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Sertraline Oral Concentrate and Silenor

Determining the interaction of Sertraline Oral Concentrate and Silenor and the possibility of their joint administration.

Check result:

Sertraline Oral Concentrate <> Silenor

Relevance: 06.11.2023 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Before taking doxepin, tell your doctor if you also use sertraline. You may need dose adjustments or special tests in order to safely take both medications together. This combination may increase the effects of doxepin in your body. You should notify your doctor if you have symptoms of sedation, dry mouth, blurred vision, constipation, or urinary retention. You might also have altered consciousness, confusion, poor muscle coordination, abdominal cramping, shivering, pupillary dilation, sweating, high blood pressure, and high heart rate. It is important that you tell your healthcare provider about all other medications that you are using including vitamins and herbs. Do not stop using your medications without first talking to your doctor first.

Professional:

MONITOR CLOSELY: Coadministration with sertraline may increase the plasma concentrations of some tricyclic antidepressants (TCAs). The proposed mechanism is sertraline inhibition of CYP450 2D6, the isoenzyme responsible for the metabolic clearance of many antidepressant and psychotropic drugs. Moderate to significant increases (up to 250%) in plasma levels have been reported for desipramine and nortriptyline. Pharmacodynamically, the combination of sertraline (or any other selective serotonin reuptake inhibitor) and a TCA may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5HT1A receptors. The syndrome has been reported in a case involving sertraline and amitriptyline.

MANAGEMENT: Caution is advised if sertraline (or other SSRIs) is prescribed with TCAs. Pharmacologic response and plasma TCA levels should be monitored more closely whenever sertraline is added to or withdrawn from therapy in patients stabilized on their existing antidepressant regimen, and the TCA dosage adjusted as necessary. Patients should be monitored closely for signs and symptoms of TCA toxicity (e.g., sedation, dry mouth, blurred vision, constipation, urinary retention) and/or excessive serotonergic activity (e.g., CNS irritability, altered consciousness, confusion, myoclonus, ataxia, abdominal cramping, hyperpyrexia, shivering, pupillary dilation, diaphoresis, hypertension, and tachycardia).

References

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Corkeron MA "Serotonin syndrome - a potentially fatal complication of antidepressant therapy." Med J Aust 163 (1995): 481-2
Barros J, Asnis G "An interaction of sertraline and desipramine." Am J Psychiatry 150 (1993): 1751
Popli AP, Baldessarini RJ, Cole JO "Interactions of serotonin reuptake inhibitors with tricyclic antidepressants." Arch Gen Psychiatry 51 (1994): 666-7
Ereshefsky L, Riesemman C, Lam YW "Antidepressant drug interactions and the cytochrome P450 system. The role of cytochrome P450 2D6." Clin Pharmacokinet 29(Suppl 1) (1995): 10-8; discussion 18-9
Kurtz DL, Bergstrom RF, Goldberg MJ, Cerimele BJ "The effect of sertraline on the pharmacokinetics of desipramine and imipramine." Clin Pharmacol Ther 62 (1997): 145-56
Riesenman C "Antidepressant drug interactions and the cytochrome p450 system: a critical appraisal." Pharmacotherapy 15 (1995): s84-99
Martin TG "Serotonin syndrome." Ann Emerg Med 28 (1996): 520-6
Taylor D "Selective serotonin reuptake inhibitors and tricyclic antidepressants in combination - interactions and therapeutic uses." Br J Psychiatry 167 (1995): 575-80
von Moltke LL, Greenblatt DJ, Cotreau-Bibbo MM, Duan SX, Harmatz JS, Shader RI "Inhibition of desipramine hydroxylation in vitro by serotonin-reuptake-inhibitor antidepressants, and by quinidine and ketoconazole: a model system to predict drug interactions in vivo." J Pharmacol Exp Ther 268 (1994): 1278-83
Preskorn SH, Alderman J, Chung M, Harrison W, Messig M, Harris S "Pharmacokinetics of desipramine coadministered with sertraline or fluoxetine." J Clin Psychopharmacol 14 (1994): 90-8
Mathew NT, Tietjen GE, Lucker C "Serotonin syndrome complicating migraine pharmacotherapy." Cephalalgia 16 (1996): 323-7
Crewe HK, Lennard MS, Tucker GT, Woods FR, Haddock RE "The effect of selective serotonin re-uptake inhibitors on cytochrome P4502D6 (CYP2D6) activity in human liver microsomes." Br J Clin Pharmacol 34 (1992): 262-5
Alderman CP, Lee PC "Serotonin syndrome associated with combined sertraline-amitriptyline treatment." Ann Pharmacother 30 (1996): 1499-500
Mills KC "Serotonin syndrome: A clinical update." Crit Care Clin 13 (1997): 763
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Sertraline Oral Concentrate

Generic Name: sertraline

Brand name: Zoloft

Synonyms: Sertraline

What is Sertraline Oral Concentrate?

Silenor

Generic Name: doxepin

Brand name: Silenor, Sinequan, Sinequan

Synonyms: n.a.

What is Silenor?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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