Sertraline with Alprazolam Interaction Details
Brand Names Associated with Sertraline
- Sertraline
- Zoloft®
Brand Names Associated with Alprazolam
- Alprazolam
- Niravam®
- Xanax®
- Xanax® XR
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Feb 27, 2024
Interaction Effect
An increased risk of psychomotor impairment and sedation
Interaction Summary
To date, limited information is available related to the effects of coadministered alprazolam and sertraline. One study found that sertraline was a moderate inhibitor in vitro of alprazolam metabolism[1]. It is theoretically possible that an interaction might occur because alprazolam is metabolized by the cytochrome P450 3A system and sertraline is thought to inhibit one or more P450 isoenzymes [2]. Current evidence indicates that alprazolam is metabolized at least in part by the CYP3A family of isoenzymes and sertraline is suspected of inhibiting the CYP3A4 isoenzyme. However, a study involving ten healthy volunteers failed to show an alteration in the pharmacokinetics or pharmacodynamics of alprazolam when given with sertraline [3].
Severity
Moderate
Onset
Rapid
Evidence
Probable
How To Manage Interaction
Caution is warranted if alprazolam and sertraline are to be coadministered. Monitor patients for signs of psychomotor impairment or excessive sedation. Alprazolam doses may need to be reduced.
Mechanism Of Interaction
Inhibition of cytochrome P450 3A-mediated alprazolam metabolism
Literature Reports
A) Ten healthy white volunteers (eight women and two men) participated in a randomized, double-blind, placebo-controlled study to determine whether therapeutic doses of sertraline have the potential to impair alprazolam metabolism and to assess whether any potential impairment is dependent on sertraline dose. Study participants received alprazolam 1 mg orally or placebo and sertraline 50 mg, 100 mg, or 150 mg daily. The alprazolam maximum concentration (Cmax), time to maximum concentration (tmax), half-life, and area under the concentration-time curve (AUC) were not clinically significantly altered in the presence of sertraline. No pharmacodynamic interactions, as measured by sedation, digit-symbol substitution test, immediate recall, and delayed recall, were detected between sertraline and alprazolam at any dose of sertraline. These in vivo findings are contrary to in vitro data which suggest that sertraline inhibits alprazolam metabolism via cytochrome P450 3A4 enzymes [3].
References
1 ) Von Moltke LL, Greenblatt DJ, Cotreau-Bibbo MM, et al: Inhibitors of alprazolam metabolism in vitro: effect of serotonin- reuptake-inhibitor antidepressants, ketoconazole and quinidine. Br J Clin Pharmacol 1994; 38:23-31.
2 ) DeVane CL: Pharmacokinetics of the newer antidepressants: clinical relevance. Am J Med 1994; 97(suppl 6A):13S-23S.
3 ) Hassan PC, Sproule BA, Naranja CA, et al: Dose-response evaluation of the interaction between sertraline and alprazolam in vivo. J Clin Psychopharmacol 2000; 20:150-158.
Sertraline Overview
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Sertraline is used to treat depression, obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over), panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks), posttraumatic stress disorder (disturbing psychological symptoms that develop after a frightening experience), and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). It is also used to relieve the symptoms of premenstrual dysphoric disorder, including mood swings, irritability, bloating, and breast tenderness. Sertraline is in a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amounts of serotonin, a natural substance in the brain that helps maintain mental balance.
Alprazolam Overview
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Alprazolam is used to treat anxiety disorders and panic disorder (sudden, unexpected attacks of extreme fear and worry about these attacks). Alprazolam is in a class of medications called benzodiazepines. It works by decreasing abnormal excitement in the brain.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.