Does Sertraline Interact With Warfarin? (5+ Precautions)

By Ivan Kahwa

Page last updated: 06/02/2024 | Next review date: 06/02/2026

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

Ivan Kahwa

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In this article, we will explore whether Sertraline affects Warfarin. We will also discuss the research findings, benefits, side effects, and precautions that should be taken when using Sertraline and Warfarin together.

Does Sertraline interact with Warfarin?

Sertraline does not interact with Warfarin. This combination of Sertraline and Warfarin should only be used if prescribed by your healthcare provider. Both of these medications, Sertraline and Warfarin, are safe to use together; however, there might be an increased risk of bleeding in patients using this combination (1).

What are the mechanisms and indications of Sertraline and Warfarin?

Warfarin is an anticoagulant that helps prevent dangerous blood clots in your veins and arteries. Warfarin has been approved by the FDA for preventing and treating blood clots in blood vessels and lungs, reducing the risk of heart attacks, and other clot-related problems.

Doctors prescribe it to patients with specific heart conditions, those with artificial heart valves, and those who have had a heart attack. Warfarin, also known as Coumadin, works by blocking an enzyme that activates vitamin K in the body.

Due to this mechanism, Warfarin lowers the amount of active clotting factors in the blood. Clotting factors make the blood clot when you get injured. To produce these clotting factors, the liver needs vitamin K. So when Warfarin reduces vitamin K, it also reduces the clotting factors the body can make (2,3).

Sertraline is a selective serotonin reuptake inhibitor (SSRI) antidepressant widely prescribed to treat major depressive disorder (MDD), post-traumatic stress disorder (PSTD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), panic disorder, and premenstrual dysphoric disorder.

As an SSRI, Sertraline, also known as Zoloft, works by blocking the reuptake of serotonin, a chemical neurotransmitter in the brain and increases serotonin levels in the brain (4).

What does research suggest?

A research study was conducted to evaluate the effect of Sertraline on the activity of Warfarin in healthy individuals. It was found that Sertraline did not affect the metabolism of Warfarin, and there was only a slight increase in blood clotting time when both Sertraline and Warfarin were used in combination.

This study suggested that Sertraline is safe to use with Warfarin. However, patients must be regularly monitored when using Sertraline and Warfarin together (1,5). Another research study examined the effect of Warfarin and SSRIs when given to patients with a brain haemorrhage.

The study found that in such cases, using the Warfarin and SSRI combination may increase the risk of death. Therefore, doctors must reconsider the treatment options in cases of brain haemorrhage (6).

A clinical study indicated that taking Sertraline (SSRI) while on Warfarin (anticoagulant) might increase the bleeding risk in patients with heart conditions. This is because Sertraline blocks the reuptake of serotonin by platelets, causing lower levels of serotonin in the platelets (7).

What are the benefits of using Sertraline and Warfarin together?

The benefits of using Sertraline in combination with Warfarin may include:

Improvement in patients’ mental well-being by enhancing antidepressant effects.
Prevention and treatment of blood clot formation in the blood vessels.
Reduction in the risk of strokes in patients with a history of heart attack.

What are the side effects of using Sertraline and Warfarin together?

The side effects of using Sertraline and Warfarin together may include:

Increased risk of bleeding (more common with Sertraline)
Abdominal pain
Difficulty breathing or swallowing
Hives, rash, or itching (allergic reactions)
Nausea
Vomiting
Diarrhea
Loss of appetite
Fatigue (more common with Sertraline)
Headaches
Flu-like symptoms
Changes in taste (8,9)

If you experience any of these side effects, you must report them to your healthcare provider. It is important to note that not everyone is prone to all of these side effects. Some patients may experience several of the above-mentioned side effects.

In such cases, this combination of Sertraline and Warfarin might not be suitable for you. Do not stop taking Sertraline or Warfarin without consulting your healthcare provider first.

What are the precautions for using Sertraline and Warfarin together?

If you are taking a combination of Sertraline and Warfarin, you should consider the following precautions:

Before taking a combination of Sertraline and Warfarin, inform your doctor if you are allergic to either of these medications.
Your doctor must be aware of your family and medical history before prescribing this combination.
Inform your doctor if you are taking any other medicines or supplements if you are breastfeeding, pregnant, or undergoing any surgery.
Avoid smoking and alcohol consumption while using Sertraline and Warfarin together.
Avoid driving, as Sertraline may make you drowsy.
Due to the increased risk of bleeding, your doctor must monitor you closely (8,9).

Conclusion

In my perspective, Sertraline does not affect the activity of Warfarin when used in combination. This combination of Sertraline and Warfarin may increase the overall physical and mental well-being of patients with depression and a history of strokes, as it prevents strokes by preventing blood clotting.

However, this combination may cause a serious risk of bleeding in some individuals. Therefore, Sertraline and Warfarin should only be used together if prescribed by your healthcare provider, and close monitoring should also be done for any serious side effects.

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References

1.-

Sansone RA, Sansone LA. Warfarin and Antidepressants: Happiness without Hemorrhaging. Psychiatry (Edgmont). 2009 Jul;6(7):24-9. PMID: 19724766; PMCID: PMC2728939. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728939/

2.-

Patel S, Singh R, Preuss CV, Patel N. Warfarin. 2023 Mar 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29261922. Available from: https://pubmed.ncbi.nlm.nih.gov/29261922/

3.-

Warfarin-MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [Last Revised – 06/15/2017]. Available from: https://medlineplus.gov/druginfo/meds/a682277.html

4.-

Singh HK, Saadabadi A. Sertraline. 2023 Feb 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31613469. Available from: https://pubmed.ncbi.nlm.nih.gov/31613469/

5.-

Apseloff G, Wilner KD, Gerber N, Tremaine LM. Effect of sertraline on protein binding of warfarin. Clin Pharmacokinet. 1997;32 Suppl 1:37-42. doi: 10.2165/00003088-199700321-00006. PMID: 9068934. Available from: https://pubmed.ncbi.nlm.nih.gov/9068934/

6.-

Löppönen P, Tetri S, Juvela S, Huhtakangas J, Saloheimo P, Bode MK, Hillbom M. Association between warfarin combined with serotonin-modulating antidepressants and increased case fatality in primary intracerebral hemorrhage: a population-based study. J Neurosurg. 2014 Jun;120(6):1358-63. doi: 10.3171/2013.12.JNS131898. Epub 2014 Feb 7. PMID: 24506245. Available from: https://pubmed.ncbi.nlm.nih.gov/24506245/

7.-

Quinn GR, Singer DE, Chang Y, Go AS, Borowsky LH, Udaltsova N, Fang MC. Effect of selective serotonin reuptake inhibitors on bleeding risk in patients with atrial fibrillation taking warfarin. Am J Cardiol. 2014 Aug 15;114(4):583-6. doi: 10.1016/j.amjcard.2014.05.037. Epub 2014 Jun 5. PMID: 25001151; PMCID: PMC5176251. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5176251/

8.-

Warfarin-MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [Last Revised – 06/15/2017]. Available from: https://medlineplus.gov/druginfo/meds/a682277.html

9.-

Sertraline-MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [Last Revised – 01/15/2022]. Available from: https://medlineplus.gov/druginfo/meds/a697048.html

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Does Sertraline interact with Warfarin? (5+ precautions)