Sertraline: Comprehensive Guide
Drug Name
Generic Name
Sertraline
Brand Name(s)
Pakistan: Serlift, Sertran, Xydep
India: Zosert, Stresnil, Serlift
US: Zoloft
UK: Lustral
Pharmacological Class
Class
Antidepressant
Subclass
Selective Serotonin Reuptake Inhibitor (SSRI)
Mechanism of Action
Sertraline works by inhibiting the reuptake of serotonin in the brain, increasing the levels of serotonin available to bind to receptors. This helps improve mood and reduce symptoms of depression and anxiety.
Indications
Primary Indications
- Major Depressive Disorder (MDD)
- Obsessive-Compulsive Disorder (OCD)
- Panic Disorder
- Post-Traumatic Stress Disorder (PTSD)
- Social Anxiety Disorder (SAD)
- Premenstrual Dysphoric Disorder (PMDD)
Off-label Uses
- Generalized Anxiety Disorder (GAD)
- Body Dysmorphic Disorder
- Bulimia Nervosa
Dosage and Administration
Standard Dosage
Starting dose for adults is typically 50 mg per day, which can be adjusted based on response and tolerability, up to a maximum of 200 mg per day.
Route of Administration
Oral
Special Populations
Pediatric: Initial dose for OCD is 25 mg per day, may be increased.
Geriatric: Lower doses may be required due to increased sensitivity.
Pharmacokinetics
Absorption
Well absorbed, with peak plasma concentrations occurring approximately 4.5-8.4 hours after dosing.
Distribution
Widely distributed, highly protein-bound (~98%).
Metabolism
Metabolized primarily in the liver by CYP450 enzymes.
Excretion
Excreted in urine and feces, primarily as metabolites.
Half-life
Approximately 26 hours.
Contraindications
Sertraline is contraindicated in patients with known hypersensitivity to the drug or any of its components. It should not be used in combination with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing an MAOI.
Warnings and Precautions
Sertraline carries a black box warning for increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults. Caution is advised in patients with a history of bipolar disorder, seizures, or liver impairment.
Side Effects
Common Side Effects
- Nausea
- Insomnia
- Diarrhea
- Dizziness
- Dry mouth
- Fatigue
Serious Side Effects
- Serotonin syndrome
- Severe allergic reactions
- Seizures
- QT prolongation
- Hyponatremia
Drug Interactions
Major Interactions
- Monoamine oxidase inhibitors (MAOIs)
- Pimozide
- Thioridazine
Moderate Interactions
- Other SSRIs or SNRIs
- Anticoagulants
- NSAIDs
Minor Interactions
- Herbal supplements (e.g., St. John's Wort)
- Alcohol
Pregnancy and Lactation
Pregnancy Category
Category C: Risk cannot be ruled out. Sertraline should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Breastfeeding Considerations
Sertraline is excreted in breast milk. Caution should be exercised when administered to a nursing woman, considering the benefits of breastfeeding and the potential risks to the infant.
Patient Counseling Information
Key Points for Patients
- Inform patients about the risk of suicidal thoughts and behaviors.
- Advise patients to report any unusual changes in mood or behavior.
- Discuss the importance of adherence to prescribed dosing regimen.