Sertraline

Concomitant use increases risk of serotonin syndrome. Sertraline is contraindicated in patients taking MAOIs.

Concomitant use increases risk of serotonin syndrome. Sertraline is contraindicated in patients taking MAOIs including linezolid.

Concomitant use increases risk of serotonin syndrome. Sertraline is contraindicated in patients taking intravenous methylene blue.

Concomitant use increases risk of serotonin syndrome. Sertraline is contraindicated in patients taking MAOIs.

Serious, sometimes fatal reactions reported when used concomitantly with MAO inhibitors.

Increased plasma concentrations may increase risk of QTc prolongation and ventricular arrhythmias. Concomitant use is contraindicated.

Concomitant use increases risk of serotonin syndrome. Sertraline is contraindicated in patients taking MAOIs.

Concomitant use increases risk of serotonin syndrome. Sertraline is contraindicated in patients taking MAOIs.

SSRI inhibits P450 2D6; caution advised in coadministration and when switching between classes.

Concomitant use increases risk of serotonin syndrome. Monitor patients for signs and symptoms, particularly during initiation and dosage increases.

Concurrent use may potentiate bleeding risk. Inform patients of increased bleeding risk.

Concomitant use increases risk of serotonin syndrome. Monitor patients for signs and symptoms, particularly during initiation and dosage increases.

SSRI that inhibits P450 2D6 and may increase clomipramine plasma levels, potentially causing toxicity.

Concurrent use may potentiate bleeding risk. Inform patients of increased bleeding risk.

SSRI that inhibits cytochrome P450 2D6, potentially increasing desipramine plasma concentrations.

SSRI concomitant use increases risk of serotonin syndrome. Monitor for signs and symptoms; discontinue if serotonin syndrome occurs.

Concomitant use of fentanyl with sertraline increases the risk of serotonin syndrome. Monitor patients for signs and symptoms.

Concurrent use may potentiate bleeding risk. Inform patients of increased bleeding risk.

Concomitant use increases risk of serotonin syndrome. Monitor patients for signs and symptoms, particularly during initiation and dosage increases.

SSRI that inhibits CYP2D6, increasing methadone plasma concentration and risk of overdose.

SSRI and CYP2D6 inhibitor that increases methadone plasma concentration, resulting in increased opioid effects and risk of fatal overdose.

SSRI that increases risk of serotonin syndrome with mirtazapine. Monitor for symptoms during initiation and dose increases.

SSRI that inhibits P450 2D6. Caution indicated in co-administration with nortriptyline; may require dose adjustment.

CYP2D6 inhibitor that increases propafenone plasma levels, potentially causing cardiac arrhythmias and proarrhythmia risk.

CYP2D6 inhibitor that increases propafenone plasma levels, potentially leading to cardiac arrhythmias and proarrhythmia risk.

Concomitant use increases risk of serotonin syndrome. Monitor patients for signs and symptoms, particularly during initiation and dosage increases.

Concomitant use of tramadol with sertraline increases the risk of serotonin syndrome. Monitor patients for signs and symptoms.

Concomitant use increases risk of serotonin syndrome. Monitor patients for signs and symptoms, particularly during initiation and dosage increases.

Concomitant use increases risk of serotonin syndrome. Monitor patients for signs and symptoms, particularly during initiation and dosage increases.

Concurrent use may potentiate bleeding risk. Monitor international normalized ratio carefully.

Sertraline inhibits P450 2D6; caution is indicated in co-administration with tricyclic antidepressants and in switching between classes.

CYP2D6 substrate; bupropion inhibits CYP2D6 and increases sertraline concentrations; consider dose reduction.

Bupropion inhibits CYP2D6 and can increase sertraline concentrations; consider dose reduction of sertraline.

CYP2D6 substrate antidepressant. Bupropion inhibits CYP2D6, increasing sertraline exposure. Dose reduction may be necessary.

CYP2D6 substrate. Bupropion inhibits CYP2D6 and can increase sertraline concentrations. Consider dose reduction of sertraline when used with bupropion.

CYP2D6-metabolized antidepressant. Bupropion inhibits CYP2D6 and can increase sertraline concentrations. Consider dose reduction.

Cimetidine increases sertraline mean AUC by 50%, Cmax by 24%, and half-life by 26%. Clinical significance is unknown but monitoring is recommended.

Other SSRIs increase risk of serotonin syndrome when used concomitantly with citalopram. Monitor for serotonin syndrome symptoms.

Other SSRIs increase risk of serotonin syndrome when used concomitantly with citalopram. Monitor for signs and symptoms of serotonin syndrome.

CYP2D6 or CYP3A4 inhibitor that can increase clozapine levels and lead to adverse reactions. Close monitoring and dose reduction may be necessary.

Sertraline decreases diazepam clearance by 32% and increases desmethyldiazepam Tmax. Clinical significance is unknown but monitoring may be warranted.

Weakness, hyperreflexia, and incoordination may occur rarely with coadministration of selective serotonin reuptake inhibitors.

SSRI that inhibits P450 2D6. Caution is indicated in coadministration with doxepin; may require dose adjustment and plasma level monitoring.

May increase phenytoin serum levels; monitoring of phenytoin levels recommended.

Gilteritinib may reduce the effects of sertraline. Avoid concomitant use unless essential for patient care.

CYP2D6 inhibitor that increases haloperidol plasma concentrations; monitor for increased adverse effects including QTc prolongation.

CYP2D6 inhibitor that increases haloperidol plasma concentrations, raising risk of adverse events including QTc prolongation.

SSRI that inhibits cytochrome P450 2D6 to variable extent. Caution indicated in coadministration with imipramine; monitoring of TCA plasma levels recommended.

SSRI that inhibits P450 2D6, increasing imipramine plasma concentrations. Caution and dose adjustment may be necessary during co-administration or switching.

Binds to dopamine transporter with high affinity and may interfere with Ioflupane I-123 imaging results.

Administration in patients stabilized on levothyroxine may result in increased levothyroxine levels. Monitor thyroid function.

Administration of sertraline in patients stabilized on levothyroxine may result in increased levothyroxine requirements.

Potent CYP2D6 inhibitor may increase plasma concentration of metoprolol, decreasing cardioselectivity.

Potent CYP2D6 inhibitor may increase metoprolol plasma concentration, decreasing cardioselectivity.

Sertraline inhibits P450 2D6, increasing perphenazine plasma concentrations. Close monitoring is essential and dose reduction may be necessary to avoid toxicity.

Sertraline inhibits cytochrome P450 2D6; caution is indicated in coadministration with amitriptyline and dose adjustments may be necessary.

May increase phenytoin serum levels; monitoring of phenytoin levels recommended.

May increase phenytoin serum levels; monitoring of phenytoin levels recommended.

Stiripentol is an inhibitor and inducer of CYP2B6; consider dose adjustment of sertraline when administered concomitantly with DIACOMIT.

In vitro data suggest possible drug interaction with triazolam. Caution recommended during coadministration.

Sertraline inhibits P450 2D6, potentially increasing trimipramine concentrations. Caution is indicated in co-administration or switching between these drugs.

Sertraline inhibits P450 2D6, potentially increasing trimipramine maleate concentrations. Caution is indicated in co-administration.

Increases exposure to zolpidem.

Increases exposure to zolpidem and may increase the pharmacodynamic effect of zolpidem.

In vitro studies suggest possible CYP3A inhibition, but in vivo study with steady state sertraline 50-150 mg/day did not reveal clinically significant pharmacokinetic changes.

Weak CYP3A4 inducer that does not affect clonazepam pharmacokinetics.

Additionally, no dosage adjustment is required for diazepam, lithium, atenolol, tolbutamide, digoxin, and drugs metabolized by CYP3A4, when sertraline hydrochloride is administered concomitantly [ See Clinical Pharmacology ( 12.3 ) ].

There was a 23% increase in T max for desmethyldiazepam in the sertraline group compared to a 20% decrease in the placebo group (p<0.03).

Sertraline may cause shifts in plasma concentrations due to competition for plasma protein binding, potentially resulting in adverse effects.

E xamples: Specific antipsychotics (e.g., ziprasidone, iloperidone, chlorpromazine, mesoridazine, droperidol); specific antibiotics (e.g., erythromycin, gatifloxacin, moxifloxacin, sparfloxacin); Class 1A antiarrhythmic medications (e.g., quinidine, procainamide); Class III antiarrhythmics (e.g., amiodarone, sotalol); and others (e.g., pentamidine, levomethadyl acetate, methadone, halofantrine, mefloquine, dolasetron mesylate, probucol or tacrolimus).

E xamples: Specific antipsychotics (e.g., ziprasidone, iloperidone, chlorpromazine, mesoridazine, droperidol); specific antibiotics (e.g., erythromycin, gatifloxacin, moxifloxacin, sparfloxacin); Class 1A antiarrhythmic medications (e.g., quinidine, procainamide); Class III antiarrhythmics (e.g., amiodarone, sotalol); and others (e.g., pentamidine, levomethadyl acetate, methadone, halofantrine, mefloquine, dolasetron mesylate, probucol or tacrolimus).

E xamples: Specific antipsychotics (e.g., ziprasidone, iloperidone, chlorpromazine, mesoridazine, droperidol); specific antibiotics (e.g., erythromycin, gatifloxacin, moxifloxacin, sparfloxacin); Class 1A antiarrhythmic medications (e.g., quinidine, procainamide); Class III antiarrhythmics (e.g., amiodarone, sotalol); and others (e.g., pentamidine, levomethadyl acetate, methadone, halofantrine, mefloquine, dolasetron mesylate, probucol or tacrolimus).

Examples: propafenone, flecainide, atomoxetine, desipramine, dextromethorphan, metoprolol, nebivolol, perphenazine, thioridazine, tolterodine, venlafaxine Phenytoin Clinical Impact: Phenytoin is a narrow therapeutic index drug.

E xamples: Specific antipsychotics (e.g., ziprasidone, iloperidone, chlorpromazine, mesoridazine, droperidol); specific antibiotics (e.g., erythromycin, gatifloxacin, moxifloxacin, sparfloxacin); Class 1A antiarrhythmic medications (e.g., quinidine, procainamide); Class III antiarrhythmics (e.g., amiodarone, sotalol); and others (e.g., pentamidine, levomethadyl acetate, methadone, halofantrine, mefloquine, dolasetron mesylate, probucol or tacrolimus).

E xamples: Specific antipsychotics (e.g., ziprasidone, iloperidone, chlorpromazine, mesoridazine, droperidol); specific antibiotics (e.g., erythromycin, gatifloxacin, moxifloxacin, sparfloxacin); Class 1A antiarrhythmic medications (e.g., quinidine, procainamide); Class III antiarrhythmics (e.g., amiodarone, sotalol); and others (e.g., pentamidine, levomethadyl acetate, methadone, halofantrine, mefloquine, dolasetron mesylate, probucol or tacrolimus).

Additionally, no dosage adjustment is required for diazepam, lithium, atenolol, tolbutamide, digoxin, and drugs metabolized by CYP3A4, when sertraline hydrochloride is administered concomitantly [ See Clinical Pharmacology ( 12.3 ) ].