Sertraline

💊 What is Sertraline used for?

• •Major depressive disorder (MDD)
• •Obsessive-compulsive disorder (OCD)
• •Panic disorder (PD)
• •Posttraumatic stress disorder (PTSD)
• •Social anxiety disorder (SAD)
• •Premenstrual dysphoric disorder (PMDD)

How it works

The label does not explain the details of how sertraline works. It classifies sertraline as a selective serotonin reuptake inhibitor (SSRI).

How it is usually taken

• •The label describes sertraline as a tablet taken by mouth once a day.
• •The label says doses are usually adjusted no more often than once a week, so the effects of a change can be seen over time.
• •For PMDD, the label says sertraline may be taken every day of the menstrual cycle or only during the luteal phase (the days before your period starts), and that the second approach is repeated with each new cycle.
• •The label says the medicine should be reduced gradually when it is stopped. Do not stop it without first talking to your healthcare provider.
• •Follow the instructions from your prescriber or pharmacist for how much to take and when.

Comes as

• •25 mg tablets: light green, film coated, elliptical, scored on one side
• •50 mg tablets: light blue, film coated, elliptical, scored on one side
• •100 mg tablets: light yellow, film coated, elliptical, scored on one side

⚠️ Sertraline side effects

🛑 Who should not take Sertraline, and who should be careful

The label says not to take it if

• 🚨You take a monoamine oxidase inhibitor (MAOI), or you have taken one within 2 weeks of stopping sertraline, unless your healthcare provider directs otherwise. The label includes linezolid and intravenous methylene blue in this group.
• 🚨You have stopped taking an MAOI in the last 2 weeks, unless your healthcare provider directs otherwise.
• 🚨You take pimozide.
• 🚨You have a known allergy (hypersensitivity) to sertraline or its inactive ingredients.
• 🚨You take any other medicine that contains sertraline.

Tell your doctor before taking it if

• •Tell your provider if you take a monoamine oxidase inhibitor (MAOI), including the antibiotic linezolid.
• •Tell your provider about any history of seizure disorders. The label says to use this medicine with caution in people with seizure disorders.
• •The label says prescribers should screen patients for bipolar disorder, because sertraline can trigger manic or hypomanic episodes.
• •Tell your provider if you have narrow angles in the eye that have not been treated, since the label says antidepressants should be avoided in that case.
• •Tell your provider about risk factors for changes in heart rhythm (QTc prolongation), since the label says to use sertraline with caution in those patients.
• •Tell your provider if you take blood thinners, aspirin, NSAIDs, or other antiplatelet drugs, because of the bleeding risk.
• •Tell your provider if you are pregnant, planning a pregnancy, or taking antidepressants in late pregnancy. The label discusses pregnancy risks in detail.
• •The Medication Guide says to keep all follow-up visits and to call between visits if you are worried about symptoms.

🔀 Sertraline with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •MAOIs (such as selegiline, tranylcypromine, isocarboxazid, phenelzine, linezolid, methylene blue): The label says these increase the risk of serotonin syndrome and are not to be used with sertraline.
• •Pimozide: The label says sertraline and pimozide must not be used together because of possible heart rhythm problems.
• •Other serotonergic drugs (such as other SSRIs, SNRIs, triptans, tricyclic antidepressants, opioids, lithium, tryptophan, buspirone, amphetamines, and St. John's Wort): The label says these can increase the risk of serotonin syndrome.
• •Blood thinners and bleeding-risk drugs (such as aspirin, clopidogrel, heparin, and warfarin): The label says these can increase bleeding risk. For warfarin, the label says the INR should be monitored carefully.
• •NSAIDs such as ibuprofen or naproxen: The Medication Guide says these can increase bleeding or bruising risk when taken with sertraline.
• •Drugs processed by the CYP2D6 pathway: The label says the dose of these drugs may need to be reduced.
• •Other protein-bound drugs: The label says the dose of these may need to be adjusted.

Alcohol and food

The label does not say.

🤰 Sertraline in pregnancy and breastfeeding

Pregnancy

The label includes a pregnancy exposure registry, the National Pregnancy Registry for Antidepressants, at 1-866-961-2388. The label says that SSRIs, particularly in the month before delivery, have been linked to a less than 2-fold increase in the risk of postpartum hemorrhage. It says published studies of sertraline in the first trimester suggest no difference in major birth defect risk compared with the background rate, while some studies report increases for specific birth defects and those results are inconclusive. The label also mentions clinical considerations for newborns exposed during the third trimester. Talk with your healthcare provider about these risks and the risks of not treating depression.

Breastfeeding

The label does not say.

🗓️ Storage, missed doses and taking too much

Storage

Store at 20°C to 25°C (68°F to 77°F), with short excursions permitted between 15°C and 30°C (59°F to 86°F). Dispense in a tight, light-resistant container. The label text on storage was cut off, so check the label or pharmacy container for any further storage instructions.

If a dose is missed

The label does not say.

If too much is taken

The label lists seizures (which may be delayed), altered mental status including coma, heart-related effects (such as changes in the QRS and QTc intervals and high blood pressure), and serotonin syndrome as reported effects of overdose. For suspected overdose, the label suggests contacting a Poison Center at 1-800-221-2222 or a medical toxicologist. The label also says activated charcoal should be considered for patients who come in early after an overdose.

🗒️ Questions to ask about Sertraline

• What should I do if I have thoughts about suicide or notice big changes in my mood or behavior?
• How long will it take before I notice whether sertraline is helping my symptoms?
• What signs of serotonin syndrome should I watch for, and who should I call if they happen?
• Are any of my current medicines, including over-the-counter drugs and supplements such as St. John's Wort, a concern with sertraline?
• Does my bleeding risk change if I take aspirin, ibuprofen, naproxen, or a blood thinner with sertraline?
• What is the plan for stopping sertraline safely if I ever need to?
• Since I may be pregnant or planning a pregnancy, what should we discuss about the risks and benefits?

❓ Sertraline: frequently asked questions