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| Interactions: | Alprazolam
Adverse Effect: An increased risk of psychomotor impairment and sedation Clinical Management: Caution is warranted if alprazolam and sertraline are to be coadministered. Monitor patients for signs of psychomotor impairment or excessive sedation. Alprazolam doses may need to be reduced.
Amitriptyline
Adverse Effect: elevated amitriptyline serum levels or possible serotonin syndrome (hypertension, hyperthermia, myoclonus, mental status changes) Clinical Management: The combined use of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) may result in the inhibition of the TCA metabolism.
Amoxapine
Adverse Effect: Modest elevation in amoxapine serum levels
Astemizole
Adverse Effect: cardiotoxicity (QT interval prolongation, torsades de pointes, cardiac arrest) Clinical Management: Concomitant use of astemizole and sertraline is not recommended.
Carbamazepine
Adverse Effect: Increased risk of carbamazepine toxicity (ataxia, nystagmus, diplopia, headache, vomiting, apnea, seizures, coma) Clinical Management: Due to the potential for elevated carbamazepine levels, patients should be closely followed for evidence of carbamazepine toxicity when sertraline is added to therapy.
Chlordiazepoxide
Adverse Effect: Elevated Chlordiazepoxide serum levels or possible serotonin syndrome (hypertension, hyperthermia, myoclonus, mental status changes) Clinical Management: The combined use of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) may result in the inhibition of the TCA metabolism. A few cases of serotonin syndrome have also been reported with concurrent TCA and SSRI therapy. Caution should be observed when drugs in these two classes are used together.
Cimetidine
Adverse Effect: Elevated sertraline serum concentrations and increased risk of adverse side effects Clinical Management: Closely follow patients for signs of sertraline toxicity (nausea, diarrhea, tremor, dizziness). Doses of sertraline may need to be reduced in patients receiving concomitant cimetidine.
Clomipramine
Adverse Effect: Modest elevations of clomipramine serum levels
Clozapine
Adverse Effect: Increased risk of clozapine toxicity (sedation, seizures, hypotension) Clinical Management: Monitor the therapeutic efficacy of clozapine and for any evidence of toxicity, particularly when the daily clozapine dose exceeds 300 mg or 3.5 mg/kg. Lower clozapine dosage may be required in some clinical situations.
Diazepam
Clinical Management: No special monitoring is required If signs of diazepam toxicity occur with concomitant therapy with sertraline, a lower diazepam dose should be considered.
Dothiepin
Adverse Effect: Modest elevations in dothiepin serum levels
Doxepin
Adverse Effect: Modest elevations in doxepin serum levels
Erythromycin
Adverse Effect: Increased risk of serotonin syndrome (hypertension, hyperthermia, myoclonus, mental status changes) Clinical Management: All patients receiving a serotonergic medication should be monitored for signs and symptoms of serotonin syndrome, including mental status changes and hypertension.
Fluphenazine
Adverse Effect: An increased risk of developing acute parkinsonism Clinical Management: Monitor patients receiving concurrent therapy with fluphenazine and sertraline for the development of drug-induced parkinsonism. Therapy with sertraline may need to be discontinued.
Imipramine
Modest elevations in imipramine serum levels
Lamotrigine
Adverse Effect: Increased risk of lamotrigine toxicity (fatigue, sedation, confusion, decreased cognition) Clinical Management: Caution should be exercised when combining sertraline and lamotrigine therapy. Lamotrigine blood levels should be closely monitored and dosages adjusted accordingly.
Lignocaine
Reduced hepatic metabolism
Metoclopramide - Antispas
Adverse Effect: Increased risk of developing extrapyramidal symptoms Clinical Management: Clinicians should be alerted to the possibility that patients may have an increased risk of experiencing extrapyramidal symptoms during coadministration of sertraline and metoclopramide. Close patient monitoring is warranted.
Mexiletine
Reduced hepatic metabolism
Moclobemide
Adverse Effect: Concomitant administration results in serious of adverse reactions # Clinical Management: Start Moclobemide therapy only after an interval of 2 weeks of stopping Sertraline
Nortriptyline
Adverse Effect: Modest elevations in nortriptyline serum levels
Phenytoin
Adverse Effect: Increased risk of phenytoin toxicity (ataxia, hyperreflexia, nystagmus, tremor) Clinical Management: Caution is warranted if phenytoin and sertraline are to be coadministered. Serum phenytoin concentrations should be monitored .Doses of phenytoin may need to be adjusted downward.
Propafenone
Adverse Effect: An increased risk of propafenone toxicity (cardiac arrhythmias) Clinical Management: Coadministration of these agents should be approached with caution. Monitor the EKG in patients receiving concurrent propafenone and sertraline. Doses of propafenone may need to be reduced.
Propranolol
Adverse Effect: Increased risk of chest pain Clinical Management: Monitor patients receiving propranolol and sertraline cotherapy for an increased incidence of chest pain. This effect may be more pronounced in patients with pre-existing coronary artery disease.
Rifampicin
Adverse Effect: Loss of sertraline efficacy Clinical Management: Monitor patients for sertraline efficacy and signs of selective serotonin reuptake inhibitor (SSRI) withdrawal syndrome. Doses of sertraline may need to be increased when rifampin is given concomitantly.
Selegiline
Adverse Effect: CNS toxicity or serotonin syndrome (hypertension, hyperthermia, myoclonus, mental status changes) Clinical Management: Concurrent use of sertraline and a MAO inhibitor is contraindicated.
Sumatriptan
Adverse Effect: An increased risk of weakness, hyperreflexia, and incoordination Clinical Management: Concomitant use is not recommended. However, if concurrent therapy is deemed to be necessary, closely monitor the patient for adverse effects (weakness, hyperreflexia, incoordination).
Terfenadine
Adverse Effect: cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest) Clinical Management: Concomitant use of terfenadine and sertraline should be avoided.
Theophylline
Adverse Effect: An increased risk of theophylline toxicity Clinical Management: Until more data are available, caution is warranted if theophylline and sertraline are to be coadministered. Follow patients for signs of theophylline toxicity (nausea, vomiting, palpitations, irritability).
Tolbutamide
Adverse Effect: A slight decrease in tolbutamide clearance
Tramadol
Adverse Effect: Increased risk of seizures Clinical Management: Caution should be used if tramadol is to be administered to patients receiving concomitant sertraline therapy. If possible, avoid this combination.
Trimipramine
Adverse Effect: Modest elevations in trimipramine serum levels
Warfarin
Adverse Effect: Increased risk of bleeding Clinical Management: In patients receiving warfarin and sertraline concurrently, particular attention to monitoring the prothrombin time ratio for stability of the anticoagulant response is indicated.
Zolpidem
Adverse Effect: Increased risk of hallucinations Clinical Management: Observe patients for hallucinatory activity. Alternative anti-insomnia medication may be warranted.
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