Selrotine Drug Interactions

Cytochrome P450 Effect: Substrate of CYP2B6 (minor), 2C9 (minor), 2C19 (major), 2D6 (major), 3A4 (minor); Inhibits CYP1A2 (weak), 2B6 (moderate), 2C8 (weak), 2C9 (weak), 2C19 (moderate), 2D6 (moderate), 3A4 (moderate).
Concomitant administration of Sertraline with other SSRIs or SNRIs potentially may result in Serotonin syndrome or NMS-like reactions and is therefore not recommended.
Sertraline should not be used with nonselective MAOIs (phenelzine, isocarboxazid) or other drugs with MAO inhibition (linezolid); fatal reactions have been reported. Wait 2 weeks after stopping a MAOI before starting Sertraline. Concurrent selegiline (a selective MAO-B inhibitor) has been associated with mania, hypertension, or serotonin syndrome (risk may be reduced relative to nonselective MAOIs).
Sertraline may increase serum concentrations of pimozide. Concomitant use of Sertraline and pimozide is contraindicated because of the low therapeutic index of pimozide and because the reported interaction between the 2 drugs occurred at a low dose of pimozide.
Sertraline may inhibit the metabolism of thioridazine or mesoridazine, resulting in increased plasma levels and increasing the risk of QT interval prolongation. This may lead to serious ventricular arrhythmias, such as torsade de pointes and sudden death. Do not use together. Wait at least 5 weeks after discontinuing Sertraline prior to starting thioridazine.
Sertraline may increase the levels/effects of amphetamines, selective beta-blockers, bupropion, selected benzodiazepines, calcium channel blockers, cisapride, cyclosporine, dextromethorphan, ergot alkaloids, fluoxetine, selected HMG-CoA reductase inhibitors, lidocaine, mesoridazine, mirtazapine, nateglinide, nefazodone, paroxetine, phenytoin, promethazine, propofol, risperidone, ritonavir, selegiline, sildenafil (and other PDE-5 inhibitors), tacrolimus, thioridazine, tricyclic antidepressants, venlafaxine, and other substrates of CYP2B6, 2D6 or 3A4.
Combined use of Sertraline and warfarin may increase the prothrombin time. In addition, prothrombin time should be monitored carefully whenever Sertraline therapy is initiated or discontinued in patients receiving anticoagulants.
The levels/effects of Sertraline may be increased by chlorpromazine, delavirdine, fluconazole, fluoxetine, fluvoxamine, gemfibrozil, isoniazid, miconazole, omeprazole, paroxetine, pergolide, quinidine, quinine, ritonavir, ropinirole, ticlopidine, and other CYP2C19 or 2D6 inhibitors.
Combined use of SSRIs and amphetamines, buspirone, meperidine, nefazodone, serotonin agonists (such as sumatriptan), sibutramine, other SSRIs/SNRIs, sympathomimetics, ritonavir, tramadol, and venlafaxine, may increase the risk of serotonin syndrome. Combined use of sumatriptan (and other serotonin agonists) may result in toxicity; weakness, hyperreflexia, and incoordination have been observed with sumatriptan and SSRIs. In addition, concurrent use may theoretically increase the risk of serotonin syndrome; includes sumatriptan, naratriptan, rizatriptan, and zolmitriptan.
In patients receiving lithium, plasma lithium concentrations should be monitored following initiation of Sertraline and lithium dosage should be adjusted accordingly. In addition, because of the potential risk of serotonin syndrome or NMS-like reactions, caution is advised during concurrent Sertraline and lithium use.
Risk of hyponatremia may increase with concurrent use of loop diuretics (bumetanide, furosemide, torsemide).
Concomitant use of Sertraline and NSAIDs, aspirin, or other drugs affecting coagulation has been associated with an increased risk of bleeding. Patients receiving Sertraline should be cautioned about the concomitant use of drugs that interfere with hemostasis.
The levels/effects of Sertraline may be decreased by aminoglutethimide, carbamazepine, phenytoin, rifampin, and other CYP2C19 inducers.
Sertraline may decrease the metabolism of tolbutamide; monitor for changes in glucose control.
Sertraline may decrease the levels/effects of CYP2D6 prodrug substrates (e.g. codeine, hydrocodone, oxycodone, tramadol).
Because SSRIs are highly bound to plasma protein, administration to a patient taking another drug that is highly protein-bound (e.g. warfarin, digoxin) may cause increased free concentrations of the other drug, potentially resulting in adverse events. Conversely, adverse effects could result from displacement of SSRIs by other highly bound drugs.
Combined use of Sertraline and St. John's wort (Hypericum perforatum) may cause increased sedative-hypnotic effects. Avoid concurrent use.