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Hypoglycemia and Linezolid

A small number of incidents have shown that linezolid, an antibiotic, may have an association with hypoglycemia…. 

Linezolid (Zyvox) belongs to a class of antibiotics known as oxazolidinones which inhibit aerobic gram positive bacteria as well as certain gram negative and anaerobic bacteria. With recent reports from the Clinical Infectious Disease journal, the FDA has added the risk of hypoglycemia onto the Warnings and Precautions section on the linezolid inserts.

FDA officials have searched the FDA Adverse Event Reporting System for incidents of hypoglycemia among people who received linezolid from April 2000 to March 2012. The average population age was 77 years old. Among the 41 reports of hypoglycemia found in patients who received linezolid, 26 were excluded with no temporal associations found between hypoglycemia and linezolid. However, among the other 15 reports, there were high correlations in having hypoglycemia while taking the antibiotic. It took approximately 7 days to develop hypoglycemia after starting linezolid. In the majority of reports, hypoglycemia was resolved after linezolid was discontinued while some outcomes were unknown.

Although the numbers may seem unconvincing, the incidence of hypoglycemia was apparent enough for the FDA to add on to the warning and precaution sections for linezolid.

Practice Pearls:
  • Linezolid (Zyvox) belongs to a class of antibiotics known as oxazolidinones which inhibit aerobic gram positive bacteria, as well as certain gram negative and anaerobic bacteria.
  • The incidence of hypoglycemia was apparent enough for the FDA to add on as a warning and precaution on the package insert for linezolid.
  • Health care providers should use caution when prescribing linezolid, especially in the diabetic population.

Viswanathan P, Iarikov D, Wassel R, et al. Hypoglycemia in Patients Treated with Linezolid. Clinical Infectious Disease. 2014 July 16.