Zoloft interactions: Alcohol, medications, and other factors

Before you start treatment with Zoloft, tell your doctor and pharmacist which prescription, over-the-counter (OTC), and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Zoloft interacts with supplements, herbs, or vitamins, see the “Zoloft and other interactions” section below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist. They can tell you which drugs should not be taken with sertraline (Zoloft).

Here’s a table of drugs that can interact with Zoloft. Keep in mind that this table doesn’t include all drugs that may interact with Zoloft. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* Zoloft is an antidepressant.
† For details about this interaction, see the “Drug interactions in depth” section below.
‡ For details about this interaction, see the “When to avoid Zoloft” section below.

In some cases, factors or conditions could prevent your doctor from prescribing Zoloft due to the risk of harm. These are known as contraindications. The contraindications of Zoloft include:

Taking disulfiram with Zoloft oral solution

Doctors typically will not prescribe Zoloft oral solution with disulfiram. This is because Zoloft oral solution contains alcohol. Disulfiram is prescribed to treat alcohol use disorder and causes unpleasant effects if it’s taken with alcohol. These effects may include nausea, vomiting, and headache.

Before you start treatment with Zoloft, tell your doctor if you take disulfiram. They’ll likely prescribe Zoloft oral tablet instead of the oral solution. The oral tablet doesn’t contain alcohol and isn’t known to interact with disulfiram.

If you have other questions about Zoloft oral solution and disulfiram, talk with your doctor.

Taking pimozide

Doctors typically will not prescribe Zoloft with pimozide. Pimozide is an antipsychotic that’s prescribed for Tourette syndrome. Taking Zoloft with pimozide may increase your risk of irregular heart rhythm as a side effect of either drug.

If you take pimozide, talk with your doctor before taking Zoloft. They’ll likely prescribe a different treatment for your condition.

Taking a MAOI

Doctors typically will not prescribe Zoloft with MAOIs. MAOIs are prescribed for depression and other conditions.

Taking Zoloft with an MAOI can increase your risk of serotonin syndrome from either drug. With this condition, your body has a high level of a chemical called serotonin. This can lead to symptoms such as diarrhea, excessive sweating, and blood pressure changes. Serotonin syndrome can be life threatening in extreme cases.

Below are a few examples of MAOIs that can interact with Zoloft:

• selegiline (Emsam)
• isocarboxazid (Marplan)
• linezolid (Zyvox)
• phenelzine (Nardil)

Before you start Zoloft treatment, tell your doctor if you take an MAOI. They’ll likely have you stop the MAOI and wait at least 2 weeks to start Zoloft treatment. Likewise, your doctor will typically have you wait at least 2 weeks to start an MAOI after stopping Zoloft treatment.

Having had an allergic reaction to Zoloft or any of its ingredients

If you have had an allergic reaction to Zoloft or any of its ingredients, your doctor will likely not prescribe Zoloft. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Zoloft, it’s important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe Zoloft.

There aren’t any known interactions between Zoloft and alcohol. However, your doctor may advise you to avoid or limit alcohol consumption during Zoloft treatment.

This is because drinking alcohol while taking the drug may worsen some of Zoloft’s side effects. For example, you may experience worsened nausea, dizziness, or sleepiness.

If you have questions about drinking alcohol while taking Zoloft, talk with your doctor.

Here’s a closer look at certain drug interactions of Zoloft.

Certain other antidepressants

As with Zoloft, other antidepressants are prescribed for depression and other mental health conditions.

Interaction result: Taking Zoloft with certain other antidepressants can increase the risk of side effects from either drug.

Interaction explained: Zoloft works by affecting the level of a chemical called serotonin in your body. Certain other antidepressants also affect the level of this chemical. Taking Zoloft with these antidepressants could lead to a very high level of serotonin, and having a high level of this chemical could result in a condition called serotonin syndrome.

Serotonin syndrome can cause symptoms such as diarrhea, excessive sweating, and blood pressure changes. This condition can be life threatening for some people.

In addition, Zoloft and certain other antidepressants may cause irregular heart rhythm as a side effect. Taking these medications together further increases this risk.

Examples of other antidepressant drugs: Here are some other antidepressants that may interact with Zoloft:

• fluoxetine (Prozac)
• duloxetine (Cymbalta)
• venlafaxine (Effexor XR)
• escitalopram (Lexapro)
• amitriptyline

Steps you or your doctor may take: Before starting Zoloft treatment, tell your doctor if you take any other antidepressants. They can advise you on whether it’s safe to take these medications together.

If your doctor prescribes Zoloft with an antidepressant it interacts with, watch for symptoms of serotonin syndrome. Your doctor may also occasionally use an EKG to check your heart rhythm. They’ll instruct you on how to manage side effects if they happen.

To learn more about Zoloft and other antidepressants, talk with your doctor or pharmacist.

Buspirone

Buspirone is prescribed to treat anxiety.

Interaction result: Taking Zoloft with buspirone can increase the risk of serotonin syndrome as a side effect of either drug.

Interaction explained: Both Zoloft and buspirone work by affecting the level of a chemical called serotonin in your body. Taking these medications together could lead to a very high level of serotonin, which could result in serotonin syndrome.

Symptoms of serotonin syndrome can include diarrhea, excessive sweating, and changes in blood pressure. This condition can be life threatening in extreme cases.

Steps you or your doctor may take: Before taking Zoloft, tell your doctor if you take buspirone. They can recommend whether it’s safe to take these drugs together.

If your doctor prescribes Zoloft with buspirone, watch closely for symptoms of serotonin syndrome. Your doctor will tell you how to manage this side effect if it happens.

To learn more about Zoloft and buspirone, talk with your doctor or pharmacist.

Blood thinners and NSAIDs

NSAIDs are taken to relieve pain, inflammation, and fever. Certain NSAIDs are available OTC, meaning you don’t need a prescription to purchase them.

Blood thinners are taken to help prevent the formation of blood clots. Other than aspirin, all blood thinners require a prescription.

Interaction result: Taking Zoloft with an NSAID or a blood thinner can increase your risk of bleeding as a side effect of either drug.

Interaction explained: Zoloft works by affecting a chemical in your body called serotonin. This chemical helps certain blood cells come together to form a blood clot. By affecting serotonin, Zoloft can prevent these blood cells from clotting, which increases your risk of bleeding. So taking Zoloft with an NSAID or blood thinner may further increase your risk of bleeding.

Examples of NSAIDs: Here are some NSAIDs that may interact with Zoloft:

• ibuprofen (Advil, Motrin)
• meloxicam (Mobic)
• naproxen (Naprosyn, others)

Examples of blood thinners: Here are some blood thinners that may interact with Zoloft:

• apixaban (Eliquis)
• dabigatran (Pradaxa)
• rivaroxaban (Xarelto)
• edoxaban (Savaysa)
• warfarin (Jantoven)
• clopidogrel (Plavix)
• aspirin
• prasugrel (Effient)
• ticagrelor (Brilinta)

Steps you or your doctor may take: Before starting treatment with Zoloft, tell your doctor if you take an NSAID or a blood thinner. They can tell you whether it’s safe to take these medications together.

Before taking any OTC pain reliever with Zoloft, talk with your doctor or pharmacist. They can advise you on which OTC products are safe to take with this drug. For example, it’s likely safe to take Zoloft with acetaminophen (Tylenol).

To learn more about Zoloft and NSAIDs or blood thinners, talk with your doctor or pharmacist.

Zoloft may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Zoloft.

Zoloft interactions with supplements

Zoloft may interact with valerian root supplements, which some people take to treat anxiety and other conditions. Taking valerian root supplements with Zoloft could increase the effect of either product. This could lead to sleepiness or fatigue.

Before you start treatment with Zoloft, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Zoloft interactions with herbs

Zoloft may interact with St. John’s wort. This is an herbal supplement that some people take to treat depression and other conditions.

Taking Zoloft with St. John’s wort can increase your risk of serotonin syndrome as a side effect. With this condition, having a high level of a chemical called serotonin in the body can lead to symptoms that may be life threatening. Examples include diarrhea, excessive sweating, and blood pressure changes.

Before taking an herbal product with Zoloft, talk with your doctor or pharmacist. They can tell you whether it’s safe to take them together.

Zoloft interactions with vitamins

There are no specific reports of vitamins interacting with Zoloft. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Zoloft.

Zoloft interactions with food

There were no reports of food interactions with Zoloft. If you’d like to learn more about eating certain foods during treatment with Zoloft, talk with your doctor.

Zoloft and vaccines

There aren’t any known interactions between Zoloft and vaccines. Talk with your doctor or pharmacist to find out whether you’re due for any vaccines.

Zoloft interactions with lab tests

Zoloft may interfere with the results of certain lab tests. Taking the medication may cause a false-positive result on a urine drug test that checks for the presence of benzodiazepines. This means the test could show that you have a benzodiazepine in your system even if you have not taken one.

Because of this, it’s important to tell the person giving you the test that you’re taking Zoloft.

For additional information, talk with your doctor or pharmacist.

ZOLOFT AND CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Zoloft. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Zoloft. The effects of cannabis may affect how well you stick to your Zoloft treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Zoloft. Before you take this drug, be sure to talk with your doctor about your health history. Zoloft may not be the right treatment option for you if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Zoloft include:

Bipolar disorder or mania: If you or a family member has bipolar disorder or mania, talk with your doctor before taking Zoloft. Taking the drug may increase the risk of a manic or mixed episode. Your doctor can recommend whether Zoloft is a safe treatment option.

Liver problems: If you have a liver problem, such as liver failure, tell your doctor before starting Zoloft treatment. Having a liver problem may increase your risk of side effects from the drug. For this reason, your doctor may prescribe a lower Zoloft dosage than is typical or recommend an alternative treatment.

Heart problems: Zoloft may cause an irregular heart rhythm as a side effect. If you have a heart problem, talk with your doctor before taking Zoloft. They can recommend whether the drug is a safe treatment option.

Seizures: It isn’t known whether Zoloft is safe for people who have a seizure condition. If you have seizures, talk with your doctor before starting Zoloft treatment.

Low sodium level in the blood: Before prescribing Zoloft, your doctor may check the level of sodium in your blood. If you have low sodium, your doctor may prescribe treatments to increase it before starting Zoloft treatment. This is because Zoloft may cause low sodium as a side effect, which could make your sodium level even lower.

Narrow eye angles: Before starting Zoloft treatment, your doctor may advise you to have an eye exam. Zoloft can cause dilated pupils, which may lead to closed-angle glaucoma in people with narrow eye angles. Closed-angle glaucoma is a medical emergency that can cause severe eye pain and vision loss. Talk with your doctor about whether Zoloft is a safe treatment option.

Bleeding problems: Zoloft may increase your risk of bleeding. Before starting treatment with the drug, tell your doctor if you have a bleeding problem such as hemophilia. They can recommend whether Zoloft is the right treatment option for your condition.

Allergic reaction: If you’ve had an allergic reaction to Zoloft or any of its ingredients, your doctor will likely not prescribe Zoloft. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Breastfeeding: It’s not known whether it’s safe to take Zoloft while breastfeeding. The drug passes into breast milk. However, it isn’t known what effects Zoloft may have on a child who is breastfed. If you’re breastfeeding or planning to, talk with your doctor before starting Zoloft. They can talk with you about treatment options and ways to feed your child.

Pregnancy: It may not be safe to take Zoloft during the last 3 months of pregnancy. If you’re pregnant or planning to become pregnant, tell your doctor before starting Zoloft. They can advise you on the right treatment plan for you.

If you are prescribed Zoloft during pregnancy, consider enrolling in the drug’s pregnancy registry. This registry collects information about any pregnancy issues that may be reported with Zoloft. To learn more, talk with your doctor. You can also visit the registry website or call 866-961-2388.

Risk of suicidal thoughts and behaviors: Zoloft has a boxed warning about the risk of suicidal thoughts and behaviors. This is a serious warning from the FDA. A boxed warning alerts doctors and patients about drug effects that may be dangerous. For details, see the boxed warning at the top of this article.

You can take certain steps to help prevent interactions with Zoloft. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Zoloft label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Zoloft doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Zoloft by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Zoloft. These resources might help:

• Overview of Zoloft: For a general overview of Zoloft, you can see this article.
• Dosage specifics: To learn about the dosage of Zoloft, see this article.
• Cost: If you’d like to learn about Zoloft and cost, see this article.
• Facts about your condition: To learn more about your condition, see our:
  • mental health hub
  • depression hub
  • anxiety hub
  • women’s health hub

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.