Moderate
Probable
Descripción
Phenytoin significantly reduces sertraline plasma concentrations via CYP enzyme induction, potentially causing antidepressant treatment failure.
Mecanismo
Phenytoin is a potent inducer of CYP2C19 and CYP3A4, the primary enzymes involved in sertraline metabolism, resulting in markedly increased clearance.
Relevancia clínica
Sertraline AUC may be reduced by more than 50%; clinical depression relapse is a realistic risk with inadequate antidepressant levels.
Manejo clínico
Monitor antidepressant efficacy; sertraline dose escalation is likely needed; consider alternative AED without CYP-inducing properties.