Tedizolid differs from linezolid in pharmacogenomic significance because its metabolic pathway avoids the drug interaction responsible for serotonin syndrome. Tedizolid's reduced interaction risk compared to linezolid is because tedizolid is:

• A Predominantly renally excreted, limiting serotonergic intestinal accumulation
• B Metabolized by CYP3A4 rather than by MAO enzymes reducing systemic MAO burden
• C A phosphate prodrug that releases active drug only intracellularly, sparing enteric MAO
• D A weaker MAO-A inhibitor while linezolid is a potent reversible MAO-A/B inhibitor ✓

Explanation

Linezolid is a reversible, non-selective inhibitor of both MAO-A and MAO-B; MAO-A inhibition is the mechanism underlying serotonin syndrome risk when combined with serotonergic drugs. Tedizolid has markedly weaker MAO-A inhibitory activity, substantially reducing this serotonergic interaction risk, which makes it safer in patients receiving SSRIs or SNRIs. Both drugs are oxazolidinones acting on 23S rRNA. The phosphate prodrug nature of tedizolid affects its bioavailability and once-daily dosing but is not the primary reason for reduced MAO interaction.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.