Sertraline

Antidepressant · SSRIs

Indications

Treatment and prevention of depression including accompanying anxiety. See under dosage.

Dosage

Adults: Anxiety/Hypnotics: Panic Disorder/Social Anxiety Disorder/PTSD: Initial: 25 mg once daily. Titrate: Increase to 50 mg once daily after 1 wk. Adjust wkly. Max: 200 mg/day. Depression: Initial: 50 mg once daily. Titrate: Adjust wkly. Max: 200 mg/day. OCD: Initial: 50 mg once daily. 6-12 yr: 25 mg once daily. Titrate: Adjust wkly. Max: 200 mg/day. PMDD: Initial: 50 mg once daily continuous or limit to luteal cycle phase. Titrate: Increase by 50 mg/cycle up to 150 mg/day for continuous or 100 mg/day for luteal phase dosing. If 1 mg/day is established for luteal phase dosing, then titrate by 50 mg/day for 3 days at beginning of each luteal phase dosing period. Children: Obsessive-compulsive disorder: 6-12 yr, initially 25 mg daily increased to 50 mg daily after 1 wk, further increased if necessary in steps of 50 mg at intervals of at least 1 wk, max 200 mg daily; 12-18 yr, initially…

Adverse Effects

GI upset, anorexia, sexual dysfunction, principally ejaculatory delay, tremor, increases sweating, akathisia, pharyngitis, increased appetite, depression, nightmares, agitation, bruxism, dysgeusia, tinnitus, palpitations, yawning, chest pain, paraesthesia, hypertonia, disturbed attention, hot flushes, dizziness, insomnia, somnolence, malaise, arthralgia, myalgia, rash, anaphylactoid reactions, angioedema, hyperprolactinaemia, postural hypotension, tachycardia, visual disturbances, headache, panic reactions, drowsiness, nervousness, symptoms associated with serotonin syndrome, urinary retention, seizures; psychosis. Rarely erythema, multiforme, hyponatraemia, activation of mania/hypomania, pancreatitis, serious liver events, altered platelet function and/or abnormal lab results, withdrawal symptoms.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Caution advised or effect undetermined. Contraindications: Severe hepatic impairment, unstable epilepsy. Within 2 weeks of stopping MAOIs or 7 days of stopping moclobemide. Precautions: Mild to moderate hepatic impairment, ECT, epilepsy, diabetes, schizophrenia, history of mania/hypomania (discontinue if enter a manic phase), monitor for suicidal ideation. Possible risk of cutaneous bleeding abnormalities, such as ecchymosis and purpura in patients taking antiplatelet drugs or those with a history of bleeding disorders. Withdraw gradually. Risk factors for QT prolongation. Poor CYP2C19 metabolisers. Long term treatment in children and adolescents; monitor growth and development.

Interactions

MAOIs including selegiline and moclobemide, pimozide, linezolid, lithium, tryptophan, fenfluramine, tramadol, TCADs, diazepam, fentanyl, phenytoin, alcohol, tolbutamide, cimetidine, warfarin, centrally acting drugs, St. John's Wort, NSAIDs and other drugs affecting platelet function, other SSRIs, SNRIs, 5HT1 agonists/triptans, other serotonergic drugs, other CYP2D6 substrates, CYP3A4 inhibitors, drugs which prolong QT interval. Grapefruit juice.

Advice to Patient

Take with or without meals. Dilute oral concentrate before taking it. Use supplied dropper to remove prescribed amount and mix it with 4 oz (one-half cup) of water, ginger ale, lemon or lime soda, lemonade, or orange juice. Do not mix oral concentrate with anything else. Mixture can be slightly hazy. Take dose immediately after mixing it. Take medication in morning. Do not stop taking medication abruptly, gradually lower the dose and then stop. Contact prescriber if there is constant lack of sleep, daytime drowsiness, agitation, muscle cramps, tremors, fatigue, nervousness, change in gait, chest pain, palpitations, change in vision, eye pain, swelling of extremities, difficulty in breathing, change in hearing, ringing in ears, skin rash, skin irritation or if there is worsening of condition. Empty bladder before taking medication. Avoid alcohol and caffeine during therapy. Take…

Pharmacokinetics

Onset of action: Depression: The onset of action is within a week, however individual response varies greatly and full response may not be seen until 8 to 12 weeks after initiation of treatment. Metabolism: Hepatic. Bioavailability: Bioavailability of tablets and solution are equivalent. Half-life elimination: Sertraline: Mean: 26 hours; N-desmethylsertraline: 62 to 104 hours. Children 6 to 12 years: Mean: 26.2 hours. Children 13 to 17 years: Mean: 27.8 hours. Adults 18 to 45 years: Mean: 27.2 hours. Time to peak, plasma: Sertraline: 4.5 to 8.4 hours. Excretion: Urine (40% to 45% as metabolites); feces (40% to 45%; 12% to 14% as unchanged drug).

Unlicensed Use

Children: Major depression: 12-18 yr, initially 50 mg once daily increased if necessary in steps of 50 mg daily at intervals of at least a wk, max 200 mg once daily.

Brands with this active ingredient

Compiled by Healify Pharmacy from published drug references. How we compile it →

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