Sertraline Cimetidine

Use of die MAOIs must be discontinued 2 weeks before the administration of die SSRIs. When the SSRIs are administered witii die tricyclic antidepressants, tiiere is an increased risk of toxic effects and an increased tiierapeutic effect. When sertraline is administered witii a MAOI, a potentially fatal reaction can occur. Sjymptoms of a serious reaction include hyper-tiiermia, rigidity, autonomic instability witii fluctuating vital signs and agitation, delirium, and coma Sertraline blood levels are increased when administered witii cimetidine. 

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... 

Haloperidol Fluoxetine214 Methadone Mibefradil Paroxetine214 Quinidine3 " Sertraline Terbinafine Cimetidine Qarithro- mycin" 4 Gestodene Nelfinavir"4 Verapamil ... 

Clinically important, potentially hazardous interactions with cimetidine, dihydroergotamine, ergot, fluoxetine, fluvoxamine, isocarboxazid, MAO inhibitors, methysergide, moclobemide, naratriptan, oral contraceptives, phenelzine, rizatriptan, sertraline, sibutramine, St John s wort, sumatriptan, tranylcypromine... 

Also analyzed acebutolol, acepromazine, acetaminophen, acetazolamide, acetophenazine, albuterol, amitriptyline, amobarbital, amoxapine, antipsrrine, atenolol, atropine, azata-dine, baclofen, benzocaine, bromocriptine, brompheniramine, brotizolam, bupivacaine, buspirone, butabarbital, butalbital, caffeine, carbamazepine, cetirizine, chlorqyclizine, chlordiazepoxide, chlormezanone, chloroquine, chlorpheniramine, chlorpromazine, chlorpropamide, chlorprothixene, chlorthalidone, chlorzoxazone, cimetidine, cisapride, clomipramine, clonazepam, clonidine, clozapine, cocaine, codeine, colchicine, qyclizine, (yclo-benzaprine, dantrolene, desipramine, diazepam, diclofenac, diflunisal, diltiazem, diphenhydramine, diphenidol, dipheno late, dipyridamole, disopyramide, dobutamine, doxapram, doxepin, droperidol, encainide, ethidium bromide, ethopropazine, fenoprofen, fentanyl, flavoxate, fluoxetine, fluphenazine, flurazepam, flurbiprofen, fluvoxamine, fii-rosemide, glutethimide, glyburide, guaifenesin, haloperidol, homatropine, hydralazine, hydrochlorothiazide, hydrocodone, hydromorphone, hydro g chloroquine, hydroxyzine, ibuprofen, imipramine, indomethacin, ketoconazole, ketoprofen, ketorolac, labetalol, le-vorphanol, lidocaine, loratadine, lorazepam, lovastatin, loxapine, mazindol, mefenamic acid, meperidine, mephenytoin, mepivacaine, mesoridazine, metaproterenol, methadone, methdilazine, methocarbamol, methotrexate, methotrimeprazine, methoxamine, methyl-dopa, methylphenidate, metoclopramide, metolazone, metoprolol, metronidazole, midazolam, moclobemide, morphine, nadolol, nalbuphine, naloxone, naphazoline, naproxen, nifedipine, nizatidine, norepinephrine, nortriptyline, oxazepam, oxycodone, oxymetazo-line, paroxetine, pemoline, pentazocine, pentobarbital, pentoxifylline, perphenazine, pheniramine, phenobarbital, phenol, phenolphthalein, phentolamine, phenylbutazone, phenyltoloxamine, phenytoin, pimozide, pindolol, piroxicam, pramoxine, prazepam, prazosin, probenecid, procainamide, procaine, prochlorperazine, procyclidine, promazine, promethazine, propafenone, propantheline, propiomazine, propofol, propranolol, protriptyline, quazepam, quinidine, quinine, racemethorphan, ranitidine, remoxipride, risperidone, salicylic acid, scopolamine, secobarbital, sertraline, sotalol, spironolactone, sulfinpyrazone, sulindac, temazepam, terbutaline, terfenadine, tetracaine, theophylline, thiethyl-perazine, thiopental, thioridazine, thiothixene, timolol, tocainide, tolbutamide, tolmetin, trazodone, triamterene, triazolam, trifluoperazine, triflupromazine, trimeprazine, trimethoprim, trimipramine, verapamil, warfarin, xylometazoline, yohimbine, zopiclone... 

A two-period crossover, double-blind study in 20 subjects given fluoxetine 20 mg or a placebo daily for 28 days, with zolmitriptan 10 mg on day 28, found that the pharmacokinetics of zolmitriptan were unaffected by fluoxetine. Only very slight changes were seen in the pharmacokinetics of its active metabolite. Sertraline, paroxetine, and citalopram are also not expected to alter the pharmacokinetics of zolmitriptan. However, fluvoxamine, a CYP1A2 inhibitor, is predicted to increase levels of zolmitriptan, based on the known interaction with cimetidine (see Triptans Zolmitriptan + Cimetidine , p.608). 

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. ... 

Citalopram, escitalopram, paroxetine and sertraline levels are moderately increased by cimetidine but the only clinically relevant effect appears to be a slight increase in adverse effects with sertraline. 

Invicta Pharmaceuticals. Phase 1 study to assess the potential of cimetidine to alter the disposition of sertraline in normal, healthy male volunteers. Data on file (Study 050-019), 1991. 

In a randomised, two-way, crossover study, 12 healthy subjects were given a single 100-mg oral dose of sertraline after taking either cimetidine 800 mg or a placebo at bedtime for 7 days. Cimetidine increased the AUC of sertraline by 50%, the maximum serum levels of sertraline by 24%, and the half-life by 26%. There was a small increase in sertraline adverse effects (not specified) while taking the cimetidine. ... 

Information on the concurrent use of cimetidine and paroxetine or sertraline seems to be limited and the clinical significance of the changes in clearance is not known. However, it would be prudent to monitor the outcome for excessive adverse effects (dry mouth, nausea, diarrhoea, dyspepsia, tremor, ejaculatory delay, sweating) if cimetidine is used with either of these SSRIs and reduce the sertraline or paroxetine dosage if necessary. 

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