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Sertraline
Aka: Sertraline, Zoloft
- Mechanism
- Selective Serotonin Reuptake Inhibitor (SSRI)
- Indications
- Major Depression
- Obsessive Compulsive Disorder
- Panic Disorder
- Post-Traumatic Stress Disorder (PTSD)
- Premenstrual Dysphoric Disorder
- Background
- Cost: $75 per month
- Preparations
- Tablets (Scored): 25, 50, 100 mg
- Oral concentrate: 20 mg/ml (60 ml bottle)
- Dosing
- Start
- Children (ages 6-12 years of age): 25 mg PO qAM
- Adults (and children over age 12): 50 mg PO qAM
- Elderly: 25 mg PO qAM
- Titrate
- Adults: Increase by 50 mg every 2 weeks
- Maximum: 200 mg per day
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Drug Interactions
- Significantly raises Pimozide levels
- Concurrent use with Pimozide is contraindicated
- Inhibits Cytochrome P450-2C and P450-3A4
- Clinically Significant interactions are uncommon
- Highly protein bound
- Interacts with other protein bound medications
- Absorption affected by food intake
- Raises Tricyclic Antidepressant levels
- Allow two week wash-out prior to starting MAO inhibitor
- Pharmacokinetics
- Half Life: 1 to 4 days
- Therapeutic Blood level 9.5 to 56 ng/ml
- Adverse Effects
- Neutral on the sedation to excitation continuum
- Less sedating than Paxil or Luvox
- Anxiety, Insomnia or other sleep disturbance
- Less stimulating than Prozac
- Consider Trazodone (Desyrel) at bedtime
- 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