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