Aurasert Drug Interactions

Cases of serious, sometimes fatal, reactions have been reported in patients receiving sertraline, in combination with a monoamine oxidase inhibitor (MAOI). Symptoms of a drug interaction between an SSRI and a MAOI include: hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, mental status changes that include confusion, irritability, and extreme agitation progressing to delirium and coma. Some cases presented with features resembling neuroleptic malignant syndrome. Therefore, sertraline should not be used in combination with a MAOI or within 14 days of discontinuing treatment with a MAOI. Similarly, at least 14 days should be allowed after stopping sertraline before starting a MAOI (see also Contraindications).
Concurrent use of intravenous diazepam with sertraline may reduce the clearance and prolong the half-life diazepam.
Caution is recommended during concurrent use of digitoxin and warfarin with sertraline because of possible displacement of either medication from protein binding sites. This may lead to increase plasma concentrations and increased risk of adverse effects. Prothrombin time should be caredully monitored when sertraline therapy is initiated or stopped in patients taking warfarin. Drugs metabolized by cytochrome P450 2D6: sertraline inhibits the biochemical activity of the drug metabolizing isozyme P450 2D6 and, thus may increase the plasma concentration of co-administered drugs (which are metabolized by P450 2D6) such as tricyclic antidepressants and type IC antiarrhythmics, propafenone and flecainide: dose reduction may be required.
Nonetheless, it is recommended that plasma lithium levels be monitored following initiation of sertraline therapy with appropriate adjustments to the lithium dose.