9 Sertraline (Zoloft) Interactions to Watch For

Sertraline (Zoloft) is a commonly prescribed antidepressant. It treats mental health conditions like anxiety and depression. It's part of the selective serotonin reuptake inhibitor (SSRI) medication class. It's thought to work by raising serotonin levels in the brain.

Sertraline can interact with other medications and substances. This often causes worse side effects. But some interactions can cause more serious problems.

Below, we'll cover nine sertraline interactions and ways you might manage them. But be sure to share a current medication list with your prescriber and pharmacist so they can more closely check for interactions.

1. Monoamine oxidase inhibitors

Monoamine oxidase inhibitors (MAOIs) are an older group of medications prescribed for Parkinson's disease and depression. They include medications like phenelzine (Nardil) and selegiline (Zelapar, Emsam). The antibiotic linezolid (Zyvox) is also an example. MAOIs are notorious for having many interactions and side effects.

Both MAOIs and sertraline raise serotonin levels in the brain. Combining these medications raises the risk of a condition called serotonin syndrome. This happens when the brain has too much serotonin, and it can be dangerous.

People with serotonin syndrome tend to experience mild symptoms such as tremors or sweating. But they could have severe symptoms like high fever and rigid muscles. Contact your prescriber for next steps if you notice any symptoms that resemble serotonin syndrome.

Luckily, serotonin syndrome is rare. And, it's unlikely if you're only taking one medication that raises serotonin levels. Taking more than one of these medications at the same time can make serotonin syndrome more likely.

You should avoid taking sertraline while taking an MAOI. If you're stopping one of these medications, you'll need to wait at least 14 days (2 weeks) before starting the other. Your prescriber and pharmacist can help you make sure to avoid this combination.

2. Other medications that raise serotonin levels

Sertraline and MAOIs aren't the only medications that affect serotonin. In fact, many medications raise serotonin levels. And combining any of them with sertraline raises the risk of serotonin syndrome.

Examples include:

• Tricyclic antidepressants (TCAs), like nortriptyline (Pamelor) and amitriptyline

• Serotonin and norepinephrine reuptake inhibitors (SNRIs), like duloxetine (Cymbalta)

• Other SSRIs, like fluoxetine (Prozac)

• Certain opioids, like tramadol (Qdolo, ConZip)

• Triptan migraine medications, like sumatriptan (Imitrex)

• St. John's wort, an herbal supplement

Keep in mind this isn't a comprehensive list. It's always a good idea to check with your healthcare team before starting sertraline. They can help lower your risk for serotonin syndrome.

3. Blood thinners

Blood thinners are medications that prevent and treat blood clots. There are a few types of blood thinners, including anticoagulants and antiplatelets. Since blood thinners make it harder for your blood to clot, you have a higher risk of bleeding. Sertraline can also raise your risk for bleeding. Taking blood thinners with sertraline raises this risk even more.

Commonly prescribed blood thinners include:

• Warfarin (Coumadin, Jantoven)

• Dabigatran (Pradaxa)

• Rivaroxaban (Xarelto)

• Clopidogrel (Plavix)

• Aspirin

Your prescriber can determine your level of risk with this sertraline interaction. Some people may have a lower chance of bleeding overall. In this case, a prescriber may OK this combination. In other cases, they might suggest medication changes to avoid this interaction.

If you're taking sertraline and a blood thinner, watch for unusual bleeding. Symptoms can include bleeding from your gums while brushing your teeth, nosebleeds, or bruising. More serious symptoms may include red or black stools and blood in your urine. Let your prescriber know if you notice any new or excessive bleeding.

4. NSAIDs such as ibuprofen

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a well-known class of pain relievers. They include medications like ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). NSAIDs have a number of potentially serious gastrointestinal side effects, including stomach ulcers and bleeding. If you combine Zoloft and NSAIDs, your risk of these complications goes up.

The risks with the interaction are highest if you're taking NSAIDs routinely or at higher doses. Lower doses and occasional use of medications like ibuprofen isn't typically a problem for most people. But you should still check with your prescriber to make sure it's safe for you to take NSAIDs while you're taking Zoloft.

5. Medications that affect heart rhythm

A long QT interval is a problematic side effect of some medications. The QT interval refers to the time when the heart relaxes between beats. A prolonged (lengthened) QT interval raises the risk for abnormal heart rhythms.

When taken by itself, sertraline has a low risk of prolonging the QT interval. This risk goes up when it's combined with other medications that also have this effect. Symptoms of a long QT interval include fainting, palpitations, or dizziness. In severe cases, heart attack and death are possible.

Other medications that can prolong the QT interval include:

• Pimozide (should be completely avoided while taking sertraline)

• Some antibiotics like ciprofloxacin (Cipro) or azithromycin (Zithromax)

• Antiarrhythmic medications, like amiodarone (Pacerone) or sotalol (Betapace)

• Other antidepressants like citalopram (Celexa)

• Opioids like methadone (Methadose)

• Antipsychotics like ziprasidone (Geodon) or haloperidol (Haldol)

• Oral azole antifungal medications like fluconazole (Diflucan)

It's best to avoid combining medications that prolong the QT interval when possible. Your prescriber may recommend medication changes to avoid this Zoloft interaction. They may also OK the combination and check your heart rhythm at follow-up visits.

6. Phenytoin

Phenytoin (Dilantin, Phenytek) is an antiseizure medication. It's an example of a narrow therapeutic index medication. This means small changes in medication levels can have big effects.

Sertraline can raise levels of phenytoin in the body. This can raise the risk of phenytoin's side effects, such as drowsiness and slurred speech. Your prescriber may need to adjust your phenytoin dose while taking sertraline. This also applies to fosphenytoin (Cerebyx). This is an injectable medication that's similar to phenytoin.

Your prescriber should routinely check your blood levels of phenytoin. This will help them make sure you're taking the right dose. They may check them more often when you first start taking sertraline or after a dose change.

7. Medications broken down by certain liver enzymes

Sertraline affects how the liver processes some medications. It makes a certain liver enzyme (protein) less active. This means that medications broken down by this enzyme reach higher levels in the body. This can raise the risk of side effects with these other medications.

Examples of medications that have this issue include:

• Propafenone (Rythmol SR)

• Risperidone (Risperdal)

• Flecainide

• Tolterodine (Detrol, Detrol LA)

• Metoprolol (Lopressor, Toprol XL)

• Atomoxetine (Strattera)

• Venlafaxine

This isn't a full list. Your pharmacist can tell you if you take other medications that have this sertraline interaction. If you're taking any medications that have this issue, you may need a lower dose when taking sertraline. Your prescriber can figure out whether you need any dose changes.

8. Antabuse (disulfiram)

Antabuse (disulfiram) is a medication prescribed for people with alcohol use disorder. It interacts with the liquid form of sertraline - not the tablets. Sertraline solution contains 12% alcohol. You shouldn't consume any alcohol while taking Antabuse, even when it's an inactive ingredient of other medications.

Taking Antabuse with sertraline solution can cause an unpleasant side effect called the "disulfiram-alcohol reaction." Symptoms of this reaction include vomiting, sweating, and flushing. In rare cases, more severe symptoms, such as heart palpitations and trouble breathing, can also occur.

Make sure all of your healthcare team members know if you take Antabuse. They can help make sure you're not taking any medications that contain alcohol.

Good to know: Brand-name Antabuse is no longer manufactured. It's only available as a generic medication. But many people still call this medication by its brand name.

9. Alcohol

Alcohol can interact with many medications. Often, it boosts medication side effects. There's no amount of alcohol that's considered safe to drink. This is especially true when taking sertraline. In fact, the medication's labeling recommends avoiding alcohol.

Combining alcohol with sertraline can worsen side effects. Symptoms can include excessive drowsiness or dizziness. On top of that, worsening depression and sleep changes are also possible.

It's best to completely avoid alcohol while taking sertraline. But if you're interested in consuming an alcoholic beverage every now and then, your prescriber can talk with you more about your unique risks with consuming alcohol.

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