8 known interactions • 3 major • 5 moderate • 0 minor
Always disclose all medications to your healthcare providers — prescription medicines, OTC medications, vitamins, and herbal supplements. This list may not include every possible interaction. Use our Medicine Interaction Checker to screen your complete medication list.
Potentially life-threatening or causing permanent damage. Avoid combination.
May worsen condition or require dose adjustment. Monitor closely.
Usually limited clinical effect. Manage with routine monitoring.
MAOIs (phenelzine, tranylcypromine, selegiline)
Potentially fatal serotonin syndrome. Sertraline must not be used with MAOIs or within 14 days of stopping an MAOI. After stopping sertraline, wait 14 days before starting an MAOI.
Management: ABSOLUTE CONTRAINDICATION. 14-day washout period required.
Linezolid / IV methylene blue
Both have serotonergic activity. Combined with sertraline, risk of serotonin syndrome is significant.
Management: Contraindicated. If linezolid is urgently needed, discontinue sertraline.
Pimozide
Sertraline inhibits CYP2D6 which metabolizes pimozide, potentially causing QTc prolongation and fatal arrhythmia.
Management: Contraindicated.
Warfarin
Sertraline can increase bleeding risk and may affect PT/INR. SSRIs inhibit platelet function via serotonin depletion.
Management: Monitor INR closely when starting, adjusting, or stopping sertraline in patients on warfarin.
NSAIDs (ibuprofen, naproxen, aspirin)
Concurrent use increases risk of GI bleeding due to additive antiplatelet effects.
Management: Use with caution. Consider gastroprotection (PPI) if concomitant use is necessary.
Tramadol
Tramadol is serotonergic; combined with sertraline, risk of serotonin syndrome. Also, sertraline inhibits CYP2D6, reducing tramadol activation to the active metabolite O-desmethyltramadol.
Management: Monitor for serotonin syndrome symptoms. Reduce tramadol dose if needed.
Triptans (sumatriptan, rizatriptan)
Weak serotonergic interaction; FDA has issued warnings but evidence for true serotonin syndrome is limited.
Management: Use cautiously; monitor for serotonin syndrome symptoms.
Lithium
Pharmacodynamic interaction increases serotonergic activity. May increase lithium toxicity risk.
Management: Monitor lithium levels and for signs of serotonin syndrome.
Always ask your pharmacist about potential interactions with food, alcohol, and supplements specific to Sertraline. Some medicines have significant interactions with grapefruit juice, high-fat meals, dairy products, or vitamin K-rich foods.