sertraline : Complexes, Storage & Clinical Research on Healthline.com

Apparently metabolized by multiple CYP isoenzymes, with none contributing more than 40% to overall metabolism. Inhibits CYP2D6 and 3A4, but less potent as an inhibitor than many other drugs.

Drugs Metabolized by Hepatic Microsomal Enzymes

Potential pharmacokinetic interactions (increased plasma concentrations of CYP2D6 substrates).

Clinically important pharmacokinetic interactions with substrates of 3A4 unlikely.

Drugs Affecting Hepatic Microsomal Enzymes

Clinically important pharmacokinetic interactions with inhibitors or inducers of CYP2D6 or 3A4 unlikely.

Drugs Affecting Hemostasis

Potential pharmacologic interaction (increased risk of bleeding) with concomitant use of drugs that affect hemostasis. Use with caution.

Protein-bound Drugs

Potential for displacement of sertraline or other protein-bound drugs from binding sites. Monitor patients for potential adverse effects.

Drugs Associated with Serotonin Syndrome

Potential pharmacologic (serotonin syndrome) interaction with serotonergic agents. Avoid such use, or use with caution. (See Serotonin Syndrome under Cautions.)

Specific Drugs

Drug	Interaction	Comments
Alcohol	Does not potentiate cognitive and motor effects of alcohol	Concomitant use not recommended
Antiarrhythmic agents (e.g., encainide, flecainide, propafenone)	Potential for increased plasma antiarrhythmic concentrations; may result in increased risk of serious, potentially fatal, adverse cardiac effects (e.g., cardiac arrhythmias)	Adjust dosages as needed
Antidepressants, tricyclic (TCAs) (e.g., desipramine, imipramine)	Decreased TCA metabolism	Monitor plasma TCA concentrations and adjust dosage as needed
Atenolol	β-adrenergic blocking activity not affected by sertraline
Benzodiazepines (e.g., diazepam)	Decreased diazepam clearance
Carbamazepine	Pharmacokinetic interaction unlikely
Cimetidine	Increased AUC, peak concentration, and elimination half-life of sertraline
Cisapride	Increased cisapride metabolism	Clinical importance unlikely
Clozapine	Increased plasma clozapine concentrations	Monitor closely; consider reduction in clozapine dosage
Digoxin	No change in digoxin pharmacokinetics
Disulfiram or other agents likely to produce disulfiram-like reactions (e.g., metronidazole)	Possible disulfiram reaction due to alcohol content in sertraline oral concentrate solution	Concomitant use with sertraline oral concentrate contraindicated
Fluoxetine	Potential for serotonin syndrome	Allow appropriate period of time to elapse between discontinuance of fluoxetine and initiation of sertraline and vice versa
5-HT₁ receptor agonists (“triptans”)	Potentially life-threatening serotonin syndrome	Observe carefully if used concomitantly, particularly during treatment initiation, dosage increases, or when another serotonergic agent is initiated
Isoniazid	Potential for serotonin syndrome
Linezolid	Possible serotonin syndrome	Use with caution
Lithium	Possible serotonin syndrome Pharmacokinetic interaction unlikely	Use with caution Monitor serum lithium concentrations; adjust dosage accordingly
MAO inhibitors (e.g., moclobemide [not commercially available in the US], selegiline)	Potentially fatal serotonin syndrome or NMS	Concomitant use contraindicated Allow at least 2 weeks to elapse between discontinuance of MAO inhibitor and initiation of sertraline and vice versa
NSAIAs (e.g., aspirin)	Increased risk of bleeding	Use with caution
Phenytoin	No change in phenytoin pharmacokinetics or pharmacodynamics observed in one study However, potential increase in plasma phenytoin concentrations and subsequent toxicity reported with sertraline and other SSRIs Decreased plasma sertraline concentrations reported during concurrent phenytoin therapy	Monitor plasma phenytoin concentrations and adjust phenytoin dosage as necessary, particularly in patients with multiple medical conditions and/or those receiving multiple medications concomitantly
Pimozide	Increased plasma pimozide concentrations; risk of QT prolongation	Concomitant use contraindicated
Propranolol	Pharmacokinetic interaction unlikely
Sibutramine	Possible serotonin syndrome	Use with caution
SSRIs and SNRIs	Possible serotonin syndrome	Avoid concomitant use
Thioridazine	Increased plasma thioridazine concentrations; risk of serious, potentially fatal, adverse cardiac effects (e.g., cardiac arrhythmias)	Concomitant use not recommended
Tolbutamide	Decreased tolbutamide clearance	Clinical importance unknown
Tramadol	Possible serotonin syndrome	Use with caution
Tryptophan and other serotonin precursors	Possible serotonin syndrome	Concomitant use not recommended
Valproic acid	Possible interaction not systematically evaluated	Monitor plasma valproate concentrations and adjust valproic acid dosage accordingly
Warfarin	Possible increased PT and risk of bleeding	Use with caution Monitor PT whenever sertraline is initiated or discontinued

Zoloft
ZOLOFT / 25 MG 25 mg	ZOLOFT / 50 MG 50 mg	ZOLOFT / 100 MG 100 mg

Drug Notebook

Generic Name: sertraline