Last week we looked at QT prolongation, now we're delving into another common drug interaction.
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1. Counselling Conundrum: a real question from a patient
2. Concise Conclusion: a straight-forward patient-friendly answer
3. Quick Wrap-up
Clearly, there are nuances that may not be captured in this format. The goal here is to provide you with helpful counselling tips which often draw from multiple sources or those which are not commonly accessed by busy healthcare providers serving the community.
Counselling Conundrum: "I am in discussions with my Doctor about which medication I should try for sleep, and my doctor said I have to be very careful of certain syndromes, as I am already taking sertraline. What does he mean?"
Concise Conclusion: Likely, your Doctor is concerned about what's called Serotonin Syndrome, which is a flu-like illness that can be very serious. It can occur by mixing too many medications such as antidepressants. However, many medications that automatically come with this warning are perfectly safe to use with your sertraline, for example trazodone and mirtazapine. I will send a note to your doctor so we can discuss possible options for you.
Quick Wrap-up: Prescribers often rule out options as soon as a Serotonin Syndrome warning pops up on their prescribing platform, which we believe unnecessarily prevents a trial of effective treatments for patients. Our rule of thumb is as follows: avoid MAO inhibitors with any serotonergics, use caution with serotonergic opioids/SSRIs/SNRIs/OTC serotonergics (like dextromethorphan), and generally ignore this warning for drugs like triptans/trazodone/mirtazapine/ondansetron, as these last drugs mentioned do not seem to stimulate serotonin 2A receptors, which are the worst for risk of Serotonin Syndrome.
Dive Deeper
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