the level or effect of trifluoperazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.tropisetronsertraline will increase the level or effect of tropisetron by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.zolmitriptansertraline, zolmitriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.5-HTPMonitor Closely (1)sertraline and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.abirateroneMonitor 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.acalabrutinibMonitor 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.aceclofenacMonitor 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.acemetacinMonitor 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.adagrasibSerious - Use Alternative (1)adagrasib, sertraline. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.albuterolMonitor Closely (1)albuterol and sertraline both increase QTc interval. Use Caution/Monitor.alfentanilSerious - Use Alternative (1)alfentanil, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.alfuzosinMonitor Closely (2)sertraline and alfuzosin both increase QTc interval. Use Caution/Monitor. alfuzosin and sertraline both increase QTc interval. Use Caution/Monitor.almotriptanMonitor 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.amifampridineMonitor 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.amiodaroneSerious - Use Alternative (1)sertraline and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.amisulprideSerious - Use Alternative (1)amisulpride and sertraline both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.amitriptylineMonitor Closely (1)sertraline and amitriptyline both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)sertraline and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.amoxapineMonitor Closely (1)sertraline and amoxapine both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)sertraline and amoxapine both increase serotonin levels. Avoid or Use Alternate Drug.anagrelideSerious - Use Alternative (1)sertraline and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.apalutamideSerious - 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.apixabanMonitor Closely (1)sertraline and apixaban both increase anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.apomorphineMonitor Closely (1)apomorphine and sertraline both increase QTc interval. Use Caution/Monitor.arformoterolMonitor Closely (1)arformoterol and sertraline both increase QTc interval. Use Caution/Monitor.aripiprazoleMonitor 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.arsenic trioxideSerious - Use Alternative (1)sertraline and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.artemetherSerious - Use Alternative (1)artemether and sertraline both increase QTc interval. Avoid or Use Alternate Drug.artemether/lumefantrineSerious - Use Alternative (1)sertraline and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.asenapineSerious - Use Alternative (1)sertraline and asenapine both increase QTc interval. Avoid or Use Alternate Drug.asenapine transdermalSerious - Use Alternative (1)asenapine transdermal and sertraline both increase QTc interval. Avoid or Use Alternate Drug.aspirinMonitor 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 rectalMonitor 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 bicarbonateMonitor 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.atazanavirMonitor Closely (1)atazanavir increases levels of sertraline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .atogepantMonitor Closely (1)sertraline will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.atomoxetineMonitor 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.avanafilMonitor 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 inhibitorsavapritinibSerious - 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.axitinibSerious - 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 .azithromycinMinor (1)azithromycin increases toxicity of sertraline by QTc interval. Minor/Significance Unknown.bedaquilineMonitor Closely (1)sertraline and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closelybenzhydrocodone/acetaminophenMonitor 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.betrixabanMonitor 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.bosutinibSerious - Use Alternative (1)sertraline increases levels of bosutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.brexpiprazoleMonitor 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.bumetanideMinor (1)bumetanide, sertraline. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.buprenorphineSerious - Use Alternative (1)sertraline and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine buccalSerious - Use Alternative (1)buprenorphine buccal and sertraline both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine subdermal implantMonitor 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.Serious - Use Alternative (1)buprenorphine subdermal implant and sertraline both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine transdermalSerious - Use Alternative (1)buprenorphine transdermal and sertraline both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine, long-acting injectionMonitor 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.Serious - Use Alternative (1)buprenorphine, long-acting injection and sertraline both increase QTc interval. Avoid or Use Alternate Drug.bupropionMonitor 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.buspironeSerious - Use Alternative (1)sertraline and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.cabozantinibMonitor Closely (1)sertraline will increase the level or effect of cabozantinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cannabidiolMonitor 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. carbamazepineMinor (1)sertraline increases levels of carbamazepine by decreasing metabolism. Minor/Significance Unknown.carvedilolMonitor Closely (1)sertraline will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.celandineMinor (1)celandine decreases effects of sertraline by pharmacodynamic antagonism. Minor/Significance Unknown. Based on animal studies.celecoxibMonitor 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.cenobamateMonitor 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. ceritinibSerious - Use Alternative (1)ceritinib and sertraline both increase QTc interval. Avoid or Use Alternate Drug.chloroquineMinor (1)chloroquine increases toxicity of sertraline by QTc interval. Minor/Significance Unknown.chlorpromazineSerious - Use Alternative (1)sertraline and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)sertraline will increase the level or effect of chlorpromazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.choline magnesium trisalicylateMonitor 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.cilostazolMonitor 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).ciprofloxacinMonitor Closely (1)sertraline and ciprofloxacin both increase QTc interval. Use Caution/Monitor.citalopramSerious - 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.clarithromycinSerious - Use Alternative (1)clarithromycin and sertraline both increase QTc interval. Avoid or Use Alternate Drug.clobazamMonitor 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. clomipramineMonitor Closely (1)sertraline will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)sertraline and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug. sertraline and clomipramine both