Sertraline

Sertraline - Use | Dose | Side Effects

Sertraline is a drug from the group of the selective serotonin reuptake inhibitor (SSRI), and is used in the treatment of:

  • Depression
  • Anxiety
  • Social phobia
  • Posttraumatic stress disorders
  • Obsessive-compulsive disorders

Sertraline is a potent and specific inhibitor of serotonin - a hormone that has a direct impact on mood. Increase in the levels of this hormone in the blood, has a direct impact on improving the symptoms of abovementioned disorders. In clinical studies, Sertraline exerted a very weak inhibitory effect on the neuronal uptake of noradrenaline and dopamine. It does not exhibit sedative effect and it is not associated with cardiotoxicity unlike other antidepressants.

Precautions

The only contraindication for use of Sertraline is concomitant administration with the following drugs:

  • Irreversible and reversible inhibitors of monoamine oxidase (MAOIs), such as:
    • moclobemide
    • isocarboxazid
    • tranylcypromine
    • nialamide
    • selegiline
    • rasagiline
    • phenelzine
    Some of these drugs are also used to treat depression, while others are used to treat Parkinson's disease. Co-administration of Sertraline with MAOIs significantly increases the risk of serotonin syndrome. Bear in mind that severe forms of serotonin syndrome can be life-threatening! Symptoms of serotonin syndrome include: hyperthermia, tremor, anxiety, shivering, tachycardia, hypertension and seizures. Wait at least 14 days after stopping MAOIs before you can start using Sertraline.
  • Pimozide (an antipsychotic). Concomitant use of these drugs increases the risk of serotonin syndrome.

Sertraline should be avoided in schizophrenic patients, because there are reported cases of exacerbation of symptoms in schizophrenics who have used Sertraline.

Since there are reported cases of Sertraline-induced seizures, this drug should not be used in epilepsy.

Like all other antidepressants, Sertraline can also cause the suicidal thoughts. If you are experiencing this adverse effect, immediately inform the family and doctor about it.

Sertraline should be used with extra precaution in patients who have a low platelet count or blood clotting disorder, because Sertraline is associated with bleeding disorders of the skin (ecchymosis and purpura) and with other forms of bleeding.

Use of Sertraline is not recommended in patients younger than 18 years.

Sertraline should be used with extra precaution in patients who have electrolytic imbalance, because it may cause hyponatremia.

Caution is also required in patients with hepatic insufficiency, as most of this drug is excreted by the liver.

Sertraline may affect the concentration of glucose in the blood, so the caution is needed in patients with diabetes.

Sertraline, pregnancy and breastfeeding

Studies have shown that use of Sertraline during the first trimester of pregnancy increases the risk of craniosynostoses (congenital defect characterized by premature closure of sutures between the bones of the skull) and of congenital atrial or ventricular defects. Use of this drug in the last trimester, can lead to the withdrawal symptoms in newborns immediately after birth. Sertraline should be used during pregnancy only if necessary.

Breastfeeding

Published data suggest that there is a small risk of adverse effects for infants whose mothers took Sertraline. Sertraline is generally excreted in very low concentrations into breast milk, although there are reported cases where the concentration in breast milk was as really high (50 % of maternal blood levels). For this reason, it is best to avoid breastfeeding while being treated with this drug.

Dosage

Sertraline tablets should be taken once daily, in the morning or in the evening.

Therapy should begin at 25 mg daily. After one week, dose may be increased to 50 mg daily.

The maximum daily dose is 200 mg.

Therapy is long-term and usually lasts from 6 months to a year.

Interactions

Co-administration of Sertraline with these drugs increases the risk of serotonin syndrome:

  • Dextromethorphan (a drug used in the treatment of cough)
  • 5-hydroxytryptophan - a drug used in the treatment of fibromyalgia and depression
  • Almotriptan, rizatriptan, sumatriptan and zolmitriptan - drugs used to treat migraine
  • Narcotic analgesics, such as: fentanyl, pentazocine, alfentanil, morphine, oxycodone, hydrocodone and tramadol
  • Cyclobenzaprine - a drug used in the treatment of muscle spasms

Side effects

Side effects of the Sertraline include:

  • Nausea (the most common side effect)
  • Anejaculation (inability to ejaculate)
  • Sexual dysfunction
  • Upper respiratory tract infections
  • Diverticulitis (inflammation and an infection of pockets which are located in the colon, resulting in diarrhea)
  • Otitis media (middle ear infection)
  • Gastroenteritis (infection of the stomach and the colon)
  • Lymphadenopathy
  • Hypercholesterolemia
  • Suicidal thoughts
  • Hallucinations
  • Nightmares
  • Confusion
  • Anxiety
  • Seizures
  • Bruxism (teeth grinding)
  • Hyperkinesias
  • Hypoesthesia
  • Hypertension
  • Tachycardia