Duke University Hospital Duke Raleigh Hospital Duke Regional Hospital

Usual Dose & Administration

Usual Adult Dose

600 mg q12h

Adjustment of Dose & Administration

Indication-Specific Adjustment

Non-TB Mycobacterium Infections: 600 mg daily.

Renal Adjustment

No adjustment in renal dysfunction

If applicable, administer dose after hemodialysis

Drug-Specific Information

IV to PO Conversion:

600 mg IV q12h = 600 mg PO q12h

Bioavailability: 100%

Toxicities

  1. Thrombocytopenia, neutropenia
  2. Serotonin syndrome in patients receiving serotonergic agents or methamphetamine abuse. Highest potential with methadone, meth, citalopram and escitalopram. Other medications that historically have been implicated in serotonin syndrome have been downgraded to low-to-moderate risk. (see attachment below)
  3. Optic and peripheral neuritis (more common with long term treatment)
  4. Lactic acidosis

 

 

 

Restricted Use

Use is unrestricted. DRH ID ASP consult is recommended. See restriction page for more information

ASP/ID Consult Exceptions:

1. patient with suspected or confrimmed MRSA pneumonia with failure to respond with 2-3 days of vancomycin therapy

2. Suspected necrotizing MRSA pneumonia requiring ICU admission.

3. Confirmed necrotizing MSSA pneumonia requiring ICU admission when linezolid is an adjunctive agent to the primary beta-lactam antibiotic.

Cost Index

$$$$$$ (51+)

General Notes

  1. Up to date cost information, click here
  2. IV antimicrobials outpatient (OPAT) dosing, click here
  3. Obesity dosing weight recommendations, click here
  4. Helpful drug-drug interaction check website here 
  5. When dosing guidance is provided it is important to note the following:

Fixed (ie non weight-based) doses in adults are historically based on a 70 kg patient. Specific disease states or individual patients may warrant dosages that differ from the above recommendations. Since product-specific criteria for dose adjustment based on creatinine clearance exist, consult product information regarding specific recommendations for dosage adjustment based on estimated creatinine clearance.