sertraline

Sertraline is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). Sertraline affects chemicals in the brain that may become unbalanced and cause depression, panic, anxiety, or obsessive-compulsive symptoms.

Sertraline is used to treat depression, obsessive-compulsive disorder, panic disorder, anxiety disorders, post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD).

Sertraline may also be used for purposes not listed in this medication guide.

Important information

You should not use sertraline if you also take pimozide, or if you are being treated with methylene blue injection.

Do not use sertraline if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using sertraline. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Do not give sertraline to anyone younger than 18 years old without the advice of a doctor. Sertraline is FDA-approved for children with obsessive-compulsive disorder (OCD). It is not approved for treating depression in children.

Before taking this medicine

You should not use sertraline if you are allergic to it, if you also take pimozide, or if you are being treated with methylene blue injection.

Do not use sertraline if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine. After you stop taking this medicine, you must wait at least 14 days before you start taking an MAOI.

To make sure sertraline is safe for you, tell your doctor if you have:

• liver or kidney disease;

• seizures or epilepsy;

• a bleeding or blood clotting disorder;

• bipolar disorder (manic depression); or

• a history of drug abuse or suicidal thoughts.

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using sertraline. Your family or other caregivers should also be alert to changes in your mood or symptoms.

FDA pregnancy category C. Taking an SSRI antidepressant during pregnancy may cause serious lung problems or other complications in the baby. However, you may have a relapse of depression if you stop taking your antidepressant. Tell your doctor right away if you become pregnant while taking sertraline. Do not start or stop taking this medicine during pregnancy without your doctor"s advice.

See also: Pregnancy and breastfeeding warnings (in more detail)

It is not known whether sertraline passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Do not give this medicine to anyone younger than 18 years old without the advice of a doctor. Sertraline is FDA-approved for children with obsessive-compulsive disorder (OCD). It is not approved for treating depression in children.

How should I take sertraline?

Take sertraline exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Sertraline may be taken with or without food. Try to take the medicine at the same time each day.

The liquid form of sertraline must be diluted before you take it. To be sure you get the correct dose, measure the liquid with the medicine dropper provided. Mix the dose with 4 ounces (one-half cup) of water, ginger ale, lemon/lime soda, lemonade, or orange juice. Do not use any other liquids to dilute the medicine. Stir this mixture and drink all of it right away. To make sure you get the entire dose, add a little more water to the same glass, swirl gently and drink right away.

This medicine can cause you to have a false positive drug screening test. If you provide a urine sample for drug screening, tell the laboratory staff that you are taking sertraline.

It may take up to 4 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve.

Do not stop using sertraline suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using sertraline.

Store sertraline at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid?

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. Using an NSAID with sertraline may cause you to bruise or bleed easily.

Drinking alcohol can increase certain side effects of sertraline.

Do not take the liquid form of sertraline if you are taking disulfiram (Antabuse). The liquid medicine may contain alcohol and you could have a severe reaction to the disulfiram.

This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Sertraline side effects

Get emergency medical help if you have any of these signs of an allergic reaction to sertraline: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

• very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, feeling like you might pass out;

• agitation, hallucinations, fever, overactive reflexes, tremors;

• nausea, vomiting, diarrhea, loss of appetite, feeling unsteady, loss of coordination; or

• headache, trouble concentrating, memory problems, weakness, fainting, seizure, shallow breathing or breathing that stops.

Common sertraline side effects may include:

• drowsiness, dizziness, tired feeling;

• mild nausea, stomach pain, upset stomach, constipation;

• dry mouth;

• changes in appetite or weight;

• sleep problems (insomnia); or

• decreased sex drive, impotence, or difficulty having an orgasm.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Sertraline dosing information

Usual Adult Dose of Sertraline for Depression:

Initial dose: 50 mg orally once a day.
Increase dose by 50 mg increments no more often than weekly.
Maintenance Dose: Can increase once a week, to a maximum of 200 mg once a day.

Usual Adult Dose of Sertraline for Obsessive Compulsive Disorder:

Initial dose: 50 mg orally once a day.
Increase dose by 50 mg increments no more often than weekly.
Maintenance Dose: Can increase once a week, to a maximum of 200 mg once a day.

Usual Adult Dose for Panic Disorder:

Initial dose: 25 mg orally once a day, after one week, the dose may be increased to 50 mg once a day. Increase dose by 50 mg increments no more often than weekly.
Maintenance dose: Can increase once a week, to a maximum of 200 mg once a day.

Usual Adult Dose of Sertraline for Post Traumatic Stress Disorder:

Initial dose: 25 mg orally once a day, after one week, the dose may be increased to 50 mg once a day. Increase dose by 50 mg increments no more often than weekly.
Maintenance dose: Can increase once a week, to a maximum of 200 mg once a day.

Usual Adult Dose for Social Anxiety Disorder:

Initial dose: 25 mg orally once a day, after one week, the dose may be increased to 50 mg once a day. Increase dose by 50 mg increments no more often than weekly.
Maintenance dose: Can increase once a week, to a maximum of 200 mg once a day.

Usual Adult Dose for Premenstrual Dysphoric Disorder:

Initial dose: 50 mg orally once a day, either throughout the menstrual cycle or limited to the luteal phase of the menstrual cycle (depending on the clinical judgement of the physician).

Patients not responding to a 50 mg per day dose may benefit from dose increases (at 50 mg increments/menstrual cycle) up to 150 mg per day when dosing daily throughout the menstrual cycle, or 100 mg per day when dosing during the luteal phase of the menstrual cycle. If a 100 mg per day dose is established with luteal phase dosing, a 50 mg per day titration step for three days should be utilized at the beginning of each luteal phase dosing period.

The effectiveness of sertraline for longer than three months has not been systematically evaluated in controlled trials.

What other drugs will affect sertraline?

Taking sertraline with other drugs that make you sleepy or slow your breathing can increase these effects. Ask your doctor before taking sertraline with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety or seizures.

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with sertraline, especially:

• any other antidepressant;

• buspirone;

• cimetidine;

• digitoxin;

• lithium;

• St. John"s wort;

• tryptophan (sometimes called L-tryptophan);

• warfarin, Coumadin;

• cough medicine that contains dextromethorphan;

• heart or blood pressure medication--flecainide, metoprolol, propafenone, propranolol, and others;

• migraine headache medicines--sumatriptan, zolmitriptan, and others;

• pain medication--fentanyl, tramadol; or

• seizure medication--divalproex, phenytoin.

This list is not complete. Other drugs may interact with sertraline, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.