Major
Sertraline × venlafaxine
Selective serotonin reuptake inhibitors (SSRIs)×SNRI (serotonin-norepinephrine reuptake inhibitor)
Mechanism
SSRI (sertraline) + SNRI (venlafaxine) – additive serotonergic load. The combination is not used in clinical practice.
Symptoms
Serotonin syndrome: agitation, confusion, tremor, myoclonus, hyperreflexia. Autonomic features: sweating, tachycardia, hypertension, fever. First signs appear within hours of co-administration.
Management
The combination is not prescribed. When switching antidepressants, allow a 1-week washout. For augmentation, add mirtazapine or agomelatine (different class).
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.