Sertraline is bound to plasma proteins. It is therefore necessary to consider the possibility of interaction with other drugs that bind to the protein (eg, diazepam, tolbutamide and warfarin). Cimetidine:simultaneous use significantly reduces the clearance of sertraline. Drugs metabolized isoenzyme cytochrome : long-term treatment with sertraline 50 mg per day accompanied by increased concentrations of desipramine.
Drugs metabolized other enzyme cytochrome systems. Experimental studies in vitro interaction showed that carried isozymesdeca durabolin for sale betagidroksilirovanie endogenous cortisol, as well as the metabolism of carbamazepine and terfenadine with long-term administration of sertraline at a dose of 200 mg not changed daily. The concentration in the blood plasma tolbutamide, warfarin and phenytoin prolonged assignment of sertraline in the same dose also varies. Thus, we can conclude that sertraline does not inhibit isoenzyme.
Sertraline has no effect on the concentration of diazepam in blood serum, which indicates the absence of inhibition of isoenzyme . According to in vitro studies, sertraline has virtually no effect or minimally inhibits isoenzyme . Lithium. The pharmacokinetics of lithium is not changed by concomitant administration of sertraline. However, the tremor occurs more often when they are used together. As well as the appointment of other selective inhibitors of reverse neuronal uptake of serotonin, the combined use of sertraline with drugs that affect the serotonergic transmission (eg, lithium), requires increased caution.Agents acting on serotonergic transmission. When you replace one inhibitor of neuronal serotonin reuptake another there is no need to “washout period”. However, you want to be careful with changes in the course of treatment. Avoid concomitant administration of tryptophan or fenfluramine with sertraline. The induction of microsomal liver enzymes. Sertraline causes minimal induction of liver enzymes. Co-administration of sertraline and antipyrine at a dose of 200 mg leads to a significant reduction in the half-life of antipyrine, although there is only 5% of cases. Atenolol: when co-administered sertraline does not change its β-adrenoceptor blocking action. Glibenclamide and digoxin: the introduction of sertraline in a daily dose 200 mg of drug interactions with these drugs have been deca durabolin for sale identified.
Sertraline should not be used in conjunction with MAOIs, and within 14 days after discontinuation of treatment MAOIs. Similarly, after the abolition of sertraline for 14 days did not prescribe MAOIs.
It should be noted that in patients undergoing electroconvulsive therapy, sufficient experience with sertraline is not. The possible success or the risk of such combined treatment has not been studied.
Patients with depression are at risk for suicide attempts. This risk persists until the development of remission. Therefore, from the beginning of the treatment and to achieve optimal clinical response for patients should establish a permanent medical supervision.
Pregnancy and breastfeeding :
Controlled results sertraline use in pregnant women is not, therefore, assign them to the drug is only if the expected benefit to the mother outweighs the potential risk to the fetus. Women of reproductive age, which is supposed to appoint sertraline should be advised to use effective contraception. Sertraline is found in breast milk, therefore the treatment with this drug is not deca durabolin for sale recommended during breast-feeding. No reliable data on safety of its use in this case. If treatment is necessary, it is better to stop breast-feeding.
Effects on ability to drive vehicles and management mechanisms :
Purpose, sertraline, are generally not accompanied by a breach of psychomotor functions. However, its use in conjunction with other drugs may impair attention and motor coordination. Therefore, during treatment with sertraline drive vehicles, special equipment or practice associated with an increased risk of the activity is not recommended.