MAOIs

    Precautions and Warnings

    Children under 18 years
    Predisposition to seizures
    Bipolar disorder
    Confusional states
    Glucose-galactose malabsorption syndrome
    Hepatic impairment
    Hereditary fructose intolerance
    History of agranulocytosis
    History of seizures
    Renal impairment - creatinine clearance below 30 ml/minute
    Schizoaffective disorder
    Sucrase-isomaltase insufficiency
    Uncontrolled hypertension

    Sodium content of formulation may be significant
    Some formulations contain aspartame - caution in phenylketonuria
    Advise ability to drive/operate machinery may be affected by side effects
    Treatment to be initiated and supervised by a specialist
    Presentations with sorbitol unsuitable in hereditary fructose intolerance
    Some formulations contain fructose
    Some formulations contain sucrose
    Some formulations may contain alcohol
    Assess risk/benefit of treatment if symptoms of peripheral neuropathy occur
    If visual disturbances occur, perform ophthalmic evaluation
    Monitor blood counts in anaemia, leukopenia and thrombocytopenia
    Monitor closely patients receiving > 10-14 days of treatment
    Monitor closely patients receiving myelosuppressive drugs
    Monitor closely patients with pre-existing myelosuppression
    Monitor for development of lactic acidosis
    Monitor for signs of superinfection with non-susceptible organisms
    Monitor full blood counts weekly
    When used with SSRIs, risk of Serotonin syndrome
    Advise patient to report new visual problems and symptoms
    Consider pseudomembranous colitis if patient presents with diarrhoea
    Discontinue if myelosuppression occurs
    Not recommended for use longer than 4 weeks
    Advise patient against consuming large amounts of tyramine rich foods

    All patients receiving linezolid should have complete blood counts (including haemoglobin levels, platelets and total and differentiated leucocyte counts) monitored weekly regardless of baseline blood count.

    Elderly patients may be at greater risk of experiencing blood dyscrasias than younger patients.

    Thrombocytopenia may occur more commonly in patients with severe renal impairment, whether or not on dialysis.

    Linezolid inhibits mitochondrial protein synthesis, which can cause lactic acidosis, anaemia and neuropathy. More commonly in treatments lasting longer than 28 days.

    As approximately 30% of a linezolid dose is removed during 3 hours of haemodialysis, linezolid should be given after dialysis with extreme caution. The primary metabolites of linezolid are removed to some extent by haemodialysis, but the concentrations of these metabolites are still very considerably higher following dialysis than those observed in patients with normal renal function or mild to moderate renal impairment.

    Linezolid reversibly decreased fertility and induced abnormal sperm morphology in adult male rats at exposure levels approximately equal to those expected in humans. Possible effects of linezolid on the human male reproductive system are not known.

    Patients should be advised against consuming large amounts of tyramine rich foods, such as mature cheese, yeast extracts, undistilled alcoholic drinks or fermented soya bean products.

    Linezolid used in patients taking or taken antimycobacterial medications to treat tuberculosis, may show an increased risk of neuropathies.

    Myelosuppression has been reported in patients receiving linezolid. The risk of these effects appears to be related to the duration of treatment.
    If significant myelosuppression occurs, discontinue treatment unless it is considered absolutely necessary to continue therapy. If therapy is continued, intensive monitoring of blood counts and appropriate management strategies should be implemented.

    Patients should be advised to report any visual impairment. If any changes occur, the patient should be evaluated immediately and referred to an ophthalmologist if necessary. In patients taking linezolid for longer than the recommended 28 days, their visual function should be monitored.

    Sideroblastic anaemia has been reported in patients who had been treated with linezolid for more than 28 days. Most patients fully or partially recovered following discontinuation of linezolid.

    CSM Warnings

    Severe optic neuropathy may occur rarely if linezolid if treatment lasts longer than 28 days.

    The CHM recommends that:

    Patients should report any symptoms of visual impairment (including blurred vision, visual field defect, changes in visual acuity and colour vision) immediately;

    Patients experiencing new visual symptoms (regardless of treatment duration) should be evaluated promptly and referred to an ophthalmologist if necessary;

    Visual function should be monitored regularly if treatment is required for longer than 28 days.

    Pregnancy and Lactation


    Use linezolid with caution in pregnancy.

    At the time of writing there is limited data from the use of linezolid in pregnant women. It is not known if linezolid crosses the placenta, but the molecular weight is low enough that transfer to the foetus should be expected.

    Studies in animals have shown reproductive toxicity and a potential risk for humans exists.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Linezolid is contraindicated during breastfeeding.

    The molecular weight is low enough that excretion of linezolid should be expected. The effects of this on the breastfed infant are unknown. Limited data indicate that the maximum dose an infant would receive through breast milk would be much lower than the standard infant dose.

    Its is suggested that if linezolid is required by the mother, breastfeeding can be continued but the infant should be monitored for possible effects on the gastrointestinal tract.

    Animal data suggest that linezolid and its metabolites may pass into breast milk; it is excreted in the milk of lactating rats. Levels observed were higher than in the maternal plasma.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Abdominal pain
    Abnormal liver function tests
    Abnormal serum sodium levels
    Blood glucose disturbances
    Blurred vision
    Bullous reactions
    Changes in blood chemistry
    Colour vision deficiencies
    Creatine kinase increased
    Creatine phosphokinase increased
    Decrease in haemoglobin and haematocrit
    Decrease in plasma calcium
    Decreased serum albumin
    Decreased total serum protein
    Diarrhoea/loose stools
    Dry mouth
    Elevated amylase levels
    Elevated serum lipase
    Fluctuating serum potassium levels
    Fungal infection
    Increase in alkaline phosphatase
    Increase in blood urea nitrogen
    Increase in lactate dehydrogenase
    Increase in plasma calcium
    Increase in serum ALT/AST
    Increased platelet count
    Increased thirst
    Increases in eosinophils
    Lactic acidosis
    Local pain
    Loss of vision
    Metallic taste
    Optic neuritis
    Optic neuropathy
    Peripheral neuropathy
    Pseudomembranous colitis
    Raised neutrophil count
    Reduced neutrophil count
    Reduced platelet count
    Renal failure
    Serotonin syndrome
    Serum bilirubin increased
    Serum creatinine increased
    Sideroblastic anaemia
    Stevens-Johnson syndrome
    Superficial tooth discolouration
    Taste disturbances
    Tongue discolouration
    Toxic epidermal necrolysis
    Transient ischaemic attack
    Visual field defects
    Vulvovaginal disorders
    White blood cell count decreased
    White blood cell count raised


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: January 2018.

    Reference Sources

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 8th edition (2008) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Medications and Mother's Milk, 14th edition (2011) Hale, T.W. Hale Publishing, Amarillo, Texas.

    Summary of Product Characteristics: Zyvox 600mg film-coated tablets, Pharmacia Ltd. Revised Septemeber 2018.

    Summary of Product Characteristics: Zyvox 100mg/5ml granules for oral suspension, Pharmacia Ltd. Revised March 2019.

    The Renal Drug Handbook. 3rd edition. (2009) ed. Ashley, C and Currie, Radcliffe Publishing Ltd, Abingdon

    NICE Evidence Services Available at: Last accessed: 19 January 2018.

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Linezolid Last revised: 23th March 2010
    Last accessed: 19 January 2018.

    Access the full UK drug database with a FREE Medscape UK Account
    It takes just a few minutes, and you’ll get unlimited access to information on over 11,000 UK drugs.
    Register for Free

    Already a member? Log in

    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

    FDB Logo

    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.