Sertraline

Generic Name: Setraline

Brand Names:

Availability: Available with Prescription

Drug Class: selective serotonin reuptake inhibitors (SSRIs).

Therapeutic action

  • Antidepressant, selective serotonin re-uptake inhibitor(SSRI)

Indications

  • Major depression, if fluoxetine or paroxetine poorly tolerated or contra-indicated Severe post-traumatic stress disorder

Forms and strengths

  • 50 mg and 100 mg tablets

Dosage

Major depression

  • Adult: 25 mg once daily for 3 days, then 50 mg once daily. In case of insufficient response after 3 weeks, increase up to 100 mg daily max.

Severe post-traumatic stress disorder

  • Adult: 50 mg once daily

Duration

  • Major depression: at least 9 months. Discontinue treatment gradually (e.g. half dose once daily for 2 weeks and then on alternate days for 2 weeks). If signs of relapse or withdrawal occur, increase the dose and decrease it more gradually.
  • Severe post-traumatic stress disorder: 2 to 3 months after symptoms resolve.Discontinue treatment gradually (over at least 2 weeks).

Contra-indications, adverse effects, precautions

  • Do not administer to patients with severe hepatic impairment. Reduce the dose by half in patients with mild to moderate hepatic impairment.
  • Administer with caution and monitor use in patients with epilepsy, diabetes;history of gastrointestinal bleeding, bipolar disorders,suicidal ideation (in young adults),or closed-angle glaucoma.
  • May cause:
    • gastrointestinal disturbances, drowsiness (caution when driving or operating machinery), fatigue, headache, dizziness, seizures, sexual dysfunction, blurred vision, hyponatraemia especially in older patients;
    • mental disorders: anxiety, insomnia, agitation, aggressive behaviour, suicidal ideation in young adults;
    • withdrawal symptoms very frequent if discontinued abruptly: dizziness, paraesthesia, nightmares, anxiety,tremors and headaches.
  • Avoid combination with:
    • aspirin, NSAIDs and warfarin(risk of bleeding);
    • serotonergic drugs:other SSRI, tricyclic antidepressants, ondansetron, tramadol,etc. (risk of serotonin syndrome).
  • Monitor combination with: risperidone (increased plasma concentration), drugs which lower the seizure threshold(antipsychotics, mefloquine, etc.).
  • Avoid alcohol during treatment(increased risk of adverse effects).
  • Pregnancy and breast-feeding: no contra-indication; re-evaluate whether the treatment is still necessary; if it is continued, maintain sertraline at effective dose. Observe the neonate (risk of agitation, tremors, hypotony, respiratory difficulties, sleeping disorders, etc.) if the mother was under treatment in the 3rd trimester.

Remarks

  • It is necessary to wait at least 2 to 3 weeks before assessing the antidepressant effect. This must be explained to the patient.

Storage

– Below 25 °C