Major
duloxetine × Sertraline
SNRI×Selective serotonin reuptake inhibitors (SSRIs)
Mechanism
SSRI (sertraline) + SNRI (duloxetine) – additive serotonergic load, serotonin syndrome risk without therapeutic rationale.
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, use mirtazapine or agomelatine.