What medications should you not take with Zoloft? (5+ interactions)
By
Ivan Kahwa
| Reviewed by
Ivan Kahwa
The contents of this article are fact-based except otherwise stated within the article.
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Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
Reviewer bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss medications that should not be taken with Zoloft (sertraline) – a selective serotonin reuptake inhibitor (SSRI) primarily used as an antidepressant.
What medications should you not take with Zoloft?
Medications that should not be taken with Zoloft (sertraline), a selective serotonin reuptake inhibitor (SSRI), include: (1)
| Medications taken with sertraline | Potential complications |
| Monoamine oxidase inhibitors (MAOIs) | Risk of serotonin syndrome |
| Additive side effects | |
| Non-steroidal anti-inflammatory drugs (NSAIDs) | Risk of severe GI disturbances/ulceration |
| Gastrointestinal bleeding | |
| Blood thinners/anticoagulants | Increased risk of bleeding |
| Other serotonergic antidepressants (SSRIs, trazodone, etc) | Risk of serotonin syndrome |
| Risk of cardiac complications | |
| Additive side effects | |
| Certain antibiotics (such as clarithromycin) | QTc prolongation |
| Inhibition of sertraline metabolism – risk of serotonin syndrome | |
| Controlled drugs (opioids, stimulants, etc) | Psychological side effects |
| Cardiological complications | |
| Serotonin syndrome | |
| Pimozide | QTc prolongation/arrhythmia |
Let’s discuss the medications mentioned above and their interactions with sertraline (Zoloft) in detail:
Monoamine oxidase inhibitors (MAOIs)
Monoamine oxidase inhibitors (MAOIs) should not be taken with Zoloft because of how these medications work. Taking these medications together can increase the risk of a rare but life-threatening condition called serotonin syndrome (2,3).
This is because Zoloft is a serotonergic antidepressant that primarily works by inhibiting the reuptake of serotonin, a monoamine neurotransmitter involved in the pathophysiology of depression and related symptoms.
MAOIs, such as selegiline, rasagiline, etc., work by inhibiting enzymes responsible for the breakdown of certain neurotransmitters, such as serotonin. When these medications are used together, serotonin levels are dangerously increased in the body, leading to the symptoms of serotonin syndrome, which include: (3)
- Agitation or restlessness
- Confusion
- Rapid heart rate
- Dilated pupils
- Loss of muscle coordination or twitching muscles
- Excessive sweating
- Shivering or goosebumps
- High blood pressure
- Dilated pupils
- Diarrhoea
- Headache
- High fever
- Shivering or tremors
- In severe cases, it can lead to seizures or unconsciousness.
Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are contraindicated for use with Zoloft. NSAIDs are commonly used medications for fever, inflammation, and pain, and some of these meds are available over the counter – meaning you do not need a prescription to purchase them.
The use of NSAIDs and Zoloft has two major concerns:
Severe gastrointestinal (GI) side effects
NSAIDs are well-known for causing GI side effects. This is because NSAIDs primarily inhibit prostaglandin synthesis, which are important mediators of inflammation and pain. However, these prostaglandins also make up the protective lining around your stomach, preventing its exposure to gastric acid (4).
When NSAIDs block prostaglandins, the protective lining of your stomach is affected, leaving it exposed to the corrosive effects of gastric acid. This is the main reason why NSAIDs cause GI side effects.
Zoloft, on the other hand, is also known for causing GI side effects, such as acid reflux, nausea, abdominal pain, etc. Using these meds together can significantly increase this risk.
Increased risk of GI bleeding
NSAIDs like aspirin are known for their blood-thinning effects. Zoloft, on the other hand, also has blood-thinning properties that could be dose-dependent. The combined use of NSAIDs and Zoloft, along with the GI disturbances these meds can cause, significantly increases the risk of gastrointestinal bleeding (4).
Blood thinners/anticoagulants
Zoloft is also contraindicated with blood thinners and anticoagulants, such as warfarin, apixaban, rivaroxaban, etc. These medications primarily inhibit platelet aggregation and cause blood thinning (5).
As discussed earlier, Zoloft also has blood-thinning properties. Although Zoloft-induced blood thinning effects are not as prominent as actual blood thinners, the concomitant use of these medications can increase the risk of bleeding and cause complications.
Other serotonergic antidepressants
Zoloft should not be taken with other serotonergic antidepressants, including other SSRIs like Celexa, Prozac, Lexapro, Paxil, and Trazodone. These antidepressants also increase serotonin levels primarily, so taking two of these can dangerously increase serotonergic activity in the brain, leading to serotonin syndrome (3).
Since these drugs have similar side effect profiles, their combination can also cause terrible additive side effects. Furthermore, some serotonergic antidepressants such as Celexa can cause QTc prolongation and related cardiac effects.
When combined with Zoloft, which can also cause this side effect in rare cases, it can increase the chances of cardiac complications.
Certain antibiotics
Some antibiotics, such as clarithromycin, should not be taken with Zoloft.
Clarithromycin and other antibiotics that can inhibit the cytochrome P450 enzyme system, particularly CYP450 3A4, involved in the metabolism or breakdown of Zoloft, can increase the concentration of Zoloft in the body, leading to an increased risk of serotonin syndrome (6).
Research also states that clarithromycin, when paired with Zoloft, can cause hallucinations and other psychological side effects in susceptible individuals. This is why antibiotics should be carefully prescribed to people who are being treated with Zoloft or any other antidepressant.
Controlled drugs
Controlled drugs, or scheduled drugs, such as opioids (morphine, codeine, hydrocodone, etc.) and stimulants (amphetamines), should be avoided or taken cautiously with Zoloft. All of these medications can affect brain chemistry and may cause additive side effects (7).
Psychological complications are also common with these medications, along with an increased risk of addiction and abuse. Some of these medications can also cause cardiac complications, such as QTc prolongation, and Zoloft can also rarely cause this side effect.
When paired together, the chances of cardiac complications can be increased. If there is a need to take Zoloft with a controlled substance, the doses are always carefully adjusted. Dose adjustment is crucial when it comes to pairing two medications that can affect your brain chemistry.
So, if you’re taking such meds together, it is important to stick to the prescribed doses and not take these medications more often than recommended. It is also important to closely monitor your side effects and report anything unusual to your provider.
Pimozide
Pimozide is also contraindicated with Zoloft. Pimozide is primarily used to manage the symptoms associated with Tourette’s syndrome.
Zoloft and some antipsychotic medications can increase the gastric permeability of pimozide – meaning these drugs can increase the absorption and bioavailability of pimozide, which can elevate its activity (8).
Pimozide is associated with cardiac complications and can cause QTc prolongation. When paired together with Zoloft, the risk of cardiac complications significantly increases, leading to life-threatening complications.
How to ensure the safe use of Zoloft with other medications?
The best way to ensure the safe and effective use of Zoloft with other medications is to make sure that the medications you are taking are compatible with Zoloft.
Some medications might have mild interactions with the antidepressant, and dose adjustments can prevent any potential risk. However, some medications should be completely avoided with this antidepressant.
That’s why it is crucial to discuss all the prescription and over-the-counter medications you are currently taking to prevent any potential drug-drug interactions. If you’re confused about anything, reach out to your doctor or pharmacist.
As a pharmacist, I always try to educate my patients about drug-drug interactions and help them choose medications for common ailments that are safe to take with their current prescription medications.
Patient education is vital in such cases, as even over-the-counter meds can potentially cause an interaction with medications like antidepressants. So, it’s best to seek professional advice to ensure the safety of your physical and mental health.
References
- Drug Interactions with Antidepressants. Available from: https://bpac.org.nz/bpj/2007/march/docs/bpjse_interactions_pages_20-23.pdf
- Sub Laban T, Saadabadi A. Monoamine Oxidase Inhibitors (MAOI). 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30969670. https://www.ncbi.nlm.nih.gov/books/NBK539848
- Simon LV, Keenaghan M. Serotonin Syndrome. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29493999. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482377
- de Jong JC, van den Berg PB, Tobi H, de Jong-van den Berg LT. Combined use of SSRIs and NSAIDs increases the risk of gastrointestinal adverse effects. Br J Clin Pharmacol. 2003 Jun;55(6):591-5. doi: 10.1046/j.0306-5251.2002.01770.x. PMID: 12814454; PMCID: PMC1884264. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884264/
- Nochaiwong S, Ruengorn C, Awiphan R, Chai-Adisaksopha C, Tantraworasin A, Phosuya C, Kanjanarat P, Chongruksut W, Sood MM, Thavorn K. Use of serotonin reuptake inhibitor antidepressants and the risk of bleeding complications in patients on anticoagulant or antiplatelet agents: a systematic review and meta-analysis. Ann Med. 2022 Dec;54(1):80-97. doi: 10.1080/07853890.2021.2017474. PMID: 34955074; PMCID: PMC8725830. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725830/
- Westphal JF. Macrolide-induced clinically relevant drug interactions with cytochrome P-450A (CYP) 3A4: an update focused on clarithromycin, azithromycin and dirithromycin. Br J Clin Pharmacol. 2000 Oct;50(4):285-95. doi: 10.1046/j.1365-2125.2000.00261.x. PMID: 11012550; PMCID: PMC2015000. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2015000/
- Shah K, Bradshaw CM, Szabadi E. Interaction between antidepressants and d-amphetamine on variable-interval performance. Psychopharmacology (Berl). 1990;100(4):548-54. doi: 10.1007/BF02244010. PMID: 2108453. https://pubmed.ncbi.nlm.nih.gov/2108453/
- Alderman J. Coadministration of sertraline with cisapride or pimozide: an open-label, nonrandomized examination of pharmacokinetics and corrected QT intervals in healthy adult volunteers. Clin Ther. 2005 Jul;27(7):1050-63. doi: 10.1016/j.clinthera.2005.07.013. PMID: 16154484. https://pubmed.ncbi.nlm.nih.gov/16154484/