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The Annals of Pharmacotherapy: Vol. 38, No. 1, pp. 62-65. DOI 10.1345/aph.1D018
© 2004 Harvey Whitney Books Company.
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Acute Delirium Associated with Combined Diphenhydramine and Linezolid Use

Ryan N Serio, PharmD

at time of writing, PharmD Student, St. John's University, Jamaica, NY; now, Supervising Pharmacist, Eckerd Pharmacy, Forest Mills, NY

Reprints: Ryan N Serio PharmD, 164-40 95th St., Howard Beach, NY 11414-3704, FAX 718/275-5496, condram{at}msn.com

OBJECTIVE: To report a case of delirium with hallucinations presumably caused by the combination of diphenhydramine and linezolid.

CASE SUMMARY: A 56-year-old white man was receiving diphenhydramine 300 mg/d for 2 days to treat pruritus caused by a bullous rash possibly induced by vancomycin. He subsequently developed visual and auditory hallucinations, with erratic, aggressive behavior persisting for 3 days. Central anticholinergic syndrome was first suspected, but the long duration and exaggerated response by a patient not prone to anticholinergic toxicity suggest that a second agent may have enhanced the reaction.

DISCUSSION: The pharmacodynamic properties of linezolid make this drug a likely contributor to the marked, prolonged effects experienced by this patient. The Naranjo probability scale suggests a possible relationship between the reaction and the combination of diphenhydramine and linezolid.

CONCLUSIONS: Drug-induced delirium can occur with several drugs, including diphenhydramine. Linezolid has dopaminergic properties that may enhance the central nervous system effects of anticholinergics. Precautionary monitoring of mental status should be advised when concomitantly administering linezolid with drugs in this class.

Key Words: delirium, diphenhydramine, linezolid

Published Online, December 5, 2003. www.theannals.com, DOI 10.1345/aph.1D018


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L. Bergeron, M. Boule, and S. Perreault
Serotonin Toxicity Associated with Concomitant Use of Linezolid
Ann. Pharmacother., May 1, 2005; 39(5): 956 - 961.
[Abstract] [Full Text] [PDF]


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Copyright © 2004 by Harvey Whitney Books Company.