Moderate
furosemide × sertraline
Loop diuretics×Selective serotonin reuptake inhibitors (SSRIs)
Mechanism
Both drugs can cause hyponatremia (furosemide via natriuresis, sertraline via an SIADH-like mechanism). In patients over 75, the rate of clinically significant hyponatremia (Na+ < 130 mmol/L) rises with the combination.
Management
Check sodium at baseline, at 2 and 4 weeks after sertraline initiation, then every 3–6 months. For Na+ < 130 mmol/L, reassess therapy.
Sources
- AGS: American Geriatrics Society 2023 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults (2023)— J Am Geriatr Soc 2023;71(7):2052–2081
- Lexicomp: Lexicomp Drug Interactions (2024)— Wolters Kluwer Clinical Drug Information, Inc. Lexi-Interact Online, 2024