increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.SAMeMonitor Closely (1)sertraline and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.saquinavirSerious - Use Alternative (1)sertraline and saquinavir both increase QTc interval. Avoid or Use Alternate Drug.selegilineContraindicated (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 transdermalSerious - Use Alternative (1)selegiline transdermal and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.selinexorSerious - 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.selpercatinibMonitor Closely (1)selpercatinib increases toxicity of sertraline by QTc interval. Use Caution/Monitor.selumetinibSerious - 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.serdexmethylphenidate/dexmethylphenidateMinor (1)serdexmethylphenidate/dexmethylphenidate increases effects of sertraline by decreasing metabolism. Minor/Significance Unknown.sevofluraneSerious - Use Alternative (1)sevoflurane and sertraline both increase QTc interval. Avoid or Use Alternate Drug.siponimodSerious - Use Alternative (3)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. sertraline and siponimod both increase QTc interval. Avoid or Use Alternate Drug. siponimod and sertraline both increase QTc interval. Avoid or Use Alternate Drug.sodium sulfate/?magnesium sulfate/potassium chlorideMonitor 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 chloride/magnesium sulfate/polyethylene glycolMonitor Closely (1)sertraline, sodium sulfate/potassium chloride/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.sodium sulfate/potassium sulfate/magnesium sulfateMonitor 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.solifenacinMonitor Closely (1)sertraline and solifenacin both increase QTc interval. Use Caution/Monitor.sonidegibMonitor 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.sorafenibMonitor Closely (1)sorafenib and sertraline both increase QTc interval. Use Caution/Monitor.sotalolMonitor Closely (1)sertraline and sotalol both increase QTc interval. Use Caution/Monitor.sparsentanMonitor Closely (2)sertraline will increase the level or effect of sparsentan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. No dosage adjustment needed. Monitor blood pressure, serum potassium, edema, and kidney function regularly if sparsentan is coadministered with moderate CYP3A4 inhibitors. sparsentan will decrease the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Sparsentan (a CYP2C19 inducer) decreases exposure of CYP2C19 substrates and reduces efficacy related to these substrates. St John's WortSerious - Use Alternative (1)sertraline and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.stiripentolMonitor 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.sufentanilSerious - Use Alternative (1)sufentanil, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.sufentanil SLMonitor 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.sulfasalazineMonitor 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.sulindacMonitor 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.sumatriptanMonitor 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 intranasalMonitor 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.sunitinibMonitor Closely (1)sertraline and sunitinib both increase QTc interval. Use Caution/Monitor.suvorexantMonitor 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 inhibitorstacrolimusMonitor Closely (1)sertraline and tacrolimus both increase QTc interval. Use Caution/Monitor.tadalafilMonitor 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. tamoxifenMonitor Closely (1)sertraline decreases effects of tamoxifen by decreasing metabolism. Use Caution/Monitor. Inhibition of CYP2D6 metabolism to tamoxifen's active metabolite, endoxifen.tamsulosinMonitor Closely (1)sertraline increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.tapentadolMonitor Closely (1)sertraline and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.tazemetostatSerious - 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). tecovirimatMonitor 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.tedizolidSerious - 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.telavancinMonitor Closely (1)sertraline and telavancin both increase QTc interval. Use Caution/Monitor.terbinafineMonitor 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.tetrabenazineSerious - Use Alternative (1)sertraline and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.tezacaftorMonitor 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.thioridazineContraindicated (2)sertraline increases levels of thioridazine by decreasing metabolism. Contraindicated. Risk of long QT syndrome. sertraline and thioridazine both increase QTc interval. Contraindicated.Serious - Use Alternative (1)sertraline will increase the level or effect of thioridazine by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated.timololMonitor Closely (1)sertraline will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.tinidazoleMonitor Closely (1)sertraline will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tofacitinibMonitor 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 acidMonitor 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.tolmetinMonitor 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.tolterodineMinor (1)sertraline will increase the level or effect of tolterodine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.toremifeneSerious - Use Alternative (1)sertraline and toremifene both increase QTc interval. Avoid or Use Alternate Drug.torsemideMinor (1)torsemide, sertraline. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.trabectedinMonitor Closely (1)sertraline will increase the level or effect of trabectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tramadolMonitor 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.tranylcypromineContraindicated (1)tranylcypromine and sertraline both increase serotonin levels. Contraindicated.trazodoneSerious - Use Alternative (2)sertraline and trazodone both increase serotonin levels. Avoid or Use Alternate Drug. sertraline and trazodone both increase QTc interval. Avoid or Use Alternate Drug.triclabendazoleMonitor Closely (2)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. sertraline and triclabendazole both increase QTc interval. Use Caution/Monitor.trifluoperazineMonitor Closely (1)sertraline and trifluoperazine both decrease QTc interval. Use Caution/Monitor.Minor (1)sertraline will increase the level or effect of trifluoperazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.trimipramineSerious - Use Alternative (2)sertraline and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug. sertraline and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.triptorelinMonitor Closely (1)sertraline and triptorelin both increase QTc interval. Use Caution/Monitor.tropisetronMinor (1)sertraline will increase the level or effect of tropisetron by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.umeclidinium bromide/vilanterol inhaledSerious - 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.valbenazineMonitor Closely (1)valbenazine and sertraline both increase QTc interval. Use Caution/Monitor.valerianMonitor Closely (1)valerian and sertraline both increase sedation. Use Caution/Monitor.vandetanibSerious - Use Alternative (1)sertraline and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.vardenafilMonitor Closely (2)sertraline and vardenafil both increase QTc interval. Use Caution/Monitor. sertraline will increase the level or effect of vardenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Vardenafil dose may need to be reduced if coadministered with moderate or strong CYP3A4 inhibitors vemurafenibSerious - Use Alternative (1)sertraline and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.venetoclaxSerious - 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.venlafaxineSerious - Use Alternative (2)sertraline and venlafaxine both increase serotonin levels. Avoid or Use Alternate Drug. sertraline and venlafaxine both decrease QTc interval. Avoid or Use Alternate Drug.vilanterol/fluticasone furoate inhaledSerious - 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.vilazodoneSerious - 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. .voclosporinMonitor 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.vorapaxarMonitor 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 .voriconazoleMonitor Closely (1)sertraline and voriconazole both increase QTc interval. Use Caution/Monitor.vorinostatMonitor Closely (1)sertraline and vorinostat both increase QTc interval. Use Caution/Monitor.vortioxetineSerious - Use Alternative (1)sertraline, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.warfarinMonitor Closely (1)sertraline, warfarin. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.