II. Mechanism
III. Indications
IV. Background
V. Safety
- Pregnancy
- Most commonly used SSRI in pregnancy, and preferred agent
- Low first trimester pregnancy risk
- But has been associated with increased risk of atrial and ventricular defects and Craniosynostosis
- Bérard (2015) Am J Obstet Gynecol 212(6):795.e1-795.e12 +PMID: 25637841 [PubMed]
-
Lactation
- Consider safe in Lactation (poorly secreted into Breast Milk)
VI. Preparations
- Tablets (Scored): 25, 50, 100 mg
- Oral concentrate: 20 mg/ml (60 ml bottle)
VII. Dosing
- Start
- Children (ages 6-12 years of age): 25 mg orally each morning
- Adults (and children over age 12): 50 mg orally each morning
- Elderly: 25 mg orally each morning
- Titrate
- Adults: Increase by 50 mg every 2 weeks
- Maximum: 200 mg per day
VIII. Drug Interactions
- Significantly raises Pimozide levels
- Concurrent use with Pimozide is contraindicated
- Metabolized by Cytochrome P450 2C9, 2C19, 2D6 and 3A4
- Moderate Cytochrome P450-2D6 Inhibitor
- Also inhibits Cytochrome P450-2C and P450-3A4
- Clinically Significant interactions are uncommon
- Highly Protein bound
- Interacts with other Protein bound medications (but does not appear to significantly affect their drug levels)
- Absorption affected by food intake
- Raises Tricyclic Antidepressant levels
- Allow two week wash-out prior to starting MAO Inhibitor
IX. Pharmacokinetics
- Half Life: 1 to 4 days
- Therapeutic Blood level 9.5 to 56 ng/ml
X. Adverse Effects
- See Antidepressant Adverse Effects
- Increased risk of Gastrointestinal Bleeding
- Neutral on the sedation to excitation continuum
- Anxiety, Insomnia or other sleep disturbance
-
Diarrhea or gastrointestinal upset
- Diarrhea more common than with Fluoxetine
- Usually resolves within 2 weeks
-
Sexual Dysfunction may be more common
- Includes decreased libido
- See Antidepressant Induced Sexual Dysfunction
-
Antidepressant Withdrawal symptoms on stopping
- Taper 50 mg per every 5-7 days
- Taper to 25-50 mg daily before stopping
XI. Resources
XII. References
- (2023) Med Lett Drugs Ther 62(1592): 25-32
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 38-9
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
Images: Related links to external sites (from Bing)
Related Studies
| sertraline (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| SERTRALINE 150 MG CAPSULE | Generic | $4.69 each |
| SERTRALINE 20 MG/ML ORAL CONC | Generic | $0.57 per ml |
| SERTRALINE 200 MG CAPSULE | Generic | $4.72 each |
| SERTRALINE HCL 100 MG TABLET | Generic | $0.05 each |
| SERTRALINE HCL 25 MG TABLET | Generic | $0.04 each |
| SERTRALINE HCL 50 MG TABLET | Generic | $0.04 each |
| zoloft (on 3/15/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ZOLOFT 100 MG TABLET | Generic | $0.05 each |
| ZOLOFT 50 MG TABLET | Generic | $0.04 each |
Ontology: Sertraline (C0074393)
| Definition (NCI_NCI-GLOSS) | A drug used to treat depression. It is a type of selective serotonin reuptake inhibitor (SSRI). |
| Definition (CSP) | selective serotonin uptake inhibitor; used as an antidepressant. |
| Definition (MSH) | A selective serotonin uptake inhibitor that is used in the treatment of depression. |
| Definition (PDQ) | The salt form of a synthetic derivative of naphthalenamine with anti-serotoninergic and anti-depressant properties. Sertraline appears to selectively inhibit the neuronal uptake of serotonin, raising serotonin levels in the CNS. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=322832&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=322832&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C29451" NCI Thesaurus) |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D020280 |
| SnomedCT | 96211006, 321958004, 372594008 |
| LNC | LP17242-6, MTHU004268 |
| English | Sertraline, 1-Naphthalenamine,1,2,3,4-tetrahydro-4-(3,4-dichlorophenyl)-N-methyl-, (1S-cis)-, Sertraline [Chemical/Ingredient], SERTRALINE, sertraline, Sertraline (product), Sertraline (substance) |
| Swedish | Sertralin |
| Czech | sertralin |
| Finnish | Sertraliini |
| Russian | SERTRALIN, СЕРТРАЛИН |
| Japanese | セルトラリン |
| Polish | Sertralina |
| Croatian | SERTRALIN |
| Spanish | sertralina (producto), sertralina (sustancia), sertralina, Sertralina |
| French | Sertraline |
| German | Sertralin |
| Italian | Sertralina |
| Portuguese | Sertralina |
Ontology: Zoloft (C0284660)
| Concepts | Organic Chemical (T109) , Pharmacologic Substance (T121) |
| MSH | D020280 |
| German | Altruline, Lustral, Zoloft |
| English | lustral, Zoloft, Lustral, Altruline, Parke Davis Brand of Sertraline Hydrochloride, Pfizer Brand of Sertraline Hydrochloride, Roerig Brand of Sertraline Hydrochloride |
