# A 50-year-old client on sertraline for depression is being prescribed linezolid for vancomycin-resistant Enterococcus faecium bacteremia. Which is the most appropriate nursing action?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375247&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 50-year-old client on sertraline for depression is being prescribed linezolid for vancomycin-resistant Enterococcus faecium bacteremia. Which is the most appropriate nursing action?

## Option

1. Administer linezolid because there is no interaction with sertraline.
2. Communicate with the prescriber and pharmacist before starting; linezolid is a reversible MAO inhibitor and combining with SSRI, SNRI, TCA, MAOI, triptan, meperidine, tramadol, dextromethorphan, or tyramine-rich foods can cause serotonin syndrome; consider holding or substituting the antidepressant under psychiatric guidance, anticipate close monitoring for hyperreflexia, clonus, agitation, autonomic instability, and avoid tyramine-rich foods such as aged cheese. **✔ Correct answer**
3. Add another SSRI to potentiate antibacterial action.
4. Increase the sertraline to overcome reduced effect.

**Correct answer: 2**

## Explanation

Linezolid is an oxazolidinone antibiotic for vancomycin-resistant Enterococcus (VRE), MRSA, and other resistant gram-positive infections. It is also a weak, reversible nonselective monoamine oxidase inhibitor. Combining linezolid with serotonergic agents such as SSRIs, SNRIs, TCAs, MAOIs, triptans, meperidine, tramadol, dextromethorphan, methylene blue, ondansetron, or stimulants can precipitate serotonin syndrome. Standard nursing/care-coordination response: (1) communicate with the prescriber and pharmacist before starting; (2) consider holding or substituting the antidepressant under psychiatric guidance, given a typical wash-out concern of about 5 weeks for fluoxetine and 2 weeks for other SSRIs/SNRIs (often impractical for acute infection); when linezolid is essential, careful surveillance is the standard; (3) monitor closely for hyperreflexia, clonus (especially ocular clonus), tremor, agitation, autonomic instability (hyperthermia, tachycardia, hypertension, sweating, GI symptoms); (4) educate the patient to avoid tyramine-rich foods (aged cheese, cured meats, red wine, soy sauce) because of risk of hypertensive reaction with MAOI activity; (5) other linezolid effects to monitor — thrombocytopenia and bone marrow suppression with use beyond about 14 days, peripheral and optic neuropathy with prolonged use, lactic acidosis, and hypoglycemia; check CBC weekly; (6) avoid in pregnancy unless benefit outweighs. Administering without checks, increasing the SSRI, or adding another SSRI are unsafe.

## In-depth explanation

Linezolid is a reversible MAOI and stacks with serotonergic drugs. Communicate, monitor, and avoid tyramine. Adding more SSRI is the trap.

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