Sertraline and Remifentanil: 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
Remifentanil
No brand names on recordSertraline
No brand names on record
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.
Sertraline (an antidepressant) and remifentanil (a strong pain medicine often used during surgery or in the hospital) can both raise a brain chemical called serotonin. When two medicines do this together, there is a small chance of a reaction called serotonin syndrome.
Signs can include feeling agitated or confused, a fast heartbeat, sweating, shivering, muscle twitching or stiffness, and a fever. These often show up within a few hours to a couple of days. The good news is that this is mostly a theoretical concern, and your care team knows to watch for it. Because remifentanil is usually given in a monitored setting, they can catch and treat any problem quickly.
Effect: Additive serotonergic activity from sertraline (SSRI) plus remifentanil (opioid with weak serotonergic potential) may increase risk of serotonin syndrome. This is a pharmacodynamic interaction; neither agent's clearance drives it.
- Direction/magnitude: Additive serotonergic effect; magnitude not quantified.
- Onset: Typically several hours to a few days, occasionally later.
- Evidence: Theoretical, supported by case-level reports with opioids.
- Management: If remifentanil is required, monitor closely during initiation and dose titration for autonomic instability, neuromuscular abnormalities (clonus, hyperreflexia, rigidity), and mental status changes. Discontinue remifentanil if serotonin syndrome is suspected and treat supportively.
What happens
Increased risk of serotonin syndrome
Interaction Deep Dive
Serotonin syndrome has been reported when remifentanil is combined with serotonergic agents. Should remifentanil therapy be necessary, monitor the patient closely, especially when starting the medication and when altering the dose. Symptoms typically appear within a few hours up to several days after the drugs are used together, although a later onset is possible. Should serotonin syndrome be suspected, stop remifentanil1.
Why it happens (mechanism)
Additive serotonergic effects
How to manage this interaction
If you take sertraline and need remifentanil (usually given during a procedure or in the hospital), keep taking your medicines as prescribed and make sure the team knows about both.
- Your care team will watch you closely, especially when remifentanil is started or the dose is changed.
- Tell staff right away about agitation, confusion, racing heart, heavy sweating, shivering, muscle twitching or stiffness, or fever.
- If serotonin syndrome is suspected, your team will stop the remifentanil and treat the symptoms.
Do not stop your sertraline on your own. Talk with your pharmacist or prescriber before any surgery about all serotonin-raising medicines you take.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) Serotonin syndrome has been reported in cases where remifentanil was used together with serotonergic agents 1.
Common questions
Can I take Sertraline and Remifentanil together?
Combining sertraline with remifentanil can add up serotonin effects and, rarely, trigger serotonin syndrome, so your care team will monitor you closely and act fast if symptoms appear. Keep both providers informed and never stop your antidepressant on your own. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Sertraline and Remifentanil 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 Remifentanil interaction managed?
If you take sertraline and need remifentanil (usually given during a procedure or in the hospital), keep taking your medicines as prescribed and make sure the team knows about both. Your care team will watch you closely, especially when remifentanil is started or the dose is changed. Tell staff right away about agitation, confusion, racing heart, heavy sweating, shivering, muscle twitching or stif… 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 Remifentanil 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: ULTIVA(R) intravenous injection, remifentanil HCl intravenous injection. Mylan Institutional LLC (per FDA), Morgantown, WV, 2023. DailyMed
Keep reading about Remifentanil
Keep reading about Sertraline
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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