Pregnancy Risk Category C
How supplied
Tablets: 50 mg, 100 mg
Capsules†: 25 mg, 50 mg, 100 mg
Action
Unknown. Probably linked to drug's inhibition of neuronal uptake of serotonin in the CNS.
Indications & dosage
Depression--
Adults: 50 mg P.O. daily. Dosage adjusted as needed and tolerated; doses of 50 to 200 mg daily have been given. Dosage adjustments should be made at intervals of no less than 1 week.
Obsessive-compulsive disorder--
Adults: 50 mg P.O. once daily. If no response, dose may be increased to maximum of 200 mg/day. Dosage adjustments should be made at intervals of no less than 1 week.
Children ages 6 to 17: initially 25 mg P.O. daily in children ages 6 to 12, or 50 mg P.O. daily in children ages 13 to 17. May increase dosage, p.r.n., up to 200 mg/day at intervals of no less than 1 week.
Panic disorder--
Adults: initially, 25 mg P.O. daily. After one week, increase dose to 50 mg P.O. daily. If no response, dose may be increased to maximum of 200 mg/day. Dosage adjustments should be made at intervals of no less than 1 week.
Posttraumatic stress disorder--
Adults: Initially, 25 mg P.O. once daily. Increase dosage to 50 mg P.O. once daily after 1 week. Dosage may be increased at weekly intervals to a maximum of 200 mg daily. Maintain patient on lowest effective dose.
Adjust-a-dose: For patients with hepatic disease, lower or less frequent doses should be used.
Adverse reactions
CNS: headache, tremor, dizziness, insomnia, somnolence, paresthesia, hypoesthesia, fatigue, nervousness, anxiety, agitation, hypertonia, twitching, confusion.
CV: palpitations, chest pain, hot flashes.
GI: dry mouth, nausea, diarrhea, loose stools, dyspepsia, vomiting, constipation, thirst, flatulence, anorexia, abdominal pain, increased appetite.
GU: male sexual dysfunction.
Hepatic: elevated serum AST and ALT levels.
Musculoskeletal: myalgia.
Skin: rash, pruritus, diaphoresis.
Interactions
Drug-drug. Benzodiazepines, tolbutamide: decreased clearance of these drugs. Clinical significance unknown; however, monitor patients for increased drug effects.
Cimetidine: decreased clearance of sertraline. Monitor closely.
MAO inhibitors: may cause serious, sometimes fatal, reactions including myoclonus rigidity, mental status changes, hyperthermia, autonomic nervous system instability, rapid fluctuations of vital signs, delirium, coma, and death. Avoid concomitant use.
Warfarin, other highly protein-bound drugs: may increase plasma levels of sertraline or other highly bound drug. PT or INR may increase by 8% with concomitant use of warfarin. Monitor closely.
Effects on diagnostic tests
None reported.
Contraindications
Contraindicated in patients taking MAO inhibitors or within 14 days of discontinuing MAO inhibitor therapy.
Nursing considerations
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING