Sertraline erythromycin

Chloral hydrate Chloramphenicol Cimetidine Ciprofloxacin Clofibrate Danazol Disulfiram Doxycycline Erythromycin Fenofibrate Fluconazole Fluorouracil Fluoxetine Fluvoxamine Gemfibrozil Influenza vaccine Isoniazid Itraconazole Fovastatin Metronidazole Miconazole Moxalactam Neomycin Norfloxacin Ofloxacin Omeprazole Phenylbutazone Piroxicam Propafenone Propoyxphene Quinidine Sertraline Sulfamethoxazole Sulfinpyrazone Tamoxifen Testosterone Vitamin E Zafirlukast... 

Pimozide Drugs that prolong the QT interval - CYP3A inhibitors (eg, clarithromycin, dirithromycin, erythromycin, itraconazole, ketoconazole, nefazodone, protease inhibitors, sertraline, telithromycin, troleandomycin, voriconazole)... 

Intermittent claudication PO 100 mg twice a day at least 30 min before or 2 hr after meals. 50 mg twice a day during concurrent therapy with clarithromycin, diltiazem, erythromycin, fluconazole, fluoxetine, omeprazole, or sertraline. 

A4 Citalopram, escitalopram, TCAs, glucocorticoids, androgens/estrogens, carbamazepine, erythromycin, Ca2+ Fluvoxamine, nefazodone, sertraline, fluoxetine. Barbiturates, glucocorticoids. 

Cyt 3A3/4 metabolizes clozapine, sertindole, quetiapine common substrates -tricyclic antidepressants, nefazodone, sertraline, carbamazepine, ethosuximide, terfenadine, benzodiazepines, diltiazem, nifedipine, verapamil, erythromycin, cyclosporine, lidocaine, quinidine, cisapride, paracetamol. Common inhibitors -nefazodone, fluvoxamine, fluoxetine, ketoconazole. 

A 12-year-old boy developed the serotonin syndrome, which is normally associated with the interaction of two or more serotonergic agents, after the co-adminis-tration of erythromycin and sertraline. 

This could have been due to erythromycin-induced inhibition of sertraline metabolism by CYP3A (102). 

Lee DO, Lee CD. Serotonin syndrome in a child associated with erythromycin and sertraline. Pharmacotherapy 1999 19(7) 894-6. 

Drug interactions leading to the serotonin syndrome usually result from pharmacodynamic mechanisms. However, the antibiotic erythromycin may have precipitated the serotonin syndrome in a patient taking sertraline by a pharmacokinetic mechanism (22). 

A 12-year-old boy, who had taken sertraline 37.5 mg/day for 5 weeks for obsessive-compulsive disorder, started to take erythromycin 200 mg bd. Within 4 days he began to feel anxious this was followed over the next 10 days by panic, restlessness, irritability, tremulousness, and confusion. These symptoms resolved within 72 hours of withdrawal of sertraline and erythromycin. 

The authors proposed that in this case erythromycin had inhibited sertraline metabolism by inhibiting CYP3A. This could have led to increased concentrations of sertraline and signs of serotonin toxicity. Unfortunately sertraline concentrations were not measured to confirm this suggestion. 

Erythromycin An isolated report describes the development of what was thought to be serotonin syndrome in a 12-year-old child taking sertraline when erythromycin was added. 

Clinically important, potentially hazardous interactions with amiodarone, azithromycin, bepredil, bosentan, bretylium, cisapride, clarithromycin, disopyramide, erythromycin, erythromycin fluconazole, fluoxetine, fluvoxamine, grapefruit juice, indinavir, itraconazole, ketoconazole, metronidazole, miconazole, nefazodone, nilotinib, paroxetine, pimozide, probucol, procainamide, quinidine, quinine, ritonavir, saquinavir, sertraline, sotalol, SSRIs, terfenadine, troleandomycin, voriconazole, zileuton, ziprasidone... 

Clinically important, potentially hazardous interactions with aprepitant, astemizole, carbamazepine, colchicine, cyclosporine, dihydroergotamine, ergot alkaloids, ergotamine, erythromycin, fluoxetine, fluvoxamine, methylprednisolone, methysergide, oral contraceptives, paroxetine, pimozide, prednisolone, rifampicin, sertraline, solifenacin, terfenadine, warfarin... 

In view of these effects the US manufacturers suggest halving the dose of cilostazol in the presence ofCYP3A4 inhibitors such as erythromycin, diltiazem, itraconazole, and ketoconazole. However, the UK manufacturers contraindicate CYP3A4 inhibitors, and they specifically name erythromycin, diltiazem, ketoconazole, cimetidine, and the protease inhibitors. Just why these recommendations differ is not clear. The US manufacturers suggest that other CYP3A4 inhibitors, such as azole anti-fungals (fluconazole, miconazole), SSRIs (fluoxetine, fluvoxamine, sertraline) and nefazodone, may also interact. ... 

A second large class of agents known to form mechanism-based quasi-irreversible P450-MI complex es [15, 24, 25, 138, 139, 223-228] includes alkyl and aromatic amines, such as the monoamine oxidase inhibitor cloigyhne [223], the SSRI sertraline [228], and many clinically useful macrolide antibiotics such as troleando-mycin (TAO), clarithromycin, and erythromycin (Fig. 5.6 [229-235]). These amines are oxidized... 

---