Sertraline

(ser-truh-leen)

Trade/other name(s): Zoloft, sertraline hydrochloride

Why would this drug be used?

Sertraline is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI). It is used to help treat depression, panic attacks, obsessive compulsive disorder, and other conditions.

How does this drug work?

Sertraline works by raising levels of serotonin, a key chemical in the brain.

Before taking this medicine

Tell your doctor…

• If you are allergic to any medicines, dyes, additives, or foods.
• If you have ever thought of or attempted suicide. Treatment with an antidepressant may raise the risk of suicidal thoughts, especially during the first few months of treatment.
• If you drink alcohol or are taking any type of sedative. This drug could possibly increase their effects on the nervous system, which in some cases could be dangerous.
• If you have ever had liver disease (including hepatitis or cirrhosis). This drug is cleared from the body mainly by the liver. Reduced liver function may result in more drug than expected staying in the body. This could lead to unwanted side effects. Your doctor will want to monitor you closely and may need to adjust your dose accordingly.
• If you have ever had bleeding problems or are taking medicines that might raise your risk of bleeding (aspirin or aspirin-containing medicines, other non-steroidal anti-inflammatory drugs (NSAIDs), warfarin (Coumadin), vitamin E, etc.). This drug may raise your risk of abnormal bleeding.
• If you have ever had seizures or bipolar disorder (manic depressive illness). This drug could make these conditions worse.
• If you have any other medical problems such as congestive heart failure, lung disease, heart disease, kidney problems, high blood pressure, diabetes, gout, or infections. You may need closer monitoring of these conditions while being treated.
• If you have taken monoamine oxidase inhibitors (such as isocarboxazid, phenelzine, selegiline, and tranylcypromine) within the past 2 weeks.
• If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug might cause problems if the woman is taking it at the time of conception or during pregnancy. It is important to check with your doctor about whether birth control should be used with this medicine. In some women who have taken this drug in the weeks before delivery, babies have required longer hospital stays due to problems that may have been related to the drug. Women who are pregnant should discuss this with their doctors before starting to take sertraline.
• If you are breast-feeding. This drug may pass into breast milk and affect the baby. Talk with your doctor about the possible risks of breast-feeding while taking this drug.
• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Sertraline may interact with a number of other drugs and dietary supplements.

Antidepressants known as monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), or selegiline (Emsam) may interact with sertraline and raise the risk of serious side effects. Sertraline should never be taken within 2 weeks of taking an MAOI.

Pimozide (Orap) and thioridazine (Mellaril) should not be taken with sertraline. If you plan to take one of these drugs, you should wait at least 2 weeks after sertraline has been stopped. Interactions with these drugs could affect the heart rhythm.

Fentanyl (a pain medicine) can cause a serious reaction when used along with sertraline (see serotonin syndrome information in “Precautions” section). Trazodone, buspirone, and other drugs that affect serotonin may also cause this kind of problem.

Sertraline may raise the risk of abnormal bleeding. This risk may be increased further if you are taking aspirin or aspirin-containing medicines, other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, warfarin (Coumadin), or vitamin E.

Tryptophan supplements and St. John's wort are not recommended while taking fluoxetine.

Drugs that are used to treat migraine or cluster headaches (triptans) can cause an increased risk of serious side effects (see serotonin syndrome information in "Precautions" section) or other problems if taken with fluoxetine:

• sumatriptan (Imitrex)
• rizatriptan (Maxalt)
• naratriptan (Amerge)
• eletriptan (Relpax)
• frovatriptan (Frova)
• almotriptan (Axert)
• zolmitriptan (Zomig)

Other drugs that could interact with sertraline include:

• sedatives, anxiety medicines, antihistamines, sleeping pills, or alcohol
• other antidepressants (amitriptyline, desipramine, doxepin, imipramine, nortriptyline, fluoxetine)
• antipsychotics such as haloperidol (Haldol), clozapine (Clozaril), and others
• anti-seizure drugs such as carbamazepine (Tegretol), phenytoin (Dilantin), valproate (Depacon), and phenobarbital
• drugs to help heart rhythm such as propafenone (Rythmol) or flecainide (Tambocor)
• tolbutamide (Orinase)
• tramadol (Ultram)
• linezolid (Zyvox)
• lithium (Eskalith, Lithobid)
• cimetidine (Tagamet)
• digoxin (Lanoxin)

The liquid form of sertraline contains a small amount of alcohol, and should not be used if you are taking disulfiram (Antabuse).

There are other drug interactions not listed above. Check with your doctor, nurse, or pharmacist about all of your medicines, herbs, and supplements.

Interactions with foods

While it has not been shown in studies, it is possible that alcohol could have more potent effects on the nervous system while taking sertraline. Its use should be minimized or avoided while taking this drug. No other serious interactions with foods are known at this time. Check with your doctor, nurse, or pharmacist about whether some foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Sertraline is taken by mouth as a tablet or liquid. It is taken once a day, in the morning or evening. The liquid comes with a special dropper to measure out the dose. This should be mixed with a half cup (4 ounces) of water, ginger ale, lemon/lime soda, orange juice, or lemonade.

The dose depends on a number of factors, including the reason the drug is being taken and the patient’s age and liver function. If needed, the dose may be increased after waiting at least a week. Lower doses may be recommended in children, elderly patients, and in those with liver problems. Do not change the dose or stop taking this drug without first speaking to your doctor or nurse. Talk to your doctor before starting any new medicines while on sertraline.

Keep the medicine in a tightly closed container and out of the reach of children or pets.

Precautions

This drug may make you feel drowsy when you first start taking it or if the dose is increased. Do not drive or operate heavy machinery until you know how the drug affects you. Use caution if taking cold or allergy medicines, sedatives, anxiety medicines, or sleeping pills or if consuming alcohol while taking this medicine. Talk to your doctor or nurse if you feel too drowsy or it does not go away.

This medicine may take 2 weeks or longer to take effect. Do not stop taking this drug without first speaking to your doctor or nurse. If you are going to stop taking sertraline, it should usually be tapered down over the course of several weeks, as directed by your doctor. Suddenly stopping the drug can cause anxiety, dizziness, irritability, headache, insomnia, and confusion in some people.

This drug should be used with caution if you have ever had liver disease (including hepatitis or cirrhosis). This drug is cleared from the body mainly by the liver. Reduced liver function may result in more drug than expected staying in the body, which could lead to unwanted side effects. Your doctor will want to monitor you closely and may need to adjust your dose accordingly.

As with other antidepressants, this drug may raise the risk of suicidal thoughts and actions, mostly in people up to age 24, especially during the first few months of treatment. If you notice any strange or unusual thoughts or behavior, such as irritability, sleep problems, confusion, aggressiveness, restlessness, panic attacks, or thoughts of suicide while on this medicine, call your doctor. Tell family members, loved ones, and caregivers that you are taking this drug, so that they can help you if they notice behavior changes.

Sertraline should be used with caution if you have ever had seizures or bipolar disorder (manic depressive illness), or have ever had bleeding problems. This drug could make these conditions worse.

Older people may have low levels of sodium in the blood while on this drug. This is usually found only on blood tests, but if severe, may cause sluggishness, unsteadiness, confusion, muscle twitching, seizures, and coma.

This drug can cause a rare problem called neuroleptic malignant syndrome, with symptoms like fever, tight muscles, tremors, sweating, constipation, and confusion. This syndrome can become life-threatening if not treated right away. If you have symptoms like these, call your doctor without delay.

This drug can rarely cause a problem called serotonin syndrome, with symptoms such as nausea, vomiting, diarrhea, headache, restlessness, and confusion. It can also cause bleeding, easy bruising, and trouble walking. This syndrome can become life-threatening if not treated quickly and is more likely if you are taking certain other medicines (see "Interactions with other drugs" section). If you have symptoms like these, call your doctor right away.

This drug may cause a false positive result on certain drug screen tests for benzodiazepines (drugs such as Valium, Xanax, or Ativan) while you are taking it and for several days after the drug is stopped.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

• headache
• trouble sleeping
• nausea
• diarrhea

Less common

• feeling drowsy*
• dry mouth*
• feeling tired or weak
• sweating
• constipation
• upset stomach
• feeling dizzy*
• trembling
• loss of appetite
• less interest in sex
• problems with ejaculation (men)

Rare

• feeling restless or nervous
• skin rash
• blurred vision
• easy bleeding or bruising*
• behavior changes such as irritability, agitation, or panic*
• impotence (men)
• decreased ability to reach orgasm (women)
• low blood sodium levels*
• suicidal thoughts*
• allergic reaction

*See the "Precautions" section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 1991.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.