Sertraline

Brand names

• Apo-sertraline
• Novo-sertraline
• Zoloft

Usage

To treat symptoms of major depression, obsessive-compulsive disorder, and panic disorder.

How it works

Sertraline affects levels of serotonin, a brain chemical that is thought to be linked to mood, emotions, and mental state.

Side effects

Serious

Skin rash, hives, or itching; unusually fast speech, fever, extreme agitation.

Common

Insomnia, diarrhea, sexual dysfunction, decrease in appetite, weight loss, drowsiness, headache, dry mouth, stomach cramps, abdominal pain, gas, trembling, fatigue, loss of initiative.

Less common

Anxiety, agitation, increased appetite, blurred or altered vision, constipation, heartbeat irregularities, flushing, unusual feeling of warmth, vomiting.

Possible interactions

Other medicaments:

Sertraline may increase the effects of:

• astemizole (Hismanal), leading to Torsade de Pointes or other heart rhythm problems.
• carbamazepine (Tegretol, others), leading to toxicity. Careful patient monitoring and more frequent carbamazepine levels are prudent.
• clozapine (Clozaril), leading to clozapine toxicity.
• dextromethorphan (in many cough "DM" suppressants).
• diazepam (Valium) and perhaps other benzodiazepines.
• diltiazem (Cardizem).
• dofetilide (Tikosyn), leading to toxicity. Caution and more frequent blood levels are prudent.
• fosphenytoin (Cerebyx) or phenytoin (Dilantin). Blood level checks are prudent if these medicines must be combined.
• lamotrigine (Lamictal).
• naratriptan (Amerge), sumatriptan (Imitrex) and rizatriptan (Maxalt), leading to loss of coordination and weakness.
• propafenone (Rythmol), leading to toxicity. Blood levels and clinical monitoring is prudent.
• sibutramine (Meridia), which may lead to toxicity (serotonin syndrome).
• theophylline (Theo-Dur, others) may lead to theophylline toxicity.
• tolbutamide (Orinase).
• warfarin (Coumadin) and related oral anticoagulants; more frequent INR (prothrombin time or protime) testing is needed. Ongoing warfarin doses should be based on INR results.

Sertraline taken concurrently with:

• antidiabetic medicaments (insulin, oral hypoglycemics) may increase the risk of hypoglycemic reactions; monitor blood and urine sugar levels carefully.
• benzodiazepines removed by the CYP 3A4 family of liver enzymes (such as triazolam or alprazolam) may lead to benzodiazepine toxicity.
• cimetidine (Tagamet, Tagamet HB 200) may lead to sertraline toxicity.
• erythromycin (various) led to a serotonin syndrome in a 12-year-old boy; other macrolide antibiotics such as clarithromycin may also lead to this effect. Doses of sertraline should be lowered if these medicines must be combined.
• flecainide (Tambocor) may lead to flecainide toxicity.
• lithium (Lithobid, others) may lead to changes. Lithium blood levels are prudent.
• metoclopramide (Reglan) may lead to sertraline toxicity.
• monoamine oxidase (MAO) type A inhibitors may cause confusion, agitation, high fever, seizures and dangerous elevations of blood pressure-avoid the concurrent use of these medicaments.
• quinidine (Quinaglute, others) may lead to quinidine toxicity-caution is advised.
• ritonavir (Norvir) and perhaps other protease inhibitors may lead to toxicity.
• terfenadine (Seldane) may lead to toxicity.
• tramadol (Ultram) may lead to seizures.
• zolpidem (Ambien) may lead to hallucinations.

Herbal medicines or minerals:

Since sertraline and St. John's wort may act to increase serotonin, the combination is not advised. Because part of the way ginseng works may be as a MAO inhibitor, do not combine with sertraline. Ma huang, yohimbe, Indian snakeroot and kava kava are also best avoided while taking this medicine.

Alcohol:

Avoid completely.

Exposure to sun:

Use caution-this medicament may (rarely) cause photosensitivity

Discontinuation:

The slow elimination of this medicament from the body makes it unlikely that any withdrawal effects will result from abrupt discontinuation. However, call your doctor if you plan to stop this medicament for any reason.

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