Sarafem use, especially along with a few other antidepressants, such as, imipramine, citalopram, and sertraline, can significantly increase the serotonin levels in the body and lead to development of serotonin syndrome. Caution must be exercised even when discontinuing on any of the above mentioned antidepressant medications with potential to increase serotonin levels and starting on Sarafem, by observing a window period of atleast 2 weeks, before the transition to Sarafem is made. Using Sarafem with these medications closely can result in dangerously elevated serotonin in the blood, leading to development of serotonin syndrome, which can contribute to nausea, vomiting, diarrhea, rapid heart rate and dangerous arrhythmias, mania, agitation, and hallucinations.
Sarafem carries significant risk for obstruction to the flow of aqueous humor, increasing the intraocular pressure, eye pain, headache, blurred vision with haloes around light, and compromised vision. So, Sarafem use is contraindicated in individuals with history of glaucoma, especially the closed-angle glaucoma.
