Sertraline and Osilodrostat: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Sertraline
No brand names on recordOsilodrostat
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Both of these medicines can affect the timing of your heartbeat. Doctors call this QT prolongation, which just means one part of the heart's electrical cycle takes a little longer to reset. Sertraline (an antidepressant) can nudge this timing slightly, and osilodrostat (Isturisa, used for Cushing's syndrome) can do the same, especially at higher doses. When you take them together, those small effects can add up.
The good news is that this is a known, manageable situation. Your care team can keep an eye on your heart rhythm with an ECG and adjust things as needed. Please keep taking both as prescribed and talk with your pharmacist or doctor before making any changes.
Effect: Additive risk of QT interval prolongation with concomitant sertraline and osilodrostat.
- Mechanism: Pharmacodynamic additivity. Osilodrostat causes dose-dependent QTc prolongation; sertraline carries a modest QT effect. Neither is a prodrug relevant here.
- Direction: Increased combined QTc effect (additive PD, not PK).
- Evidence: Theoretical; severity rated major.
- Onset: Unspecified.
- Management: Use caution; obtain more frequent ECG monitoring. Consider temporary discontinuation of osilodrostat if QTc exceeds 480 ms. Correct electrolytes (K+, Mg2+) and review other QT-prolonging agents.
What happens
Increased risk of QT interval prolongation
Interaction Deep Dive
When osilodrostat is given alongside other agents recognized for extending the QT interval, caution is warranted. Osilodrostat produces a dose-dependent prolongation of the QT interval. Should the two be administered together, more frequent ECG monitoring should be considered. If the QTc interval exceeds 480 milliseconds, consider temporarily stopping osilodrostat1.
Why it happens (mechanism)
Additive QT interval prolongation
How to manage this interaction
This combination can be used safely with the right precautions. Here is what typically happens and what you can do:
- Keep taking both exactly as prescribed unless your doctor tells you otherwise.
- Your team may check your heart rhythm with an ECG more often to make sure the timing stays in a safe range.
- Your osilodrostat dose may need to be adjusted and individualized by your care team, and they may pause it temporarily if your QT reading gets too high.
- Tell your pharmacist or doctor if you feel fainting, dizziness, or a fluttering or pounding heartbeat, and mention any other medicines you take.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Sertraline and Osilodrostat together?
Taking sertraline and osilodrostat together can add up to affect your heart rhythm (QT interval), so your care team may monitor you more closely with ECGs and adjust the osilodrostat dose. Keep taking both as prescribed and report any fainting, dizziness, or palpitations. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Sertraline and Osilodrostat interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Sertraline and Osilodrostat interaction managed?
This combination can be used safely with the right precautions. Here is what typically happens and what you can do: Keep taking both exactly as prescribed unless your doctor tells you otherwise. Your team may check your heart rhythm with an ECG more often to make sure the timing stays in a safe range. Your osilodrostat dose may need to be adjusted and individualized by your care team, and they may… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Sertraline or Osilodrostat need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: ISTURISA(R) oral tablets, osilodrostat oral tablets. Recordati Rare Disease Inc (per FDA), Lebanon, NJ, 2020. DailyMed
Keep reading about Sertraline
Keep reading about Osilodrostat
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major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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