What are the interactions between alcohol and sertraline (Selective Serotonin Reuptake Inhibitor)?

From the Guidelines

Mixing alcohol with sertraline is generally not recommended due to increased side effects and potential reduction in medication effectiveness. The combination of alcohol and sertraline can lead to enhanced sedative effects, including drowsiness, dizziness, and impaired coordination, as noted in various studies 1. Furthermore, alcohol consumption can exacerbate the symptoms of depression and anxiety that sertraline is intended to treat, potentially diminishing the medication's efficacy.

Key Considerations

• The liver processes both alcohol and sertraline, which may lead to increased liver strain when combined.
• Individual factors such as dosage, other medications, and personal health conditions can influence how alcohol and sertraline interact in the body.
• Monitoring for increased side effects and adjusting behavior accordingly is crucial when consuming alcohol while taking sertraline.

Recommendations

• Avoid alcohol completely, especially when first starting sertraline or after dose adjustments, to minimize the risk of adverse interactions and ensure the medication's effectiveness.
• If alcohol consumption is unavoidable, do so minimally and cautiously, paying close attention to how the body responds to the combination.
• Consult a healthcare provider before combining alcohol with sertraline, as they can provide personalized advice based on specific circumstances and medical history.

Evidence Basis

The most recent and highest quality study 1 emphasizes the importance of cautious prescribing practices for SSRIs like sertraline, highlighting potential side effects and the need for close monitoring, especially in vulnerable populations. While this study does not directly address alcohol and sertraline interactions, its focus on safety and efficacy aligns with the recommendation to approach such combinations with caution.

From the FDA Drug Label

Do not drink alcohol while using sertraline Patients should be told that although sertraline has not been shown in experiments with normal subjects to increase the mental and motor skill impairments caused by alcohol, the concomitant use of sertraline and alcohol is not advised Although sertraline did not potentiate the cognitive and psychomotor effects of alcohol in experiments with normal subjects, the concomitant use of sertraline and alcohol is not recommended

Alcohol use is not recommended while taking sertraline. The FDA drug label advises against drinking alcohol while using sertraline, although it notes that sertraline did not increase the mental and motor skill impairments caused by alcohol in experiments with normal subjects 2, 2, 2.

From the Research

Interaction between Alcohol and Sertraline

• The interaction between alcohol and sertraline is a complex one, with various studies yielding different results 3, 4, 5, 6.
• A study published in the Journal of Clinical Psychopharmacology in 2003 found that sertraline, combined with cognitive behavioral therapy, may provide some modest benefit in terms of drinking outcome and improved depression in female alcohol-dependent subjects 4.
• Another study published in the Journal of Clinical Psychopharmacology in 2006 found that sertraline treatment of co-occurring alcohol dependence and major depression did not provide consistent support for the use of sertraline to treat these co-occurring disorders 6.
• A review of the clinical use of sertraline in mood and anxiety disorders published in the International Clinical Psychopharmacology journal in 2009 found that sertraline is effective for the acute treatment of major depressive disorders and prevention of relapse or recurrence, and is also effective for the acute treatment and longer-term management of social anxiety disorder, posttraumatic stress disorder, panic disorder, and generalized anxiety disorder 5.

Effects of Sertraline on Alcohol Consumption

• The study published in the Journal of Clinical Psychopharmacology in 2003 found that subjects who received sertraline had fewer drinks per drinking day than subjects who received placebo 4.
• The study published in the Journal of Clinical Psychopharmacology in 2006 found that there were no reliable medication group differences on depressive symptoms or drinking behavior in either group A or B patients 6.
• The study published in the Journal of Clinical Psychopharmacology in 2003 suggested that less drinking during the study was associated with improved depression outcome 4.

Safety and Tolerability of Sertraline

• The review published in the International Clinical Psychopharmacology journal in 2009 found that sertraline has a good tolerability profile and has low fatal toxicity 5.
• The study published in the Journal of Clinical Psychopharmacology in 2006 found that sertraline was well tolerated, with no serious adverse events reported 6.