Sertraline with Dipyrone Interaction Details
Brand Names Associated with Sertraline
- Sertraline
- Zoloft®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 08, 2023
Interaction Effect
An increased risk of bleeding and a reduced sertraline exposure
Interaction Summary
Coadministration of metamizole (dipyrone) and sertraline may significantly reduce sertraline exposure, and increase risk of intracranial and gastrointestinal bleeding. When an SSRI and an NSAID are given concurrently, closely monitor for signs of adverse events, including GI bleeds, especially in elderly and those with a history of GI ulcers. Consider other pain management (eg, acetaminophen), use antidepressants with less serotonin reuptake inhibition, or prescribe antiulcer prophylaxis . If sertraline and metamizole are coadministered, use therapeutic drug monitoring (TDM) to dose-adjust sertraline, and repeat TDM if the dose of metamizole is changed, or therapy is discontinued .
Severity
Major
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Coadministration of metamizole (dipyrone) and sertraline may significantly reduce sertraline exposure, and increase risk of intracranial and gastrointestinal bleeding. When an SSRI and an NSAID are given concurrently, closely monitor for signs of adverse events, including GI bleeds, especially in elderly and those with a history of GI ulcers. Consider other pain management (eg, acetaminophen), use antidepressants with less serotonin reuptake inhibition, or prescribe antiulcer prophylaxis . If sertraline and metamizole are coadministered, use therapeutic drug monitoring (TDM) to dose-adjust sertraline, and repeat TDM if the dose of metamizole is changed, or therapy is discontinued .
Mechanism Of Interaction
Depletion of platelet serotonin by SSRI; possible induction of CYP2B6 and/or CYP3A4 metabolism of sertraline
Literature Reports
A) In retrospective analysis, significantly lower median sertraline plasma concentrations occurred with concomitant use of metamizole and sertraline (n=15) compared with sertraline matched controls (n=19; 14 vs 42 ng/mL); there was no significant difference between metamizole and ibuprofen groups (n=19; 14 vs 31 ng/mL), or ibuprofen and sertraline control groups (31 vs 42 ng/mL). Ibuprofen was not expected to pharmacokinetically interact with sertraline and therefore served as an additional control group. Additionally, significantly more patients in the metamizole and sertraline group had sertraline levels below therapeutic reference range of 10 to 150 ng/mL compared with both the concomitant ibuprofen (40% vs 5.3%) and sertraline control (40% vs 0%) groups. Patients were receiving a median sertraline dose of 100 mg/day in both the metamizole and ibuprofen groups, and 125 mg/day in the sertraline control group; analgesics (metamizole or ibuprofen) were used daily .
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.
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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.