sertraline and amitriptyline

[poker43]

I have been on amitriptyline for a while for headaches, i have recently started on sertraline as well. Had no side effects, but my sleep has started to be disturbed after a couple of weeks. Could they interact with each other to disrupt sleep?

 

[Judee]

https://www.drugs.com/interactions-check.php?drug_list=2057-0,168-0

You can also click on Switch to professional interaction data for a more medically technical view.

There is a duplication warning on this.

That professional version also mentions, "hyperstimulation of brainstem 5HT1A receptors." if you are experiencing serotonin syndrome.

I'm not smart enough to know what those receptors are but I'm guessing that hyperstimulation could upset sleep and I would also be concerned that you are starting to experience that dangerous "serotonin syndrome."

I would talk to your pharmacist right away. If the same doctor prescribed both of these for you, he or she should have been aware of this...especially the duplication warning.

 

[halcyon]

I have been on amitriptyline for a while for headaches, i have recently started on sertraline as well. Had no side effects, but my sleep has started to be disturbed after a couple of weeks. Could they interact with each other to disrupt sleep?

Sertraline and Prozac are both considered highly “activating“ SSRIs, and insomnia and sleep disturbance are very common side effects of these two. You may want to look into fluvoxamine or citalopram/escitalopram instead.

In general, serotonin syndrome isn’t a big concern with amitriptyline; its serotonin reuptake inhibition isn’t very strong compared with other tricyclics, so it can be combined with serotonergic drugs if need be (Foong et al., 2018).

What you do need to look out for with amitriptyline is combining it with other drugs that are inhibitors of CY2D6, as this can cause an increase of amitriptyline levels in the blood. Paxil for example is a strong 2D6 inhibitor and probably shouldn’t be combined with amitriptyline. My recollection is that escitalopram has the weakest effect on 2D6 of all the SSRIs and so it should be able to be combined safely with amitriptyline. ETA: Sorry, I misremembered, it's fluvoxamine that has the weakest 2D6 inhibition effect and is safe to combine with amitriptyline (Vezmar et al., 2009; Westenberg & Sandner, 2006). But I have confirmed previously with at least one psychiatrist that citalopram/escitalopram can be safely combined with amitriptyline/nortriptyline also. And if there is any concern, your doctor can order blood tests to monitor amitriptyline/nortriptyline levels in the blood.