Major
Dronedarone × Sertraline
Class III antiarrhythmic×Selective serotonin reuptake inhibitors (SSRIs)
Mechanism
Sertraline at high doses (above 150 mg/day) moderately prolongs QT. Combined with dronedarone, risk of torsades de pointes rises, especially in older patients.
Symptoms
QT prolongation on ECG. Dizziness, syncope, palpitations. Severe cases: polymorphic ventricular tachycardia (torsades de pointes). Risk is higher with hypokalaemia and hypomagnesaemia.
Management
Avoid the combination with sertraline above 100 mg. At low doses (50–100 mg) with normal potassium and magnesium, the combination is acceptable with ECG monitoring at 2 weeks. Alternative antidepressants: mirtazapine or agomelatine.