Sertraline with Ginkgo Interaction Details
Brand Names Associated with Sertraline
- Sertraline
- Zoloft®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 08, 2023
Interaction Effect
Increased risk of serotonin syndrome (hypertension, hyperthermia, myoclonus, mental status changes)
Interaction Summary
The addition of Ginkgo biloba and/or St. John's Wort to therapy with buspirone and fluoxetine may have precipitated a hypomanic episode in a case report. It is unclear if Ginkgo or St. John's Wort, the combination of both, or other patient factors, contributed to the effect. Theoretically, Ginkgo may increase the risk of serotonin syndrome when taken with selective serotonin reuptake inhibitors (SSRIs). Caution is advised, especially when ginkgo is taken to counteract sexual dysfunction associated with SSRIs. Ginkgo may inhibit monoamine oxidase , and has demonstrated serotonergic activity in animals which might increase the risk of serotonin syndrome when ginkgo is combined with SSRIs. The potential MAO inhibitory activity of ginkgo is questionable. A human study did not show MAO inhibition in the brain following oral consumption . Ginkgo biloba extract inhibited MAO-A/MAO-B in the rat brain in vitro and MAO-B in human platelets in vitro . No significant MAO inhibition was found in mice following oral consumption .
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Monitor patients closely for symptoms of serotonin syndrome if ginkgo is combined with selective serotonin reuptake inhibitors (SSRIs).
Mechanism Of Interaction
Additive pharmacologic effects resulting in excessive serotonergic stimulation
Literature Reports
A) A 42-year-old female experienced symptoms consistent with a mixed hypomanic episode following concomitant use of fluoxetine, buspirone, Ginkgo biloba, and St. John's Wort. The symptoms resolved following discontinuation of Ginkgo and St. John's Wort. The patient was being treated for depression following a mild traumatic brain injury with fluoxetine 20 milligrams (mg) twice daily and buspirone 15 mg twice daily. Several weeks prior to presentation, buspirone was increased to 20 mg twice daily for persistent anxiety and the patient began taking Ginkgo biloba, melatonin, and St. John's Wort in unspecified doses. Melatonin was considered unlikely to have contributed to her symptoms. Ginkgo and St. John's Wort were considered possible contributors since they may potentiate antidepressants, and considering the temporal relationship between the use of the herbs and onset of symptoms and discontinuation of the herbs and resolution of symptoms. However, the brain injury was considered a possible contributor .
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.