Sertraline with Oxcarbazepine Interaction Details
Brand Names Associated with Sertraline
- Sertraline
- Zoloft®
Brand Names Associated with Oxcarbazepine
- Oxcarbazepine
- Oxtellar XR®
- Trileptal®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 08, 2023
Interaction Effect
An increased risk of serotonin syndrome
Interaction Summary
Coadministration of oxcarbazepine, a CYP2C19 inhibitor, and sertraline, a CYP2C19 substrate , may result in the development of symptoms suggestive of serotonin syndrome. In a case report, an 87-year-old man developed serotonin syndrome symptoms 24 hours following coadministration . When oxcarbazepine and sertraline are coadministered, use cautiously and monitor the patient for signs of serotonin syndrome (tachycardia, hyperthermia, myoclonus, mental status changes).
Severity
Major
Onset
Rapid
Evidence
Probable
How To Manage Interaction
Coadministration of oxcarbazepine and sertraline may result in serotonin syndrome. If these agents are used together, closely monitor the patient for signs of serotonin syndrome (restlessness, hyperthermia, hyperreflexia, incoordination).
Mechanism Of Interaction
Inhibition of CYP2C19-mediated metabolism of sertraline by oxcarbazepine
Literature Reports
A) Symptoms of serotonin syndrome developed in an 87-year-old man following concurrent administration of oxcarbazepine and sertraline. The man was hospitalized for suspected cellulitis after an 8-day history of bilateral lower extremity swelling and redness. Prior to admission, medications included sertraline 50 mg daily. The patient was started on levofloxacin 500 mg daily for the cellulitis. After 5 days of treatment, pain and burning continued in his legs, and he was started on oxcarbazepine 150 mg a day for neuropathy. Vomiting, fever, hypertension, lethargy, mild stiffness, and upper body tremor developed the following day. The patient was intubated, and started on IV fentanyl and midazolam. Body temperature measured 109 degrees F and mean arterial pressure was 30 mmHg. Leukocytosis (WBC 22.4 x 10(4), increased from 9.3 on admission) and elevated creatinine kinase (592 units/L) developed. Sedation was discontinued and cooling blankets were applied. The patient developed septic shock and continued to deteriorate despite treatment with aggressive hydration, vasopressors, hydrocortisone, amikacin, metronidazole, ciprofloxacin, and linezolid. Absent brain stem reflexes were noted within 30 hours of intubation. The patient was extubated and died .
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.
Oxcarbazepine Overview
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Oxcarbazepine (Trileptal) is used alone or in combination with other medications to control certain types of seizures in adults and children. Oxcarbazepine extended-release tablets (Oxtellar XR) are used in combination with other medications to control certain types of seizures in adults and children 6 years of age and older. Oxcarbazepine is in a class of medications called anticonvulsants. It works by decreasing abnormal electrical activity 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.