When considering medications that cannot mix with Zoloft (sertraline), it's crucial to understand that certain drug combinations can lead to severe, even life-threatening, side effects. Always consult with a healthcare professional before starting or stopping any medication, as they can provide personalized advice based on your full medical history.
Drugs that generally cannot mix or require extreme caution and close monitoring with Zoloft include:
Drugs with Absolute Contraindications or High-Risk Interactions
Combining Zoloft with the following medications carries a significant risk of severe adverse reactions:
1. Monoamine Oxidase Inhibitors (MAOIs)
Monoamine Oxidase Inhibitors (MAOIs) are a class of antidepressants that, when taken with Zoloft, can lead to a dangerous condition called serotonin syndrome. This syndrome results from an excessive buildup of serotonin in the brain and can manifest with symptoms such as agitation, hallucinations, rapid heart rate, fever, muscle stiffness, and severe nausea or diarrhea. A washout period (typically 14 days) is required between stopping an MAOI and starting Zoloft, or vice versa.
Examples of MAOIs include:
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Selegiline (Emsam, Eldepryl, Zelapar)
- Tranylcypromine (Parnate)
- Linezolid (Zyvox), an antibiotic with MAOI activity
- Methylene blue (used as a dye or for certain medical conditions)
2. Pimozide
Pimozide, an antipsychotic medication, is strictly contraindicated with Zoloft. The combination can lead to a significant increase in pimozide levels in the body, which can cause serious and potentially fatal heart rhythm abnormalities, specifically QT prolongation and Torsades de Pointes.
Medications Increasing Serotonin Syndrome Risk
Beyond MAOIs, other drugs that increase serotonin levels in the brain can elevate the risk of serotonin syndrome when combined with Zoloft. While not always an absolute "cannot mix," these combinations often require careful monitoring or avoidance.
- Triptans: Used for migraine treatment (e.g., sumatriptan, zolmitriptan).
- Other Serotonergic Antidepressants:
- Other SSRIs (Selective Serotonin Reuptake Inhibitors)
- SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)
- Tricyclic Antidepressants (TCAs)
- Opioids: Certain opioids like fentanyl and tramadol.
- Lithium: Used to treat bipolar disorder.
- St. John's Wort: An herbal supplement commonly used for mood.
- Dextromethorphan: Found in many cough and cold medicines.
Medications Increasing Bleeding Risk
Zoloft can affect blood clotting, increasing the risk of bleeding. This risk is amplified when combined with other medications that also thin the blood.
1. Blood Thinners (Anticoagulants and Antiplatelets)
Combining Zoloft with blood thinners can significantly increase the risk of bleeding, including gastrointestinal bleeding or bruising.
Examples of blood thinners that may interact with Zoloft include:
- Apixaban (Eliquis)
- Dabigatran (Pradaxa)
- Rivaroxaban (Xarelto)
- Edoxaban (Savaysa)
- Warfarin (Jantoven)
- Clopidogrel (Plavix)
- Aspirin
- Prasugrel (Effient)
2. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs, commonly used for pain and inflammation, can also increase the risk of gastrointestinal bleeding when taken with Zoloft.
Common NSAIDs include:
- Ibuprofen (Advil, Motrin)
- Naproxen (Aleve, Naprosyn)
Other Important Interactions
Alcohol
Mixing Zoloft with alcohol is generally not recommended. Both substances can cause central nervous system (CNS) depression, leading to increased drowsiness, dizziness, impaired coordination, and worsening of mood symptoms.
Other CNS Depressants
Medications that depress the central nervous system, such as benzodiazepines (e.g., alprazolam, diazepam) or other sedatives, can have their sedative effects amplified when taken with Zoloft, leading to excessive drowsiness and impaired cognitive function.
Drugs Affecting Heart Rhythm
As Zoloft can cause a slight prolongation of the QT interval (a measure of heart's electrical activity), combining it with other medications known to prolong the QT interval can increase the risk of dangerous heart rhythm disturbances.
Summary of Key Interactions
| Drug Class | Why it Cannot Mix / High Risk | Potential Outcome |
|---|---|---|
| Monoamine Oxidase Inhibitors (MAOIs) | Severe serotonin buildup | Serotonin syndrome (potentially fatal) |
| Pimozide | Increased pimozide levels | Serious heart rhythm problems (QT prolongation) |
| Other Serotonergic Drugs | Increased serotonin levels | Serotonin syndrome |
| Blood Thinners (Anticoagulants/Antiplatelets) | Increased bleeding risk due to Zoloft's effect on platelets | Increased risk of bruising, gastrointestinal bleeding, hemorrhage |
| NSAIDs | Increased bleeding risk | Increased risk of gastrointestinal bleeding |
| Alcohol | Combined CNS depressant effects | Increased drowsiness, dizziness, impaired coordination, worsened mood |
It is essential to provide your doctor with a complete list of all medications, supplements, and herbal products you are taking to avoid potentially harmful interactions.
