The interaction is believed to be metabolic. Patients should be monitored for increased effects of these drugs if used concomitantly. The effect of atenolol on sertraline was not evaluated. Although no data are available, it is possible that inhibitors of hepatic enzymes such as cimetidine may affect sertraline pharmacokinetics. Until more data are available, cimetidine should be used cautiously in patients receiving sertraline.
Sertraline can increase the anticoagulant effects of warfarin if used concomitantly.
Patients should be monitored closely. Close monitoring of lithium concentrations is advisable, particularly before steady-state has been achieved. Discontinuation of tryptophan usually resolves symptoms. Since sumatriptan is also an agonist at serotonin receptors, it is theoretically possible that a similar reaction could occur if sumatriptran was administered to patients receiving this type of antidepressant. Cyproheptadine is an antagonist of serotonin in the CNS, and this pharmacologic action opposes the pharmacologic actions of sertraline.