Safest Antidepressant with Warfarin?
Answer: (b) Sertraline.
Warfarin has two isomers:
- S-isomer (three times more potent than R-isomer): metabolized by 2C9.
- R-isomer: metabolized by 1A2 (major) and 2C19 & 3A4 (minor)
—> monitor for antidepressants inhibiting 2C9 (and 1A2)
SERTRALINE
- 2C9 inhibition: —
- 1A2 inhibition: —
- Risk of interaction is Low: no clinical effects noted.
- Monitoring PT is recommended (may increase PT- not clinically significant in most)
- SERTRALINE APPEARS TO BE SAFE WITH WARFARIN.
WARFARIN & ANTIDEPRESSANTS
The following PEFA chapter will summarize the interaction of following antidepressants with warfarin:
- SSRIs: Fluoxetine, Fluvoxamine, Sertraline, Paroxetine, Citalopram & Escitalopram
- SNRIs: Venlafaxine, Duloxetine
- Bupropion
- Mirtazapine
- Trazodone
- TCAs: Amitriptyline, Nortriptyline.
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