sertraline (Rx)

Major depressive disorder

Indicated for major depressive disorder (MDD)

Tablets

• Initial dose: 50 mg PO qDay
• May increase by 25 mg at weekly intervals; not to exceed 200 mg qDay

Capsules

• Do not use to initiate treatment; only available as 150-mg or 200-mg doses
• Use another sertraline HCl product for initial dosage, titration, and dosages below 150 mg qDay
• Refer to prescribing information of other sertraline HCl products for the recommended dosage for those products
• May initiate capsules in patients receiving 100 mg or 125 mg of another sertraline HCl product for at least 1 week
• Recommended dosage: 150 mg or 200 mg PO qDay; not to exceed 200 mg qDay

Obsessive-Compulsive Disorder

Indicated for obsessive-compulsive disorder (OCD)

Tablets

• Initial dose: 50 mg PO qDay
• May increase by 25 mg at weekly intervals; not to exceed 200 mg qDay

Capsules

• Do not use to initiate treatment; only available as 150-mg or 200-mg doses
• Use another sertraline HCl product for initial dosage, titration, and dosages below 150 mg qDay
• Refer to prescribing information of other sertraline HCl products for the recommended dosage for those products
• May initiate capsules in patients receiving 100 mg or 125 mg of another sertraline HCl product for at least 1 week
• Recommended dosage: 150 mg or 200 mg PO qDay; not to exceed 200 mg qDay

Panic Disorder

Tablets only

Indicated for panic disorder (PD)

Initial: 25 mg PO qDay

May increase by 25 mg at weekly intervals; not to exceed 200 mg qDay

Posttraumatic Stress Disorder

Tablets only

Indicated posttraumatic stress disorder (PTSD)

Initial: 25 mg PO qDay

May increase by 25 mg at weekly intervals; not to exceed 200 mg qDay

Social Anxiety Disorder

Tablets only

Indicated for social anxiety disorder (SAD)

Initial: 25 mg PO qDay

May increase by 25 mg at weekly intervals; not to exceed 200 mg qDay

Premenstrual Dysphoric Disorder

Tablets only

Indicated for premenstrual dysphoric disorder (PMDD)

Continuous dosing

• Initial: 50 mg per day continuously (every day throughout the menstrual cycle)
• May increase by 50 mg per menstrual cycle to up to 150 mg per day if necessary

Intermittent dosing

• Initial: 50 mg per day intermittently (only during the luteal phase of the menstrual cycle, ie, starting daily dosage 14 days before the anticipated onset of menstruation and continuing through the onset of menses)
• Repeat intermittent dosing with each new cycle
• May increase to a maximum 100 mg per day during the next menstrual cycle
• Subsequent cycles: 50 mg/day during the first 3 days of dosing followed by 100 mg/day during the remaining days in the dosing cycle

Dosage Modifications

Renal impairment

• All severities (eGFR 15-89 mL/min/1.73 m²): No dosage adjustment necessary
• Sertraline exposure does not appear to be affected by renal impairment

Hepatic impairment

Capsules: Dosage adjustments are not possible with available dosage strengths

Tablets

• Mild (Child Pugh scores 5 or 6): Reduce starting and therapeutic range by half the recommended daily dosage; dosage adjustments are not possible with capsules
• Moderate-to-severe (Child Pugh scores 7-15): Not recommended

Dosing Considerations

Before initiating treatment

• Before initiating treatment, screen for personal or family history of bipolar disorder, mania, or hypomania

Switching to or from a monoamine oxidase inhibitor (MAOI)

• When switching to or from a MAOI antidepressant, at least 14 days must elapse between discontinuing MAOI antidepressant and initiating sertraline
• Additionally, at least 14 days must elapse after stopping sertraline capsules before starting an MAOI antidepressant

Discontinuation of sertraline HCl capsules

• Abrupt discontinuation may result in adverse effects including nausea, sweating, dysphoric mood, irritability, agitation, dizziness, sensory disturbances (eg, paresthesia, tremor, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures
• Gradually taper dose over at least several weeks to limit possibilities of withdrawal symptoms and detection of re-emerging symptoms
• Consider the half-life of antidepressant when tapering; those with a shorter half-life may require longer and more conservative dose reductions

• Capsules only

  • Given that dosage strengths lower than 150 mg are not available, gradual dosage reduction will require the use of another sertraline HCl product

Obsessive-Compulsive Disorder

Indicated for obsessive-compulsive disorder (OCD) in adults and children aged ≥6 years

<6 years: Safety and efficacy not established

Tablets

• 6-12 years: 25 mg PO qDay initially
• 12-17 years: 50 mg PO qDay initially
• May increase by 50 mg qDay at weekly intervals, not to exceed 200 mg qDay; give qHS if somnolence experienced

Capsules

• Do not use to initiate treatment; only available as 150-mg or 200-mg doses
• Use another sertraline HCl product for initial dosage, titration, and dosages below 150 mg qDay
• Refer to prescribing information of other sertraline HCl products for the recommended dosage for those products
• May initiate capsules in patients receiving 100 mg or 125 mg of another sertraline HCl product for at least 1 week
• Recommended dosage: 150 mg or 200 mg PO qDay; not to exceed 200 mg qDay

Dosage Modifications

Renal impairment

• All severities (eGFR 15-89 mL/min/1.73 m²): No dosage adjustment necessary
• Sertraline exposure does not appear to be affected by renal impairment

Hepatic impairment

Capsules: Dosage adjustments are not possible with available dosage strengths

Tablets

• Mild (Child Pugh scores 5 or 6): Reduce starting and therapeutic range by half the recommended daily dosage; dosage adjustments are not possible with capsules
• Moderate-to-severe (Child Pugh scores 7-15): Not recommended

Dosing Considerations

Before initiating treatment

• Before initiating treatment, screen for personal or family history of bipolar disorder, mania, or hypomania

Switching to or from a monoamine oxidase inhibitor (MAOI)

• When switching to or from a MAOI antidepressant, at least 14 days must elapse between discontinuing MAOI antidepressant and initiating sertraline
• Additionally, at least 14 days must elapse after stopping sertraline capsules before starting an MAOI antidepressant

Discontinuation of sertraline HCl capsules

• Abrupt discontinuation may result in adverse effects including nausea, sweating, dysphoric mood, irritability, agitation, dizziness, sensory disturbances (eg, paresthesia, tremor, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures
• Gradually taper dose over at least several weeks to limit possibilities of withdrawal symptoms and detection of re-emerging symptoms
• Consider the half-life of antidepressant when tapering; those with a shorter half-life may require longer and more conservative dose reductions

• Capsules only

  • Given that dosage strengths lower than 150 mg are not available, gradual dosage reduction will require the use of another sertraline HCl product

The elderly are prone to SSRI/SNRI-induced hyponatremia; monitor closely

Major Depressive Disorder

25 mg PO qDay initially; may increase by 25 mg every 2-3 days; not to exceed 200 mg qDay

Alzheimer dementia related depression: Start at 12.5 mg/day and titrate every 1-2 weeks to response; not to exceed 150-200 mg

Dosage Modifications

Renal impairment: Dose adjustment not necessary

Mild hepatic impairment (Child-Pugh 5-6): Decrease recommended starting dose and therapeutic dose by 50%

Moderate-to-severe hepatic impairment (Child-Pugh 7-15): Not recommended; sertraline is extensively metabolized, and the effects in patients with moderate and severe hepatic impairment have not been studied

Contraindicated (11)

• eliglustat

  sertraline increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.

• flibanserin

  sertraline will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration of flibanserin with moderate or strong CYP3A4 inhibitors is contraindicated. Severe hypotension or syncope can occur.

• isocarboxazid

  isocarboxazid and sertraline both increase serotonin levels. Contraindicated.

• lomitapide

  sertraline increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Increases lomitapide levels several folds.

• lonafarnib

  sertraline will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lonafarnib is a sensitive CYP3A4 substrate. Coadministration with strong or moderate CYP3A4 inhibitors is contraindicated.

• phenelzine

  phenelzine and sertraline both increase serotonin levels. Contraindicated.

• pimozide

  sertraline increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of prolonged QTc interval.

• procarbazine

  procarbazine and sertraline both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

• selegiline

  selegiline and sertraline both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with a serotonergic drug.

• thioridazine

  sertraline increases levels of thioridazine by decreasing metabolism. Contraindicated. Risk of long QT syndrome.

• tranylcypromine

  tranylcypromine and sertraline both increase serotonin levels. Contraindicated.

Serious - Use Alternative (105)

• alfentanil

  alfentanil, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• amisulpride

  amisulpride and sertraline both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• amitriptyline

  sertraline and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• amoxapine

  sertraline and amoxapine both increase serotonin levels. Avoid or Use Alternate Drug.

• apalutamide

  apalutamide will decrease the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP2C19 inducer, with drugs that are CYP2C19 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered.

• artemether

  artemether and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• avapritinib

  sertraline will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of avapritinib with moderate CYP3A4 inhibitors. If unable to avoid, reduce avapritinib starting dose. See drug monograph Dosage Modifications.

• axitinib

  sertraline increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid coadministration with moderate CYP3A4 inhibitors, monitor closely and reduce dose if necessary .

• bosutinib

  sertraline increases levels of bosutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• buspirone

  sertraline and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.

• ceritinib

  ceritinib and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• citalopram

  citalopram and sertraline both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
  
  citalopram and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin

  clarithromycin and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• clomipramine

  sertraline and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• cobimetinib

  sertraline will increase the level or effect of cobimetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If concurrent short term (14 days or less) use of moderate CYP3A inhibitors is unavoidable for patients who are taking cobimetinib 60 mg, reduce the cobimetinib dose to 20 mg. After discontinuation of a moderate CYP3A inhibitor, resume cobimetinib 60 mg. Use an alternative to a moderate CYP3A inhibitor in patients who are taking a reduced dose of cobimetinib (40 or 20 mg daily).

• crizotinib

  crizotinib and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• cyclobenzaprine

  sertraline and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

• dacomitinib

  dacomitinib will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• desflurane

  desflurane and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• desipramine

  sertraline and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  desipramine and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• desvenlafaxine

  sertraline and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• dextromethorphan

  sertraline and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.

• dofetilide

  dofetilide increases toxicity of sertraline by QTc interval. Avoid or Use Alternate Drug.

• dolasetron

  dolasetron, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• dosulepin

  sertraline and dosulepin both increase serotonin levels. Avoid or Use Alternate Drug.

• doxepin

  sertraline and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.
  
  doxepin and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• duloxetine

  sertraline will increase the level or effect of duloxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
  
  duloxetine and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.

• eliglustat

  sertraline increases levels of eliglustat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Moderate CYP3A4 inhibitors are not recommended with eliglustat poor or intermediate metabolizers; reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive metabolizers .

• encorafenib

  encorafenib and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• entrectinib

  sertraline will increase the level or effect of entrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of moderate CYP3A4 inhibitors with entrectinib, a CYP3A4 substrate. If coadministration unavoidable, reduce dose to 200 mg/day for patients aged 12 y or older with BSA >1.50m2. Resume previous entrectinib dose after discontinuing moderate CYP3A inhibitor for 3-5 elimination half-lives.
  
  entrectinib and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• eribulin

  eribulin and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• escitalopram

  escitalopram and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.
  
  escitalopram increases toxicity of sertraline by QTc interval. Avoid or Use Alternate Drug.

• fedratinib

  sertraline will increase the level or effect of fedratinib by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of fedratinib (a CYP3A4 and CYP2C19 substrate) with dual CYP3A4 and CYP2C19 inhibitor. Effect of coadministration of a dual CYP3A4 and CYP2C19 inhibitor with fedratinib has not been studied.

• fentanyl

  sertraline will increase the level or effect of fentanyl by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.
  
  fentanyl, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fentanyl intranasal

  sertraline will increase the level or effect of fentanyl intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.
  
  fentanyl intranasal, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fentanyl transdermal

  sertraline will increase the level or effect of fentanyl transdermal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.
  
  fentanyl transdermal, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fentanyl transmucosal

  sertraline will increase the level or effect of fentanyl transmucosal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.
  
  fentanyl transmucosal, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• fexinidazole

  fexinidazole and sertraline both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

• fluoxetine

  sertraline will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
  
  fluoxetine and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.

• fluvoxamine

  fluvoxamine and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.

• gilteritinib

  gilteritinib will decrease the level or effect of sertraline by Other (see comment). Avoid or Use Alternate Drug. Coadministration of gilteritinib with drugs that inhibit 5HT2B or sigma nonspecific receptors. Avoid use of these drugs with gilteritinib unless coadministration is necessary.

• givosiran

  givosiran will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• granisetron

  granisetron, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• hydromorphone

  hydromorphone, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• hydroxychloroquine sulfate

  hydroxychloroquine sulfate and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• ibrutinib

  sertraline increases levels of ibrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration with moderate CYP3A4 inhibitors, reduce ibrutinib dose to 280 mg qDay (B-cell malignancies) or 420 mg qDay (graft versus host disease). After CYP3A inhibitor discontinuation, resume previous dose of ibrutinib.

• imipramine

  sertraline and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• infigratinib

  sertraline will increase the level or effect of infigratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• irinotecan

  sertraline will increase the level or effect of irinotecan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• irinotecan liposomal

  sertraline will increase the level or effect of irinotecan liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• ivabradine

  sertraline will increase the level or effect of ivabradine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of ivabradine with moderate CYP3A4 inhibitors.

• ivosidenib

  ivosidenib and sertraline both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

• lefamulin

  lefamulin and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• lemborexant

  sertraline will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of lemborexant with moderate or strong CYP3A inhibitors.

• levomilnacipran

  levomilnacipran and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.

• linezolid

  linezolid and sertraline both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

• lofepramine

  sertraline and lofepramine both increase serotonin levels. Avoid or Use Alternate Drug.

• lorcaserin

  sertraline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• lurbinectedin

  sertraline will increase the level or effect of lurbinectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• macimorelin

  macimorelin and sertraline both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• maprotiline

  sertraline and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• mefloquine

  mefloquine increases toxicity of sertraline by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

• meperidine

  sertraline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  meperidine, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• methylene blue

  methylene blue and sertraline both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

• metoclopramide

  metoclopramide and sertraline both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

• metoclopramide intranasal

  sertraline, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

• midazolam intranasal

  sertraline will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of moderate CYP3A4 inhibitors with midazolam intranasal causes higher midazolam systemic exposure, which may prolong sedation.

• milnacipran

  milnacipran and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.

• mobocertinib

  sertraline will increase the level or effect of mobocertinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use of moderate CYP3A4 inhibitor unavoidable, reduce mobocertinib dose by ~50% (eg, 160 to 80 mg); closely monitor QTc interval.
  
  mobocertinib and sertraline both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• morphine

  morphine, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• naloxegol

  sertraline will increase the level or effect of naloxegol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministation of naloxegol with moderate CYP3A4 inhibitors is unavoidable, reduce naloxegol dose to 12.5 mg qDay

• nefazodone

  nefazodone and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.

• neratinib

  sertraline will increase the level or effect of neratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of neratinib with strong/moderate CYP3A4 inhibitors.

• netupitant/palonosetron

  netupitant/palonosetron, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• nortriptyline

  sertraline and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• olaparib

  sertraline will increase the level or effect of olaparib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with moderate CYP3A inhibitors cannot be avoided, reduce olaparib dose to 200 mg (capsule) or 150 mg (tablet) PO BID. Do not substitute tablets with capsules.

• ondansetron

  ondansetron and sertraline both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
  
  ondansetron, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• ozanimod

  ozanimod increases toxicity of sertraline by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• palonosetron

  palonosetron, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• paroxetine

  sertraline will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
  
  paroxetine and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.

• pemigatinib

  sertraline will increase the level or effect of pemigatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors is unavoidable, reduce pemigatinib dose (refer to drug monograph dosage modifications). After discontinuing the CYP3A4 inhibitor for 3 elimination half-lives, may resume previous pemigatinib dose.

• pexidartinib

  sertraline will increase the level or effect of pexidartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors is unavoidable, reduce pexidartinib dose (refer to drug monograph dosage modifications). After discontinuing the CYP3A4 inhibitor for 3 elimination half-lives, may resume previous pexidartinib dose.

• phentermine

  sertraline, phentermine. Either increases toxicity of the other by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of serotonin syndrome.

• protriptyline

  sertraline and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• rasagiline

  rasagiline and sertraline both increase serotonin levels. Avoid or Use Alternate Drug. Severe CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Avoid combination within 14 days of MAOI use.

• remifentanil

  remifentanil, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• ribociclib

  ribociclib increases toxicity of sertraline by QTc interval. Avoid or Use Alternate Drug.

• selegiline transdermal

  selegiline transdermal and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.

• selinexor

  selinexor, sertraline. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• selumetinib

  sertraline will increase the level or effect of selumetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors cannot be avoided, reduce selumetinib dosage (refer to selumetinib monograph for further information). After discontinuation of the strong or moderate CYP3A4 inhibitor for 3 elimination half-lives, resume selumetinib dose that was taken before initiating the inhibitor.

• siponimod

  sertraline will increase the level or effect of siponimod by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of siponimod with a moderate or strong CYP3A4 inhibitor PLUS a moderate or strong CYP2C9 inhibitor is not recommended.

• St John's Wort

  sertraline and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.

• sufentanil

  sufentanil, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• tazemetostat

  sertraline will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of tazemetostat with moderate CYP3A4 inhibitors. If coadministration is unavoidable, reduce tazemetostat current dose (see drug monograph Dosage Modifications).

• tedizolid

  tedizolid, sertraline. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.

• thioridazine

  sertraline will increase the level or effect of thioridazine by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.

• trazodone

  sertraline and trazodone both increase serotonin levels. Avoid or Use Alternate Drug.

• trimipramine

  sertraline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• umeclidinium bromide/vilanterol inhaled

  sertraline increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• venetoclax

  sertraline will increase the level or effect of venetoclax by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If a moderate CYP3A inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.

• venlafaxine

  sertraline and venlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• vilanterol/fluticasone furoate inhaled

  sertraline increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vilazodone

  sertraline, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .

• vortioxetine

  sertraline, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

• warfarin

  sertraline increases levels of warfarin by decreasing metabolism. Avoid or Use Alternate Drug.

Monitor Closely (212)

• 5-HTP

  sertraline and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.

• abiraterone

  abiraterone increases levels of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

• acalabrutinib

  sertraline will increase the level or effect of acalabrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease acalabrutinib dose to 100 mg once daily if coadministered with a moderate CYP3A inhibitor.

• aceclofenac

  sertraline, aceclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• acemetacin

  sertraline, acemetacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• albuterol

  albuterol and sertraline both increase QTc interval. Use Caution/Monitor.

• alfuzosin

  sertraline and alfuzosin both increase QTc interval. Use Caution/Monitor.
  
  alfuzosin and sertraline both increase QTc interval. Use Caution/Monitor.

• almotriptan

  almotriptan and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.

• amifampridine

  sertraline increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• apixaban

  sertraline and apixaban both increase anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

• apomorphine

  apomorphine and sertraline both increase QTc interval. Use Caution/Monitor.

• arformoterol

  arformoterol and sertraline both increase QTc interval. Use Caution/Monitor.

• aripiprazole

  sertraline will increase the level or effect of aripiprazole by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  aripiprazole and sertraline both increase QTc interval. Use Caution/Monitor.

• aspirin

  sertraline, aspirin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• aspirin rectal

  sertraline, aspirin rectal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• aspirin/citric acid/sodium bicarbonate

  sertraline, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• atazanavir

  atazanavir increases levels of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• atogepant

  sertraline will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• atomoxetine

  sertraline will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  atomoxetine and sertraline both increase QTc interval. Use Caution/Monitor.

• avanafil

  sertraline will increase the level or effect of avanafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inhibitors may reduce avanafil clearance increasing systemic exposure to avanafil; increased levels may result in increased associated adverse events; the maximum recommended dose of STENDRA is 50 mg, not to exceed once every 24 hours for patients taking concomitant moderate CYP3A4 inhibitors

• bedaquiline

  sertraline and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• benzhydrocodone/acetaminophen

  sertraline will increase the level or effect of benzhydrocodone/acetaminophen by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Hydromorphone (<3% of the circulating parent hydrocodone [benzhydrocodone is prodrug of hydrocodone]) is mainly formed by CYP2D6 mediated O-demethylation of hydrocodone. Hydromorphone may contribute to the total analgesic effect of hydrocodone.
  
  benzhydrocodone/acetaminophen, sertraline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• betrixaban

  sertraline, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

• brexpiprazole

  sertraline will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP2D6 inhibitor PLUS a strong/moderate CYP3A4 inhibitor.
  
  sertraline will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP3A4 inhibitor PLUS a strong/moderate CYP2D6 inhibitor.

• buprenorphine subdermal implant

  sertraline will increase the level or effect of buprenorphine subdermal implant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor patients already on buprenorphine subdermal implant who require newly-initiated treatment with CYP3A4 inhibitors for signs and symptoms of overmedication. If the dose of the concomitant CYP3A4 inhibitor cannot be reduced or discontinued, implant removal may be necessary and the patient should then be treated with a buprenorphine dosage form that permits dose adjustments. If a CYP3A4 inhibitor is discontinued in a patient who has been stabilized on buprenorphine, monitor the patient for withdrawal.
  
  sertraline, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

• buprenorphine, long-acting injection

  sertraline will increase the level or effect of buprenorphine, long-acting injection by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Patients who transfer to buprenorphine long-acting injection from transmucosal buprenorphine coadministered with CYP3A4 inhibitors should be monitored to ensure buprenorphine plasma levels are adequate. Within 2 weeks, if signs and symptoms of buprenorphine toxicity or overdose occur and the concomitant CYP3A4 inhibitor cannot be reduced or discontinued, transition the patient back to a buprenorphine formulation that permits dose adjustments.
  
  sertraline, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.

• bupropion

  sertraline increases levels of bupropion by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor. Sertraline may inhibit hydroxylation of bupropion to its major active metabolite hydroxybupropion.
  
  bupropion will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• cabozantinib

  sertraline will increase the level or effect of cabozantinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cannabidiol

  sertraline will increase the level or effect of cannabidiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Consider reducing the cannabidiol dose when coadministered with a moderate CYP3A4 inhibitor.
  
  cannabidiol will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with cannabidiol.

• carvedilol

  sertraline will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• celecoxib

  sertraline, celecoxib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• cenobamate

  cenobamate will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.
  
  cenobamate, sertraline. Either increases effects of the other by sedation. Use Caution/Monitor.

• choline magnesium trisalicylate

  sertraline, choline magnesium trisalicylate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• cilostazol

  sertraline increases toxicity of cilostazol by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider decreasing cilostazol dose; moderate CYP2C19 inhibitors may increase serum levels of 3,4-dehydrocilostazol (active metabolite).

• clobazam

  clobazam will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.

• clomipramine

  sertraline will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.

• clonidine

  clonidine, sertraline. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.

• clopidogrel

  sertraline increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SSRIs affect platelet activation; coadministration of SSRIs with clopidogrel may increase the risk of bleeding.

• clozapine

  sertraline increases levels of clozapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Plasma levels of clozapine may be increased, resulting in increased pharmacologic and toxic effects. Adjust clozapine dose as needed when initiating or discontinuing certain SSRIs. .
  
  clozapine and sertraline both increase QTc interval. Use Caution/Monitor.

• cobicistat

  cobicistat will increase the level or effect of sertraline by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with SSRIs and cobicistat.

• cocaine

  sertraline and cocaine both increase serotonin levels. Modify Therapy/Monitor Closely.

• codeine

  sertraline decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• cyproheptadine

  cyproheptadine decreases effects of sertraline by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SSRIs.

• daridorexant

  sertraline will increase the level or effect of daridorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Daridorexant dose should not exceed 25 mg per night when coadministered with moderate CYP3A4 inhibitors.
  
  sertraline and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darunavir

  darunavir decreases levels of sertraline by Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Carefully titrate SSRI dose based on clinical assessment of antidepressant response.
  
  darunavir will increase the level or effect of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with SSRIs, TCAs, or trazodone may require dose titration of antidepressant to desired effect (eg, using the lowest feasible initial or maintenance dose). Monitor for antidepressant response.

• dasatinib

  dasatinib and sertraline both increase QTc interval. Use Caution/Monitor.

• defibrotide

  defibrotide increases effects of sertraline by Other (see comment). Use Caution/Monitor. Comment: Defibrotide may enhance effects of platelet inhibitors.

• deflazacort

  sertraline will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

• degarelix

  degarelix and sertraline both increase QTc interval. Use Caution/Monitor.

• desipramine

  sertraline will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.

• deutetrabenazine

  deutetrabenazine and sertraline both increase QTc interval. Use Caution/Monitor.

• dexfenfluramine

  sertraline and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dextroamphetamine

  sertraline will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  sertraline and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• diazepam intranasal

  sertraline will increase the level or effect of diazepam intranasal by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Strong or moderate CYP2C19 inhibitors may decrease rate of diazepam elimination, thereby increasing adverse reactions to diazepam.
  
  sertraline will increase the level or effect of diazepam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong or moderate CYP3A4 inhibitors may decrease rate of diazepam elimination, thereby increasing adverse reactions to diazepam.
  
  diazepam intranasal, sertraline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

• diclofenac

  sertraline, diclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• difelikefalin

  difelikefalin and sertraline both increase sedation. Use Caution/Monitor.

• diflunisal

  sertraline, diflunisal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• dihydroergotamine

  sertraline and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dihydroergotamine intranasal

  sertraline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.

• dolasetron

  dolasetron and sertraline both increase QTc interval. Use Caution/Monitor.

• donepezil

  donepezil and sertraline both increase QTc interval. Use Caution/Monitor.

• edoxaban

  sertraline increases effects of edoxaban by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• efavirenz

  efavirenz will decrease the level or effect of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  efavirenz and sertraline both increase QTc interval. Use Caution/Monitor.

• eletriptan

  eletriptan and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.

• eliglustat

  eliglustat increases levels of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• ergotamine

  sertraline and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eslicarbazepine acetate

  eslicarbazepine acetate will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• etodolac

  sertraline, etodolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• fedratinib

  fedratinib will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2C19 substrates as necessary.
  
  fedratinib will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

• fenbufen

  sertraline, fenbufen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• fenfluramine

  sertraline and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  fenfluramine, sertraline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

• fenoprofen

  sertraline, fenoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• fexinidazole

  fexinidazole will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• finerenone

  sertraline will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or moderate CYP3A4 inhibitors. Adjust finererone dosage as needed.

• fingolimod

  fingolimod and sertraline both increase QTc interval. Use Caution/Monitor.

• fish oil triglycerides

  fish oil triglycerides will increase the level or effect of sertraline by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

• fluoxetine

  sertraline and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.

• flurbiprofen

  sertraline, flurbiprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• fondaparinux

  sertraline increases effects of fondaparinux by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• fosamprenavir

  fosamprenavir increases levels of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• fosphenytoin

  sertraline increases levels of fosphenytoin by decreasing metabolism. Use Caution/Monitor.

• fostemsavir

  sertraline and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

• frovatriptan

  frovatriptan and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.

• gabapentin

  gabapentin, sertraline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin enacarbil

  gabapentin enacarbil, sertraline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gemifloxacin

  gemifloxacin and sertraline both increase QTc interval. Use Caution/Monitor.

• grapefruit

  grapefruit will increase the level or effect of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• green tea

  green tea, sertraline. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding.

• guanfacine

  sertraline will increase the level or effect of guanfacine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Strong or moderate CYP3A4 inhibitors significantly increase guanfacine plasma concentrations. FDA-approved labeling for extended-release (ER) guanfacine recommends that, if coadministered, the guanfacine dosage should be decreased to half of the recommended dose. Specific recommendations for immediate-release (IR) guanfacine are not available.

• haloperidol

  sertraline will increase the level or effect of haloperidol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  haloperidol and sertraline both increase QTc interval. Use Caution/Monitor.

• hydrocodone

  sertraline will increase the level or effect of hydrocodone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Hydromorphone (<3% of the circulating parent hydrocodone) is mainly formed by CYP2D6 mediated O-demethylation of hydrocodone. Hydromorphone may contribute to the total analgesic effect of hydrocodone.
  
  hydrocodone, sertraline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• hydromorphone

  sertraline will increase the level or effect of hydromorphone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• ibrutinib

  ibrutinib will increase the level or effect of sertraline by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

• ibuprofen

  sertraline, ibuprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ibuprofen IV

  sertraline, ibuprofen IV. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ifosfamide

  sertraline decreases effects of ifosfamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration .

• iloperidone

  sertraline will increase the level or effect of iloperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• imipramine

  sertraline will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.

• indinavir

  indinavir increases levels of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• indomethacin

  sertraline, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ioflupane I 123

  sertraline decreases effects of ioflupane I 123 by receptor binding competition. Use Caution/Monitor. Drugs that bind to dopamine transporter receptor with high affinity may interfere with the image following ioflupane I 123 administration.

• isavuconazonium sulfate

  sertraline will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• isoniazid

  sertraline and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.

• ivacaftor

  sertraline will increase the level or effect of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce ivacaftor dose if coadministered with moderate CYP3A4 inhibitors. See specific ivacaftor-containing product for precise dosage modification.

• ivosidenib

  sertraline will increase the level or effect of ivosidenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with moderate CYP3A4 inhibitors may increase ivosidenib plasma concentrations, thus increasing the risk of QTc prolongation. Monitor for increased risk of QTc interval prolongation.

• ketoprofen

  sertraline, ketoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ketorolac

  sertraline, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ketorolac intranasal

  sertraline, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• L-tryptophan

  sertraline and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

• lamotrigine

  lamotrigine increases toxicity of sertraline by unspecified interaction mechanism. Modify Therapy/Monitor Closely. CNS depressants may increase the toxic effects of selective serotonin reuptake inhibitors; psychomotor impairment may be enhanced.

• lasmiditan

  lasmiditan, sertraline. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
  
  sertraline increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.

• lefamulin

  sertraline will increase the level or effect of lefamulin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for adverse effects if lefamulin is coadministered with moderate CYP3A inhibitors.

• lemborexant

  lemborexant, sertraline. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• letermovir

  letermovir increases levels of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levamlodipine

  sertraline will increase the level or effect of levamlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with moderate and strong CYP3A inhibitors results in increased systemic exposure to amlodipine and may require dose reduction. Monitor for symptoms of hypotension and edema when amlodipine is coadministered with CYP3A inhibitors to determine the need for dose adjustment.

• lisdexamfetamine

  sertraline, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s).

• lithium

  sertraline and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

• lofepramine

  sertraline will increase the level or effect of lofepramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• lopinavir

  lopinavir increases levels of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity.

• lorcaserin

  lorcaserin will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• lornoxicam

  sertraline, lornoxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• lsd

  sertraline and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.

• lumacaftor/ivacaftor

  lumacaftor/ivacaftor, sertraline. affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C19 substrates. .
  
  lumacaftor/ivacaftor will decrease the level or effect of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. A higher dose of sertraline may be required to obtain desired therapeutic effect. Sertraline is a substrate of CYP3A4, CYP2C19, CYP2C9, CYP2D6, and CYP2B6. Lumacaftor/ivacaftor is a strong inducer of CYP3A and lumacaftor has the potential to induce CYP2C19, CYP2C9, CYP2D6, and CYP2B6.

• lurasidone

  lurasidone, sertraline. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

• maraviroc

  maraviroc increases levels of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• meclofenamate

  sertraline, meclofenamate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• mefenamic acid

  sertraline, mefenamic acid. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• mefloquine

  sertraline will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• meloxicam

  sertraline, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• metformin

  sertraline increases effects of metformin by pharmacodynamic synergism. Use Caution/Monitor.

• methamphetamine

  sertraline will increase the level or effect of methamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• metoprolol

  sertraline will increase the level or effect of metoprolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• midazolam intranasal

  midazolam intranasal, sertraline. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• mifepristone

  mifepristone, sertraline. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

• mipomersen

  mipomersen, sertraline. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

• mirabegron

  mirabegron will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mirtazapine

  sertraline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.

• morphine

  sertraline will increase the level or effect of morphine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  sertraline and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.

• nabumetone

  sertraline, nabumetone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• naldemedine

  sertraline increases levels of naldemedine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with strong or moderate CYP3A4 inhibitors.

• naproxen

  sertraline, naproxen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• naratriptan

  naratriptan and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.

• nebivolol

  sertraline will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• nelfinavir

  nelfinavir increases levels of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• nevirapine

  nevirapine will decrease the level or effect of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• nortriptyline

  sertraline will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.

• oliceridine

  sertraline will increase the level or effect of oliceridine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal.
  
  sertraline will increase the level or effect of oliceridine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal.
  
  sertraline, oliceridine. Either increases toxicity of the other by serotonin levels. Modify Therapy/Monitor Closely.

• osilodrostat

  osilodrostat and sertraline both increase QTc interval. Use Caution/Monitor.

• osimertinib

  osimertinib and sertraline both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• oxaprozin

  sertraline, oxaprozin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• oxycodone

  sertraline will increase the level or effect of oxycodone by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.
  
  oxycodone increases effects of sertraline by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Opioids may enhance the serotonergic effects of SSRIs and increase risk for serotonergic syndrome.

• oxymorphone

  sertraline will increase the level or effect of oxymorphone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• ozanimod

  ozanimod and sertraline both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

• palbociclib

  sertraline will increase the level or effect of palbociclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• parecoxib

  sertraline, parecoxib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• pasireotide

  sertraline and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• peginterferon alfa 2b

  peginterferon alfa 2b, sertraline. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.

• pentazocine

  sertraline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• phenytoin

  sertraline increases levels of phenytoin by decreasing metabolism. Use Caution/Monitor.

• piroxicam

  sertraline, piroxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• pregabalin

  pregabalin, sertraline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• propranolol

  sertraline will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Sertraline is a moderate to weak inhibitor of the hepatic (CYP2D6) which may be involved in the metabolism of propranolol. Monitor patients receiving propranolol and sertraline cotherapy for an increased incidence of chest pain. This effect may be more pronounced in patients with preexisting coronary artery disease.

• quinine

  sertraline and quinine both increase QTc interval. Use Caution/Monitor.

• remimazolam

  remimazolam, sertraline. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• rimegepant

  sertraline will increase the level or effect of rimegepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Avoid repeating rimegepant dose within 48 hr if coadministered with a moderate CYP3A4 inhibitor.

• risperidone

  sertraline will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• ritonavir

  ritonavir increases levels of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased risk of serotonin syndrome.

• rivaroxaban

  sertraline increases effects of rivaroxaban by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• rizatriptan

  rizatriptan and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.

• rolapitant

  rolapitant will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

• rucaparib

  rucaparib will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP2C19 substrates, if clinically indicated.

• ruxolitinib

  sertraline will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ruxolitinib topical

  sertraline will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• safinamide

  sertraline, safinamide. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Monitor patients for symptoms of serotonin syndrome if SSRIs are coadministered with safinamide.

• salicylates (non-asa)

  sertraline, salicylates (non-asa). Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• salsalate

  sertraline, salsalate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• SAMe

  sertraline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

• selpercatinib

  selpercatinib increases toxicity of sertraline by QTc interval. Use Caution/Monitor.

• sodium sulfate/?magnesium sulfate/potassium chloride

  sodium sulfate/?magnesium sulfate/potassium chloride increases effects of sertraline by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.

• sodium sulfate/potassium sulfate/magnesium sulfate

  sodium sulfate/potassium sulfate/magnesium sulfate increases effects of sertraline by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.

• sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

  sertraline, sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

• sonidegib

  sertraline will increase the level or effect of sonidegib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Avoid coadministration of sonidegib with moderate CYP3A4 inhibitors. If a moderate CYP3A inhibitor must be used, administer the moderate CYP3A inhibitor for <14 days and monitor closely for adverse reactions, particularly musculoskeletal adverse reactions.

• sorafenib

  sorafenib and sertraline both increase QTc interval. Use Caution/Monitor.

• stiripentol

  stiripentol will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of CYP2C19 substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.
  
  stiripentol, sertraline. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

• sufentanil SL

  sufentanil SL, sertraline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
  
  sertraline will increase the level or effect of sufentanil SL by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of sufentanil SL with any CYP3A4 inhibitor may increase sufentanil plasma concentration, and, thereby increase or prolonged adverse effects, including potentially fatal respiratory depression.

• sulfasalazine

  sertraline, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• sulindac

  sertraline, sulindac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• sumatriptan

  sumatriptan and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.

• sumatriptan intranasal

  sumatriptan intranasal and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.

• suvorexant

  sertraline will increase the level or effect of suvorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease suvorexant starting dose to 5 mg HS if coadministered with moderate CYP3A4 inhibitors

• tadalafil

  sertraline will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inhibitors may reduce tadalafil clearance increasing systemic exposure to tadalafil; increased levels may result in increased associated adverse events.

• tamoxifen

  sertraline decreases effects of tamoxifen by decreasing metabolism. Use Caution/Monitor. Inhibition of CYP2D6 metabolism to tamoxifen's active metabolite, endoxifen.

• tamsulosin

  sertraline increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tapentadol

  sertraline and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.

• tecovirimat

  tecovirimat will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Tecovirimat is a weak inhibitor of CYP2C8 and CYP2C19. Monitor for adverse effects if coadministered with sensitive substrates of these enzymes.

• terbinafine

  terbinafine will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• tezacaftor

  sertraline will increase the level or effect of tezacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust tezacaftor dosage regimen if coadministered with a moderate CYP3A inhibitor.

• timolol

  sertraline will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tinidazole

  sertraline will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tofacitinib

  sertraline increases levels of tofacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. No specific dose adjustment recommended when tofacitinib coadministered with moderate CYP3A4 inhibitors; decrease tofacitinib dose if coadministered with both moderate CYP3A4 and potent CYP2C19 inhibitors.

• tolfenamic acid

  sertraline, tolfenamic acid. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• tolmetin

  sertraline, tolmetin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• trabectedin

  sertraline will increase the level or effect of trabectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tramadol

  sertraline decreases effects of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.
  
  sertraline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  sertraline decreases effects of tramadol by decreasing metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

• triclabendazole

  triclabendazole will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. If plasma concentrations of the CYP2C19 substrates are elevated during triclabendazole, recheck plasma concentration of the CYP2C19 substrates after discontinuation of triclabendazole.

• valerian

  valerian and sertraline both increase sedation. Use Caution/Monitor.

• voclosporin

  sertraline will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.
  
  voclosporin, sertraline. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• vorapaxar

  sertraline, vorapaxar. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive antiplatelet effect may occur; SSRIs and SNRIs may cause platelet serotonin depletion .

• zanubrutinib

  sertraline will increase the level or effect of zanubrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce zanubrutinib dose when coadministered with a moderate CYP3A4 inhibitor. Interrupt dose as recommended for adverse reactions. After discontinuing the CYP3A4 inhibitor, resume previous dose of zanubrutinib. See zanubrutinib Dosage Modifications for precise recommendation.
  
  sertraline, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.

• ziprasidone

  sertraline and ziprasidone both decrease QTc interval. Modify Therapy/Monitor Closely.

• zolmitriptan

  zolmitriptan and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.

Minor (44)

• almotriptan

  sertraline, almotriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• azithromycin

  azithromycin increases toxicity of sertraline by QTc interval. Minor/Significance Unknown.

• bumetanide

  bumetanide, sertraline. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

• carbamazepine

  sertraline increases levels of carbamazepine by decreasing metabolism. Minor/Significance Unknown.

• celandine

  celandine decreases effects of sertraline by pharmacodynamic antagonism. Minor/Significance Unknown. Based on animal studies.

• chloroquine

  chloroquine increases toxicity of sertraline by QTc interval. Minor/Significance Unknown.

• chlorpromazine

  sertraline will increase the level or effect of chlorpromazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• codeine

  sertraline decreases effects of codeine by decreasing metabolism. Minor/Significance Unknown. Decreased conversion of codeine to active metabolite morphine.

• dexfenfluramine

  sertraline will increase the level or effect of dexfenfluramine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• dexmethylphenidate

  dexmethylphenidate increases effects of sertraline by decreasing metabolism. Minor/Significance Unknown.

• dextromethorphan

  sertraline will increase the level or effect of dextromethorphan by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• donepezil

  sertraline will increase the level or effect of donepezil by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• doxepin

  sertraline will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• eletriptan

  sertraline, eletriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• encainide

  sertraline will increase the level or effect of encainide by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• esmolol

  sertraline increases levels of esmolol by decreasing metabolism. Minor/Significance Unknown.

• estradiol vaginal

  sertraline will increase the level or effect of estradiol vaginal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ethacrynic acid

  ethacrynic acid, sertraline. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

• fesoterodine

  sertraline will increase the level or effect of fesoterodine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• flecainide

  sertraline will increase the level or effect of flecainide by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown. Monitor the EKG in patients receiving concurrent flecainide and sertraline. Doses of flecainide may need to be reduced.

• fluphenazine

  sertraline will increase the level or effect of fluphenazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• frovatriptan

  sertraline, frovatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• furosemide

  furosemide, sertraline. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

• galantamine

  sertraline will increase the level or effect of galantamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• lithium

  sertraline, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.

• loratadine

  sertraline will increase the level or effect of loratadine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• mexiletine

  sertraline will increase the level or effect of mexiletine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• naratriptan

  sertraline, naratriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• panax ginseng

  panax ginseng increases effects of sertraline by pharmacodynamic synergism. Minor/Significance Unknown.

• perhexiline

  sertraline will increase the level or effect of perhexiline by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• perphenazine

  sertraline will increase the level or effect of perphenazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• pleurisy root

  pleurisy root decreases effects of sertraline by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.

• prochlorperazine

  sertraline will increase the level or effect of prochlorperazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• promazine

  sertraline will increase the level or effect of promazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• promethazine

  sertraline will increase the level or effect of promethazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• propafenone

  sertraline will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown. Monitor the EKG in patients receiving concurrent propafenone and sertraline. Doses of propafenone may need to be reduced.

• rizatriptan

  sertraline, rizatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• sumatriptan

  sertraline, sumatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• sumatriptan intranasal

  sertraline, sumatriptan intranasal. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• tolterodine

  sertraline will increase the level or effect of tolterodine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• torsemide

  torsemide, sertraline. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

• trifluoperazine

  sertraline will increase the level or effect of trifluoperazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• tropisetron

  sertraline will increase the level or effect of tropisetron by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• zolmitriptan

  sertraline, zolmitriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• 5-HTP

  Monitor Closely (1)sertraline and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.

• abiraterone

  Monitor Closely (1)abiraterone increases levels of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

• acalabrutinib

  Monitor Closely (1)sertraline will increase the level or effect of acalabrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease acalabrutinib dose to 100 mg once daily if coadministered with a moderate CYP3A inhibitor.

• aceclofenac

  Monitor Closely (1)sertraline, aceclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• acemetacin

  Monitor Closely (1)sertraline, acemetacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• albuterol

  Monitor Closely (1)albuterol and sertraline both increase QTc interval. Use Caution/Monitor.

• alfentanil

  Serious - Use Alternative (1)alfentanil, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• alfuzosin

  Monitor Closely (2)sertraline and alfuzosin both increase QTc interval. Use Caution/Monitor.
  
  alfuzosin and sertraline both increase QTc interval. Use Caution/Monitor.

• almotriptan

  Monitor Closely (1)almotriptan and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)sertraline, almotriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• amifampridine

  Monitor Closely (1)sertraline increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amisulpride

  Serious - Use Alternative (1)amisulpride and sertraline both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• amitriptyline

  Serious - Use Alternative (1)sertraline and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• amoxapine

  Serious - Use Alternative (1)sertraline and amoxapine both increase serotonin levels. Avoid or Use Alternate Drug.

• apalutamide

  Serious - Use Alternative (1)apalutamide will decrease the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP2C19 inducer, with drugs that are CYP2C19 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered.

• apixaban

  Monitor Closely (1)sertraline and apixaban both increase anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

• apomorphine

  Monitor Closely (1)apomorphine and sertraline both increase QTc interval. Use Caution/Monitor.

• arformoterol

  Monitor Closely (1)arformoterol and sertraline both increase QTc interval. Use Caution/Monitor.

• aripiprazole

  Monitor Closely (2)sertraline will increase the level or effect of aripiprazole by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  aripiprazole and sertraline both increase QTc interval. Use Caution/Monitor.

• artemether

  Serious - Use Alternative (1)artemether and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• aspirin

  Monitor Closely (1)sertraline, aspirin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• aspirin rectal

  Monitor Closely (1)sertraline, aspirin rectal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• aspirin/citric acid/sodium bicarbonate

  Monitor Closely (1)sertraline, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• atazanavir

  Monitor Closely (1)atazanavir increases levels of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• atogepant

  Monitor Closely (1)sertraline will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• atomoxetine

  Monitor Closely (2)atomoxetine and sertraline both increase QTc interval. Use Caution/Monitor.
  
  sertraline will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• avanafil

  Monitor Closely (1)sertraline will increase the level or effect of avanafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inhibitors may reduce avanafil clearance increasing systemic exposure to avanafil; increased levels may result in increased associated adverse events; the maximum recommended dose of STENDRA is 50 mg, not to exceed once every 24 hours for patients taking concomitant moderate CYP3A4 inhibitors

• avapritinib

  Serious - Use Alternative (1)sertraline will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of avapritinib with moderate CYP3A4 inhibitors. If unable to avoid, reduce avapritinib starting dose. See drug monograph Dosage Modifications.

• axitinib

  Serious - Use Alternative (1)sertraline increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid coadministration with moderate CYP3A4 inhibitors, monitor closely and reduce dose if necessary .

• azithromycin

  Minor (1)azithromycin increases toxicity of sertraline by QTc interval. Minor/Significance Unknown.

• bedaquiline

  Monitor Closely (1)sertraline and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• benzhydrocodone/acetaminophen

  Monitor Closely (2)sertraline will increase the level or effect of benzhydrocodone/acetaminophen by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Hydromorphone (<3% of the circulating parent hydrocodone [benzhydrocodone is prodrug of hydrocodone]) is mainly formed by CYP2D6 mediated O-demethylation of hydrocodone. Hydromorphone may contribute to the total analgesic effect of hydrocodone.
  
  benzhydrocodone/acetaminophen, sertraline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• betrixaban

  Monitor Closely (1)sertraline, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

• bosutinib

  Serious - Use Alternative (1)sertraline increases levels of bosutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• brexpiprazole

  Monitor Closely (2)sertraline will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP2D6 inhibitor PLUS a strong/moderate CYP3A4 inhibitor.
  
  sertraline will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP3A4 inhibitor PLUS a strong/moderate CYP2D6 inhibitor.

• bumetanide

  Minor (1)bumetanide, sertraline. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

• buprenorphine subdermal implant

  Monitor Closely (2)sertraline, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
  
  sertraline will increase the level or effect of buprenorphine subdermal implant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor patients already on buprenorphine subdermal implant who require newly-initiated treatment with CYP3A4 inhibitors for signs and symptoms of overmedication. If the dose of the concomitant CYP3A4 inhibitor cannot be reduced or discontinued, implant removal may be necessary and the patient should then be treated with a buprenorphine dosage form that permits dose adjustments. If a CYP3A4 inhibitor is discontinued in a patient who has been stabilized on buprenorphine, monitor the patient for withdrawal.

• buprenorphine, long-acting injection

  Monitor Closely (2)sertraline, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.
  
  sertraline will increase the level or effect of buprenorphine, long-acting injection by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Patients who transfer to buprenorphine long-acting injection from transmucosal buprenorphine coadministered with CYP3A4 inhibitors should be monitored to ensure buprenorphine plasma levels are adequate. Within 2 weeks, if signs and symptoms of buprenorphine toxicity or overdose occur and the concomitant CYP3A4 inhibitor cannot be reduced or discontinued, transition the patient back to a buprenorphine formulation that permits dose adjustments.

• bupropion

  Monitor Closely (2)bupropion will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  sertraline increases levels of bupropion by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor. Sertraline may inhibit hydroxylation of bupropion to its major active metabolite hydroxybupropion.

• buspirone

  Serious - Use Alternative (1)sertraline and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.

• cabozantinib

  Monitor Closely (1)sertraline will increase the level or effect of cabozantinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cannabidiol

  Monitor Closely (2)sertraline will increase the level or effect of cannabidiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Consider reducing the cannabidiol dose when coadministered with a moderate CYP3A4 inhibitor.
  
  cannabidiol will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with cannabidiol.

• carbamazepine

  Minor (1)sertraline increases levels of carbamazepine by decreasing metabolism. Minor/Significance Unknown.

• carvedilol

  Monitor Closely (1)sertraline will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• celandine

  Minor (1)celandine decreases effects of sertraline by pharmacodynamic antagonism. Minor/Significance Unknown. Based on animal studies.

• celecoxib

  Monitor Closely (1)sertraline, celecoxib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• cenobamate

  Monitor Closely (2)cenobamate, sertraline. Either increases effects of the other by sedation. Use Caution/Monitor.
  
  cenobamate will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

• ceritinib

  Serious - Use Alternative (1)ceritinib and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• chloroquine

  Minor (1)chloroquine increases toxicity of sertraline by QTc interval. Minor/Significance Unknown.

• chlorpromazine

  Minor (1)sertraline will increase the level or effect of chlorpromazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• choline magnesium trisalicylate

  Monitor Closely (1)sertraline, choline magnesium trisalicylate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• cilostazol

  Monitor Closely (1)sertraline increases toxicity of cilostazol by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider decreasing cilostazol dose; moderate CYP2C19 inhibitors may increase serum levels of 3,4-dehydrocilostazol (active metabolite).

• citalopram

  Serious - Use Alternative (2)citalopram and sertraline both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
  
  citalopram and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin

  Serious - Use Alternative (1)clarithromycin and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• clobazam

  Monitor Closely (1)clobazam will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.

• clomipramine

  Monitor Closely (1)sertraline will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)sertraline and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• clonidine

  Monitor Closely (1)clonidine, sertraline. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.

• clopidogrel

  Monitor Closely (1)sertraline increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SSRIs affect platelet activation; coadministration of SSRIs with clopidogrel may increase the risk of bleeding.

• clozapine

  Monitor Closely (2)sertraline increases levels of clozapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Plasma levels of clozapine may be increased, resulting in increased pharmacologic and toxic effects. Adjust clozapine dose as needed when initiating or discontinuing certain SSRIs. .
  
  clozapine and sertraline both increase QTc interval. Use Caution/Monitor.

• cobicistat

  Monitor Closely (1)cobicistat will increase the level or effect of sertraline by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with SSRIs and cobicistat.

• cobimetinib

  Serious - Use Alternative (1)sertraline will increase the level or effect of cobimetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If concurrent short term (14 days or less) use of moderate CYP3A inhibitors is unavoidable for patients who are taking cobimetinib 60 mg, reduce the cobimetinib dose to 20 mg. After discontinuation of a moderate CYP3A inhibitor, resume cobimetinib 60 mg. Use an alternative to a moderate CYP3A inhibitor in patients who are taking a reduced dose of cobimetinib (40 or 20 mg daily).

• cocaine

  Monitor Closely (1)sertraline and cocaine both increase serotonin levels. Modify Therapy/Monitor Closely.

• codeine

  Monitor Closely (1)sertraline decreases effects of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.Minor (1)sertraline decreases effects of codeine by decreasing metabolism. Minor/Significance Unknown. Decreased conversion of codeine to active metabolite morphine.

• crizotinib

  Serious - Use Alternative (1)crizotinib and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• cyclobenzaprine

  Serious - Use Alternative (1)sertraline and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

• cyproheptadine

  Monitor Closely (1)cyproheptadine decreases effects of sertraline by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SSRIs.

• dacomitinib

  Serious - Use Alternative (1)dacomitinib will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• daridorexant

  Monitor Closely (2)sertraline will increase the level or effect of daridorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Daridorexant dose should not exceed 25 mg per night when coadministered with moderate CYP3A4 inhibitors.
  
  sertraline and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darunavir

  Monitor Closely (2)darunavir decreases levels of sertraline by Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Carefully titrate SSRI dose based on clinical assessment of antidepressant response.
  
  darunavir will increase the level or effect of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with SSRIs, TCAs, or trazodone may require dose titration of antidepressant to desired effect (eg, using the lowest feasible initial or maintenance dose). Monitor for antidepressant response.

• dasatinib

  Monitor Closely (1)dasatinib and sertraline both increase QTc interval. Use Caution/Monitor.

• defibrotide

  Monitor Closely (1)defibrotide increases effects of sertraline by Other (see comment). Use Caution/Monitor. Comment: Defibrotide may enhance effects of platelet inhibitors.

• deflazacort

  Monitor Closely (1)sertraline will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

• degarelix

  Monitor Closely (1)degarelix and sertraline both increase QTc interval. Use Caution/Monitor.

• desflurane

  Serious - Use Alternative (1)desflurane and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• desipramine

  Monitor Closely (1)sertraline will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)sertraline and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  desipramine and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• desvenlafaxine

  Serious - Use Alternative (1)sertraline and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• deutetrabenazine

  Monitor Closely (1)deutetrabenazine and sertraline both increase QTc interval. Use Caution/Monitor.

• dexfenfluramine

  Monitor Closely (1)sertraline and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)sertraline will increase the level or effect of dexfenfluramine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• dexmethylphenidate

  Minor (1)dexmethylphenidate increases effects of sertraline by decreasing metabolism. Minor/Significance Unknown.

• dextroamphetamine

  Monitor Closely (2)sertraline will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  sertraline and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dextromethorphan

  Serious - Use Alternative (1)sertraline and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.Minor (1)sertraline will increase the level or effect of dextromethorphan by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• diazepam intranasal

  Monitor Closely (3)sertraline will increase the level or effect of diazepam intranasal by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Strong or moderate CYP2C19 inhibitors may decrease rate of diazepam elimination, thereby increasing adverse reactions to diazepam.
  
  sertraline will increase the level or effect of diazepam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong or moderate CYP3A4 inhibitors may decrease rate of diazepam elimination, thereby increasing adverse reactions to diazepam.
  
  diazepam intranasal, sertraline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

• diclofenac

  Monitor Closely (1)sertraline, diclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• difelikefalin

  Monitor Closely (1)difelikefalin and sertraline both increase sedation. Use Caution/Monitor.

• diflunisal

  Monitor Closely (1)sertraline, diflunisal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• dihydroergotamine

  Monitor Closely (1)sertraline and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• dihydroergotamine intranasal

  Monitor Closely (1)sertraline and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.

• dofetilide

  Serious - Use Alternative (1)dofetilide increases toxicity of sertraline by QTc interval. Avoid or Use Alternate Drug.

• dolasetron

  Monitor Closely (1)dolasetron and sertraline both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)dolasetron, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• donepezil

  Monitor Closely (1)donepezil and sertraline both increase QTc interval. Use Caution/Monitor.Minor (1)sertraline will increase the level or effect of donepezil by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• dosulepin

  Serious - Use Alternative (1)sertraline and dosulepin both increase serotonin levels. Avoid or Use Alternate Drug.

• doxepin

  Serious - Use Alternative (2)sertraline and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.
  
  doxepin and sertraline both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)sertraline will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• duloxetine

  Serious - Use Alternative (2)duloxetine and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.
  
  sertraline will increase the level or effect of duloxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• edoxaban

  Monitor Closely (1)sertraline increases effects of edoxaban by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• efavirenz

  Monitor Closely (2)efavirenz and sertraline both increase QTc interval. Use Caution/Monitor.
  
  efavirenz will decrease the level or effect of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• eletriptan

  Monitor Closely (1)eletriptan and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)sertraline, eletriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• eliglustat

  Contraindicated (1)sertraline increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.Monitor Closely (1)eliglustat increases levels of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.Serious - Use Alternative (1)sertraline increases levels of eliglustat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Moderate CYP3A4 inhibitors are not recommended with eliglustat poor or intermediate metabolizers; reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive metabolizers .

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Monitor Closely (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• encainide

  Minor (1)sertraline will increase the level or effect of encainide by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• encorafenib

  Serious - Use Alternative (1)encorafenib and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• entrectinib

  Serious - Use Alternative (2)sertraline will increase the level or effect of entrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of moderate CYP3A4 inhibitors with entrectinib, a CYP3A4 substrate. If coadministration unavoidable, reduce dose to 200 mg/day for patients aged 12 y or older with BSA >1.50m2. Resume previous entrectinib dose after discontinuing moderate CYP3A inhibitor for 3-5 elimination half-lives.
  
  entrectinib and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• ergotamine

  Monitor Closely (1)sertraline and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

• eribulin

  Serious - Use Alternative (1)eribulin and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• escitalopram

  Serious - Use Alternative (2)escitalopram and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.
  
  escitalopram increases toxicity of sertraline by QTc interval. Avoid or Use Alternate Drug.

• eslicarbazepine acetate

  Monitor Closely (1)eslicarbazepine acetate will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

• esmolol

  Minor (1)sertraline increases levels of esmolol by decreasing metabolism. Minor/Significance Unknown.

• estradiol vaginal

  Minor (1)sertraline will increase the level or effect of estradiol vaginal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ethacrynic acid

  Minor (1)ethacrynic acid, sertraline. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

• etodolac

  Monitor Closely (1)sertraline, etodolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• fedratinib

  Monitor Closely (2)fedratinib will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2C19 substrates as necessary.
  
  fedratinib will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.Serious - Use Alternative (1)sertraline will increase the level or effect of fedratinib by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of fedratinib (a CYP3A4 and CYP2C19 substrate) with dual CYP3A4 and CYP2C19 inhibitor. Effect of coadministration of a dual CYP3A4 and CYP2C19 inhibitor with fedratinib has not been studied.

• fenbufen

  Monitor Closely (1)sertraline, fenbufen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• fenfluramine

  Monitor Closely (2)fenfluramine, sertraline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.
  
  sertraline and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

• fenoprofen

  Monitor Closely (1)sertraline, fenoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• fentanyl

  Serious - Use Alternative (2)fentanyl, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
  
  sertraline will increase the level or effect of fentanyl by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

• fentanyl intranasal

  Serious - Use Alternative (2)fentanyl intranasal, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
  
  sertraline will increase the level or effect of fentanyl intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

• fentanyl transdermal

  Serious - Use Alternative (2)fentanyl transdermal, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
  
  sertraline will increase the level or effect of fentanyl transdermal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

• fentanyl transmucosal

  Serious - Use Alternative (2)fentanyl transmucosal, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
  
  sertraline will increase the level or effect of fentanyl transmucosal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

• fesoterodine

  Minor (1)sertraline will increase the level or effect of fesoterodine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• fexinidazole

  Monitor Closely (1)fexinidazole will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)fexinidazole and sertraline both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

• finerenone

  Monitor Closely (1)sertraline will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or moderate CYP3A4 inhibitors. Adjust finererone dosage as needed.

• fingolimod

  Monitor Closely (1)fingolimod and sertraline both increase QTc interval. Use Caution/Monitor.

• fish oil triglycerides

  Monitor Closely (1)fish oil triglycerides will increase the level or effect of sertraline by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

• flecainide

  Minor (1)sertraline will increase the level or effect of flecainide by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown. Monitor the EKG in patients receiving concurrent flecainide and sertraline. Doses of flecainide may need to be reduced.

• flibanserin

  Contraindicated (1)sertraline will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration of flibanserin with moderate or strong CYP3A4 inhibitors is contraindicated. Severe hypotension or syncope can occur.

• fluoxetine

  Monitor Closely (1)sertraline and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)fluoxetine and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.
  
  sertraline will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• fluphenazine

  Minor (1)sertraline will increase the level or effect of fluphenazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• flurbiprofen

  Monitor Closely (1)sertraline, flurbiprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• fluvoxamine

  Serious - Use Alternative (1)fluvoxamine and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.

• fondaparinux

  Monitor Closely (1)sertraline increases effects of fondaparinux by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• fosamprenavir

  Monitor Closely (1)fosamprenavir increases levels of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• fosphenytoin

  Monitor Closely (1)sertraline increases levels of fosphenytoin by decreasing metabolism. Use Caution/Monitor.

• fostemsavir

  Monitor Closely (1)sertraline and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

• frovatriptan

  Monitor Closely (1)frovatriptan and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)sertraline, frovatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• furosemide

  Minor (1)furosemide, sertraline. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

• gabapentin

  Monitor Closely (1)gabapentin, sertraline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin enacarbil

  Monitor Closely (1)gabapentin enacarbil, sertraline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• galantamine

  Minor (1)sertraline will increase the level or effect of galantamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• gemifloxacin

  Monitor Closely (1)gemifloxacin and sertraline both increase QTc interval. Use Caution/Monitor.

• gilteritinib

  Serious - Use Alternative (1)gilteritinib will decrease the level or effect of sertraline by Other (see comment). Avoid or Use Alternate Drug. Coadministration of gilteritinib with drugs that inhibit 5HT2B or sigma nonspecific receptors. Avoid use of these drugs with gilteritinib unless coadministration is necessary.

• givosiran

  Serious - Use Alternative (1)givosiran will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• granisetron

  Serious - Use Alternative (1)granisetron, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• grapefruit

  Monitor Closely (1)grapefruit will increase the level or effect of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• green tea

  Monitor Closely (1)green tea, sertraline. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding.

• guanfacine

  Monitor Closely (1)sertraline will increase the level or effect of guanfacine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Strong or moderate CYP3A4 inhibitors significantly increase guanfacine plasma concentrations. FDA-approved labeling for extended-release (ER) guanfacine recommends that, if coadministered, the guanfacine dosage should be decreased to half of the recommended dose. Specific recommendations for immediate-release (IR) guanfacine are not available.

• haloperidol

  Monitor Closely (2)sertraline will increase the level or effect of haloperidol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  haloperidol and sertraline both increase QTc interval. Use Caution/Monitor.

• hydrocodone

  Monitor Closely (2)sertraline will increase the level or effect of hydrocodone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Hydromorphone (<3% of the circulating parent hydrocodone) is mainly formed by CYP2D6 mediated O-demethylation of hydrocodone. Hydromorphone may contribute to the total analgesic effect of hydrocodone.
  
  hydrocodone, sertraline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• hydromorphone

  Monitor Closely (1)sertraline will increase the level or effect of hydromorphone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)hydromorphone, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• hydroxychloroquine sulfate

  Serious - Use Alternative (1)hydroxychloroquine sulfate and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• ibrutinib

  Monitor Closely (1)ibrutinib will increase the level or effect of sertraline by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding. Serious - Use Alternative (1)sertraline increases levels of ibrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration with moderate CYP3A4 inhibitors, reduce ibrutinib dose to 280 mg qDay (B-cell malignancies) or 420 mg qDay (graft versus host disease). After CYP3A inhibitor discontinuation, resume previous dose of ibrutinib.

• ibuprofen

  Monitor Closely (1)sertraline, ibuprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ibuprofen IV

  Monitor Closely (1)sertraline, ibuprofen IV. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ifosfamide

  Monitor Closely (1)sertraline decreases effects of ifosfamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration .

• iloperidone

  Monitor Closely (1)sertraline will increase the level or effect of iloperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• imipramine

  Monitor Closely (1)sertraline will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)sertraline and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• indinavir

  Monitor Closely (1)indinavir increases levels of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• indomethacin

  Monitor Closely (1)sertraline, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• infigratinib

  Serious - Use Alternative (1)sertraline will increase the level or effect of infigratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• ioflupane I 123

  Monitor Closely (1)sertraline decreases effects of ioflupane I 123 by receptor binding competition. Use Caution/Monitor. Drugs that bind to dopamine transporter receptor with high affinity may interfere with the image following ioflupane I 123 administration.

• irinotecan

  Serious - Use Alternative (1)sertraline will increase the level or effect of irinotecan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• irinotecan liposomal

  Serious - Use Alternative (1)sertraline will increase the level or effect of irinotecan liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• isavuconazonium sulfate

  Monitor Closely (1)sertraline will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• isocarboxazid

  Contraindicated (1)isocarboxazid and sertraline both increase serotonin levels. Contraindicated.

• isoniazid

  Monitor Closely (1)sertraline and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.

• ivabradine

  Serious - Use Alternative (1)sertraline will increase the level or effect of ivabradine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of ivabradine with moderate CYP3A4 inhibitors.

• ivacaftor

  Monitor Closely (1)sertraline will increase the level or effect of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce ivacaftor dose if coadministered with moderate CYP3A4 inhibitors. See specific ivacaftor-containing product for precise dosage modification.

• ivosidenib

  Monitor Closely (1)sertraline will increase the level or effect of ivosidenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with moderate CYP3A4 inhibitors may increase ivosidenib plasma concentrations, thus increasing the risk of QTc prolongation. Monitor for increased risk of QTc interval prolongation.Serious - Use Alternative (1)ivosidenib and sertraline both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

• ketoprofen

  Monitor Closely (1)sertraline, ketoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ketorolac

  Monitor Closely (1)sertraline, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• ketorolac intranasal

  Monitor Closely (1)sertraline, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• L-tryptophan

  Monitor Closely (1)sertraline and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

• lamotrigine

  Monitor Closely (1)lamotrigine increases toxicity of sertraline by unspecified interaction mechanism. Modify Therapy/Monitor Closely. CNS depressants may increase the toxic effects of selective serotonin reuptake inhibitors; psychomotor impairment may be enhanced.

• lasmiditan

  Monitor Closely (2)lasmiditan, sertraline. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
  
  sertraline increases effects of lasmiditan by serotonin levels. Use Caution/Monitor. Coadministration may increase risk of serotonin syndrome.

• lefamulin

  Monitor Closely (1)sertraline will increase the level or effect of lefamulin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for adverse effects if lefamulin is coadministered with moderate CYP3A inhibitors.Serious - Use Alternative (1)lefamulin and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

• lemborexant

  Monitor Closely (1)lemborexant, sertraline. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.Serious - Use Alternative (1)sertraline will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of lemborexant with moderate or strong CYP3A inhibitors.

• letermovir

  Monitor Closely (1)letermovir increases levels of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levamlodipine

  Monitor Closely (1)sertraline will increase the level or effect of levamlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with moderate and strong CYP3A inhibitors results in increased systemic exposure to amlodipine and may require dose reduction. Monitor for symptoms of hypotension and edema when amlodipine is coadministered with CYP3A inhibitors to determine the need for dose adjustment.

• levomilnacipran

  Serious - Use Alternative (1)levomilnacipran and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.

• linezolid

  Serious - Use Alternative (1)linezolid and sertraline both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.

• lisdexamfetamine

  Monitor Closely (1)sertraline, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s).

• lithium

  Monitor Closely (1)sertraline and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)sertraline, lithium. Mechanism: unknown. Minor/Significance Unknown. Risk of neurotoxicity.

• lofepramine

  Monitor Closely (1)sertraline will increase the level or effect of lofepramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)sertraline and lofepramine both increase serotonin levels. Avoid or Use Alternate Drug.

• lomitapide

  Contraindicated (1)sertraline increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Increases lomitapide levels several folds.

• lonafarnib

  Contraindicated (1)sertraline will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lonafarnib is a sensitive CYP3A4 substrate. Coadministration with strong or moderate CYP3A4 inhibitors is contraindicated.

• lopinavir

  Monitor Closely (1)lopinavir increases levels of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity.

• loratadine

  Minor (1)sertraline will increase the level or effect of loratadine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• lorcaserin

  Monitor Closely (1)lorcaserin will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)sertraline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• lornoxicam

  Monitor Closely (1)sertraline, lornoxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• lsd

  Monitor Closely (1)sertraline and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.

• lumacaftor/ivacaftor

  Monitor Closely (2)lumacaftor/ivacaftor will decrease the level or effect of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. A higher dose of sertraline may be required to obtain desired therapeutic effect. Sertraline is a substrate of CYP3A4, CYP2C19, CYP2C9, CYP2D6, and CYP2B6. Lumacaftor/ivacaftor is a strong inducer of CYP3A and lumacaftor has the potential to induce CYP2C19, CYP2C9, CYP2D6, and CYP2B6.
  
  lumacaftor/ivacaftor, sertraline. affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C19 substrates. .

• lurasidone

  Monitor Closely (1)lurasidone, sertraline. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

• lurbinectedin

  Serious - Use Alternative (1)sertraline will increase the level or effect of lurbinectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• macimorelin

  Serious - Use Alternative (1)macimorelin and sertraline both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• maprotiline

  Serious - Use Alternative (1)sertraline and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

• maraviroc

  Monitor Closely (1)maraviroc increases levels of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• meclofenamate

  Monitor Closely (1)sertraline, meclofenamate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• mefenamic acid

  Monitor Closely (1)sertraline, mefenamic acid. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• mefloquine

  Monitor Closely (1)sertraline will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)mefloquine increases toxicity of sertraline by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

• meloxicam

  Monitor Closely (1)sertraline, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• meperidine

  Serious - Use Alternative (2)sertraline and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.
  
  meperidine, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• metformin

  Monitor Closely (1)sertraline increases effects of metformin by pharmacodynamic synergism. Use Caution/Monitor.

• methamphetamine

  Monitor Closely (1)sertraline will increase the level or effect of methamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• methylene blue

  Serious - Use Alternative (1)methylene blue and sertraline both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.

• metoclopramide

  Serious - Use Alternative (1)metoclopramide and sertraline both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

• metoclopramide intranasal

  Serious - Use Alternative (1)sertraline, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

• metoprolol

  Monitor Closely (1)sertraline will increase the level or effect of metoprolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mexiletine

  Minor (1)sertraline will increase the level or effect of mexiletine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• midazolam intranasal

  Monitor Closely (1)midazolam intranasal, sertraline. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.Serious - Use Alternative (1)sertraline will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of moderate CYP3A4 inhibitors with midazolam intranasal causes higher midazolam systemic exposure, which may prolong sedation.

• mifepristone

  Monitor Closely (1)mifepristone, sertraline. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

• milnacipran

  Serious - Use Alternative (1)milnacipran and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.

• mipomersen

  Monitor Closely (1)mipomersen, sertraline. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

• mirabegron

  Monitor Closely (1)mirabegron will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mirtazapine

  Monitor Closely (1)sertraline and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.

• mobocertinib

  Serious - Use Alternative (2)sertraline will increase the level or effect of mobocertinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use of moderate CYP3A4 inhibitor unavoidable, reduce mobocertinib dose by ~50% (eg, 160 to 80 mg); closely monitor QTc interval.
  
  mobocertinib and sertraline both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• morphine

  Monitor Closely (2)sertraline will increase the level or effect of morphine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  sertraline and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)morphine, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• nabumetone

  Monitor Closely (1)sertraline, nabumetone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• naldemedine

  Monitor Closely (1)sertraline increases levels of naldemedine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with strong or moderate CYP3A4 inhibitors.

• naloxegol

  Serious - Use Alternative (1)sertraline will increase the level or effect of naloxegol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministation of naloxegol with moderate CYP3A4 inhibitors is unavoidable, reduce naloxegol dose to 12.5 mg qDay

• naproxen

  Monitor Closely (1)sertraline, naproxen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• naratriptan

  Monitor Closely (1)naratriptan and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)sertraline, naratriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• nebivolol

  Monitor Closely (1)sertraline will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• nefazodone

  Serious - Use Alternative (1)nefazodone and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.

• nelfinavir

  Monitor Closely (1)nelfinavir increases levels of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

• neratinib

  Serious - Use Alternative (1)sertraline will increase the level or effect of neratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of neratinib with strong/moderate CYP3A4 inhibitors.

• netupitant/palonosetron

  Serious - Use Alternative (1)netupitant/palonosetron, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• nevirapine

  Monitor Closely (1)nevirapine will decrease the level or effect of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• nortriptyline

  Monitor Closely (1)sertraline will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)sertraline and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• olaparib

  Serious - Use Alternative (1)sertraline will increase the level or effect of olaparib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with moderate CYP3A inhibitors cannot be avoided, reduce olaparib dose to 200 mg (capsule) or 150 mg (tablet) PO BID. Do not substitute tablets with capsules.

• oliceridine

  Monitor Closely (3)sertraline will increase the level or effect of oliceridine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal.
  
  sertraline will increase the level or effect of oliceridine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal.
  
  sertraline, oliceridine. Either increases toxicity of the other by serotonin levels. Modify Therapy/Monitor Closely.

• ondansetron

  Serious - Use Alternative (2)ondansetron and sertraline both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
  
  ondansetron, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• osilodrostat

  Monitor Closely (1)osilodrostat and sertraline both increase QTc interval. Use Caution/Monitor.

• osimertinib

  Monitor Closely (1)osimertinib and sertraline both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• oxaprozin

  Monitor Closely (1)sertraline, oxaprozin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• oxycodone

  Monitor Closely (2)sertraline will increase the level or effect of oxycodone by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.
  
  oxycodone increases effects of sertraline by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Opioids may enhance the serotonergic effects of SSRIs and increase risk for serotonergic syndrome.

• oxymorphone

  Monitor Closely (1)sertraline will increase the level or effect of oxymorphone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• ozanimod

  Monitor Closely (1)ozanimod and sertraline both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.Serious - Use Alternative (1)ozanimod increases toxicity of sertraline by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

• palbociclib

  Monitor Closely (1)sertraline will increase the level or effect of palbociclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• palonosetron

  Serious - Use Alternative (1)palonosetron, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• panax ginseng

  Minor (1)panax ginseng increases effects of sertraline by pharmacodynamic synergism. Minor/Significance Unknown.

• parecoxib

  Monitor Closely (1)sertraline, parecoxib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• paroxetine

  Serious - Use Alternative (2)paroxetine and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.
  
  sertraline will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• pasireotide

  Monitor Closely (1)sertraline and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• peginterferon alfa 2b

  Monitor Closely (1)peginterferon alfa 2b, sertraline. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.

• pemigatinib

  Serious - Use Alternative (1)sertraline will increase the level or effect of pemigatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors is unavoidable, reduce pemigatinib dose (refer to drug monograph dosage modifications). After discontinuing the CYP3A4 inhibitor for 3 elimination half-lives, may resume previous pemigatinib dose.

• pentazocine

  Monitor Closely (1)sertraline and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

• perhexiline

  Minor (1)sertraline will increase the level or effect of perhexiline by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• perphenazine

  Minor (1)sertraline will increase the level or effect of perphenazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• pexidartinib

  Serious - Use Alternative (1)sertraline will increase the level or effect of pexidartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors is unavoidable, reduce pexidartinib dose (refer to drug monograph dosage modifications). After discontinuing the CYP3A4 inhibitor for 3 elimination half-lives, may resume previous pexidartinib dose.

• phenelzine

  Contraindicated (1)phenelzine and sertraline both increase serotonin levels. Contraindicated.

• phentermine

  Serious - Use Alternative (1)sertraline, phentermine. Either increases toxicity of the other by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of serotonin syndrome.

• phenytoin

  Monitor Closely (1)sertraline increases levels of phenytoin by decreasing metabolism. Use Caution/Monitor.

• pimozide

  Contraindicated (1)sertraline increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of prolonged QTc interval.

• piroxicam

  Monitor Closely (1)sertraline, piroxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• pleurisy root

  Minor (1)pleurisy root decreases effects of sertraline by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.

• pregabalin

  Monitor Closely (1)pregabalin, sertraline. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• procarbazine

  Contraindicated (1)procarbazine and sertraline both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.

• prochlorperazine

  Minor (1)sertraline will increase the level or effect of prochlorperazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• promazine

  Minor (1)sertraline will increase the level or effect of promazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• promethazine

  Minor (1)sertraline will increase the level or effect of promethazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• propafenone

  Minor (1)sertraline will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown. Monitor the EKG in patients receiving concurrent propafenone and sertraline. Doses of propafenone may need to be reduced.

• propranolol

  Monitor Closely (1)sertraline will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Sertraline is a moderate to weak inhibitor of the hepatic (CYP2D6) which may be involved in the metabolism of propranolol. Monitor patients receiving propranolol and sertraline cotherapy for an increased incidence of chest pain. This effect may be more pronounced in patients with preexisting coronary artery disease.

• protriptyline

  Serious - Use Alternative (1)sertraline and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

• quinine

  Monitor Closely (1)sertraline and quinine both increase QTc interval. Use Caution/Monitor.

• rasagiline

  Serious - Use Alternative (1)rasagiline and sertraline both increase serotonin levels. Avoid or Use Alternate Drug. Severe CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Avoid combination within 14 days of MAOI use.

• remifentanil

  Serious - Use Alternative (1)remifentanil, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• remimazolam

  Monitor Closely (1)remimazolam, sertraline. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• ribociclib

  Serious - Use Alternative (1)ribociclib increases toxicity of sertraline by QTc interval. Avoid or Use Alternate Drug.

• rimegepant

  Monitor Closely (1)sertraline will increase the level or effect of rimegepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Avoid repeating rimegepant dose within 48 hr if coadministered with a moderate CYP3A4 inhibitor.

• risperidone

  Monitor Closely (1)sertraline will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• ritonavir

  Monitor Closely (1)ritonavir increases levels of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased risk of serotonin syndrome.

• rivaroxaban

  Monitor Closely (1)sertraline increases effects of rivaroxaban by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• rizatriptan

  Monitor Closely (1)rizatriptan and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)sertraline, rizatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• rolapitant

  Monitor Closely (1)rolapitant will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

• rucaparib

  Monitor Closely (1)rucaparib will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP2C19 substrates, if clinically indicated.

• ruxolitinib

  Monitor Closely (1)sertraline will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ruxolitinib topical

  Monitor Closely (1)sertraline will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• safinamide

  Monitor Closely (1)sertraline, safinamide. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Monitor patients for symptoms of serotonin syndrome if SSRIs are coadministered with safinamide.

• salicylates (non-asa)

  Monitor Closely (1)sertraline, salicylates (non-asa). Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• salsalate

  Monitor Closely (1)sertraline, salsalate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• SAMe

  Monitor Closely (1)sertraline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

• selegiline

  Contraindicated (1)selegiline and sertraline both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with a serotonergic drug.

• selegiline transdermal

  Serious - Use Alternative (1)selegiline transdermal and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.

• selinexor

  Serious - Use Alternative (1)selinexor, sertraline. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• selpercatinib

  Monitor Closely (1)selpercatinib increases toxicity of sertraline by QTc interval. Use Caution/Monitor.

• selumetinib

  Serious - Use Alternative (1)sertraline will increase the level or effect of selumetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors cannot be avoided, reduce selumetinib dosage (refer to selumetinib monograph for further information). After discontinuation of the strong or moderate CYP3A4 inhibitor for 3 elimination half-lives, resume selumetinib dose that was taken before initiating the inhibitor.

• siponimod

  Serious - Use Alternative (1)sertraline will increase the level or effect of siponimod by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of siponimod with a moderate or strong CYP3A4 inhibitor PLUS a moderate or strong CYP2C9 inhibitor is not recommended.

• sodium sulfate/?magnesium sulfate/potassium chloride

  Monitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases effects of sertraline by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.

• sodium sulfate/potassium sulfate/magnesium sulfate

  Monitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases effects of sertraline by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.

• sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

  Monitor Closely (1)sertraline, sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.

• sonidegib

  Monitor Closely (1)sertraline will increase the level or effect of sonidegib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Avoid coadministration of sonidegib with moderate CYP3A4 inhibitors. If a moderate CYP3A inhibitor must be used, administer the moderate CYP3A inhibitor for <14 days and monitor closely for adverse reactions, particularly musculoskeletal adverse reactions.

• sorafenib

  Monitor Closely (1)sorafenib and sertraline both increase QTc interval. Use Caution/Monitor.

• St John's Wort

  Serious - Use Alternative (1)sertraline and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.

• stiripentol

  Monitor Closely (2)stiripentol, sertraline. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.
  
  stiripentol will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of CYP2C19 substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

• sufentanil

  Serious - Use Alternative (1)sufentanil, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

• sufentanil SL

  Monitor Closely (2)sufentanil SL, sertraline. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
  
  sertraline will increase the level or effect of sufentanil SL by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of sufentanil SL with any CYP3A4 inhibitor may increase sufentanil plasma concentration, and, thereby increase or prolonged adverse effects, including potentially fatal respiratory depression.

• sulfasalazine

  Monitor Closely (1)sertraline, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• sulindac

  Monitor Closely (1)sertraline, sulindac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• sumatriptan

  Monitor Closely (1)sumatriptan and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)sertraline, sumatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• sumatriptan intranasal

  Monitor Closely (1)sumatriptan intranasal and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)sertraline, sumatriptan intranasal. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.

• suvorexant

  Monitor Closely (1)sertraline will increase the level or effect of suvorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease suvorexant starting dose to 5 mg HS if coadministered with moderate CYP3A4 inhibitors

• tadalafil

  Monitor Closely (1)sertraline will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inhibitors may reduce tadalafil clearance increasing systemic exposure to tadalafil; increased levels may result in increased associated adverse events.

• tamoxifen

  Monitor Closely (1)sertraline decreases effects of tamoxifen by decreasing metabolism. Use Caution/Monitor. Inhibition of CYP2D6 metabolism to tamoxifen's active metabolite, endoxifen.

• tamsulosin

  Monitor Closely (1)sertraline increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tapentadol

  Monitor Closely (1)sertraline and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.

• tazemetostat

  Serious - Use Alternative (1)sertraline will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of tazemetostat with moderate CYP3A4 inhibitors. If coadministration is unavoidable, reduce tazemetostat current dose (see drug monograph Dosage Modifications).

• tecovirimat

  Monitor Closely (1)tecovirimat will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Tecovirimat is a weak inhibitor of CYP2C8 and CYP2C19. Monitor for adverse effects if coadministered with sensitive substrates of these enzymes.

• tedizolid

  Serious - Use Alternative (1)tedizolid, sertraline. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.

• terbinafine

  Monitor Closely (1)terbinafine will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• tezacaftor

  Monitor Closely (1)sertraline will increase the level or effect of tezacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust tezacaftor dosage regimen if coadministered with a moderate CYP3A inhibitor.

• thioridazine

  Contraindicated (1)sertraline increases levels of thioridazine by decreasing metabolism. Contraindicated. Risk of long QT syndrome.Serious - Use Alternative (1)sertraline will increase the level or effect of thioridazine by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.

• timolol

  Monitor Closely (1)sertraline will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tinidazole

  Monitor Closely (1)sertraline will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tofacitinib

  Monitor Closely (1)sertraline increases levels of tofacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. No specific dose adjustment recommended when tofacitinib coadministered with moderate CYP3A4 inhibitors; decrease tofacitinib dose if coadministered with both moderate CYP3A4 and potent CYP2C19 inhibitors.

• tolfenamic acid

  Monitor Closely (1)sertraline, tolfenamic acid. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• tolmetin

  Monitor Closely (1)sertraline, tolmetin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

• tolterodine

  Minor (1)sertraline will increase the level or effect of tolterodine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• torsemide

  Minor (1)torsemide, sertraline. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.

• trabectedin

  Monitor Closely (1)sertraline will increase the level or effect of trabectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tramadol

  Monitor Closely (3)sertraline and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.
  
  sertraline decreases effects of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.
  
  sertraline decreases effects of tramadol by decreasing metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.

• tranylcypromine

  Contraindicated (1)tranylcypromine and sertraline both increase serotonin levels. Contraindicated.

• trazodone

  Serious - Use Alternative (1)sertraline and trazodone both increase serotonin levels. Avoid or Use Alternate Drug.

• triclabendazole

  Monitor Closely (1)triclabendazole will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. If plasma concentrations of the CYP2C19 substrates are elevated during triclabendazole, recheck plasma concentration of the CYP2C19 substrates after discontinuation of triclabendazole.

• trifluoperazine

  Minor (1)sertraline will increase the level or effect of trifluoperazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• trimipramine

  Serious - Use Alternative (1)sertraline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.

• tropisetron

  Minor (1)sertraline will increase the level or effect of tropisetron by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

• umeclidinium bromide/vilanterol inhaled

  Serious - Use Alternative (1)sertraline increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• valerian

  Monitor Closely (1)valerian and sertraline both increase sedation. Use Caution/Monitor.

• venetoclax

  Serious - Use Alternative (1)sertraline will increase the level or effect of venetoclax by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If a moderate CYP3A inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.

• venlafaxine

  Serious - Use Alternative (1)sertraline and venlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

• vilanterol/fluticasone furoate inhaled

  Serious - Use Alternative (1)sertraline increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vilazodone

  Serious - Use Alternative (1)sertraline, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .

• voclosporin

  Monitor Closely (2)voclosporin, sertraline. Either increases effects of the other by QTc interval. Use Caution/Monitor.
  
  sertraline will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

• vorapaxar

  Monitor Closely (1)sertraline, vorapaxar. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive antiplatelet effect may occur; SSRIs and SNRIs may cause platelet serotonin depletion .

• vortioxetine

  Serious - Use Alternative (1)sertraline, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

• warfarin

  Serious - Use Alternative (1)sertraline increases levels of warfarin by decreasing metabolism. Avoid or Use Alternate Drug.

• zanubrutinib

  Monitor Closely (2)sertraline will increase the level or effect of zanubrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce zanubrutinib dose when coadministered with a moderate CYP3A4 inhibitor. Interrupt dose as recommended for adverse reactions. After discontinuing the CYP3A4 inhibitor, resume previous dose of zanubrutinib. See zanubrutinib Dosage Modifications for precise recommendation.
  
  sertraline, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.

• ziprasidone

  Monitor Closely (1)sertraline and ziprasidone both decrease QTc interval. Modify Therapy/Monitor Closely.

• zolmitriptan

  Monitor Closely (1)zolmitriptan and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)sertraline, zolmitriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.