Antibacterials/digoxin/linezolid interaction
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Thrombocytopenia and elevated drug serum concentration: case report An 82-year-old man had high serum concentrations of digoxin and linezolid during concomitant administration of linezolid, digoxin, imipenem/cilastatin and cefoperazone/sulbactam. Additionally, high serum concentration of linezolid resulted in thrombocytopenia [not all routes stated]. The man with congestive left heart failure and severe pneumonia, was admitted to the respiratory ICU. Prior to admission, he was administered empiric treatment with IV cefoperazone/sulbactam (2g/1g every 8 hours) for 10 days. On hospital day 1, antibacterial treatment was switched to IV linezolid 600mg every 12 hours and imipenem/cilastatin (500mg/500mg every 8 hours). Also, on day 1 he started receiving treatment with oral digoxin 0.25mg once daily for heart failure. Additionally, he was receiving treatment with various concomitant medications. On day 4 of admission, linezolid serum concentrations and digoxin trough concentrations increased. Also, a decrease in platelet count by 30% was observed. Therefore, the man’s linezolid dose was reduced by 50% to 600mg once daily, and digoxin dose reduced by 50% to 0.125mg once daily. On day 6, imipenem/cilastatin was switched to cefoperazone/sulbactam every 12 hours. On day 8, linezolid concentrations were found to be 8.9 mg/L in 3 hours and 5.9 mg/L in 30 minutes prior to the next dose, and platelet count continued to decline below the normal range. Digoxin trough concentration was observed as 1.6 ng/mL, and the dose was reduced by 50% again to 0.125mg every two days. On day 16 (8 days after adjustment of digoxin dose), linezolid concentrations were 5.0 mg/L in 3 hours and 3.6 mg/L in 30 minutes before the next dose. The platelet count was back to the normal range. However, the digoxin trough concentration increased to 2.3 ng/mL. His treatment with linezolid and cefoperazone/sulbactam was discontinued. On day 24 (6 days after the discontinuation of linezolid), the platelet count was 212 × 109/L, and the digoxin trough concentration was 0.8 ng/mL. Based on these findings and clinical presentation it was concluded that the interaction between linezolid, digoxin, imipenem/cilastatin and cefoperazone/sulbactam resulted in high serum concentrations of digoxin and linezolid, and high serum concentration of linezolid resulted in thrombocytopenia. Yulin Z, et al. A possible interaction between linezolid and digoxin: A case report of therapeutic drug monitoring. Saudi Pharmaceutical Journal : 2020. Available from: URL: 803515112 http://doi.org/10.1016/j.jsps.2020.09.005
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Reactions 14 Nov 2020 No. 1830
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