Sertraline has a number of drug-drug interactions of which clinicians need to be aware. Because the drug is tightly bound to plasma proteins, caution should be employed when sertraline is used in combination with pharmaceuticals possessing similar characteristics, such as warfarin, and prothrombin time should be monitored when sertraline and warfarin are used concurrently ("Zoloft" 2001). The potential for serotonin syndrome may be increased when sertraline is combined with other SSRls, serotonin-norepinephrine reuptake inhibitors, or triptans used for the acute treatment of migraines. The administration of sertraline and MAOIs is contraindicated because of the significant risk of serotonin syndrome with this combination.
As discussed earlier, sertraline inhibits a number of enzymes in the cytochrome P450 system, most significantly CYP2D6. However, the degree of inhibition is relatively minor in comparison with other SSRls, such as fluoxetine and paroxetine (Preskorn et al. 2007). Because TCAs are substrates of CYP2D6, drug levels and dosages need to be closely monitored when TCAs are used in combination with sertraline.
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