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Thursday, February 10, 2011

sertraline hydrochloride

Posted by Sampil 2:21 AM, under | No comments

sertraline hydrochloride
(sir' trah leen)
Zoloft

Pregnancy Category C

Drug classes
Antidepressant
SSRI

Therapeutic actions
Acts as an antidepressant by inhibiting CNS neuronal uptake of serotonin; blocks uptake of serotonin with little effect on norepinephrinemuscarinichistaminergic, and alpha1-adrenergic or dopaminergic receptors.

Indications
·        Treatment of major depressive disorder
·        Treatment of OCD
·        Treatment of panic disorder with or without agoraphobia
·        Treatment of PTSD; long-term use to prevent relapse and sustain symptom improvement
·        Treatment of PMDD
·        Treatment of social anxiety disorder (social phobia)

Contraindications and cautions
·        Contraindicated with hypersensitivity to sertraline.
·        Use cautiously with impaired hepatic or renal function, lactation, pregnancy; in children and adolescents with major depressive disorder.

Available forms
Tablets—25, 50, 100 mg; oral concentrate—20 mg/mL

Dosages
ADULTS
·        Major depressive disorder and OCD: Administer once a day, morning or evening. 50 mg PO daily; may be increased to up to 200 mg/day; dosage increases should not occur at intervals < 1 wk.
·        Panic disorder and PTSD: 25 mg PO daily. After 1 wk increase to 50 mg once daily.
·        PMDD: 50 mg/day PO daily or just during luteal phase of menstrual cycle.
·        Social anxiety disorder: 25 mg/day PO; increase to 50 mg/day after 1 wk. Range, 50–200 mg/day.
PEDIATRIC PATIENTS
·        OCD:
6–12 yr: 25 mg PO once daily. May be increased slowly as needed.
13–17 yr: 50 mg PO once daily. May be increased slowly as needed.
GERIATRIC PATIENTS OR PATIENTS WITH HEPATIC IMPAIRMENT
Give a lower or less frequent dose. Use response as dosage guide.

Pharmacokinetics
Route
Onset
Peak
Oral
Slow
4.5–8.4 hr

Metabolism: Hepatic; T1/2: 26 hr (104—active metabolite)
Distribution: Crosses placenta; may enter breast milk
Excretion: Feces, urine

Adverse effects
·        CNS: Headache, nervousness, drowsiness, anxiety, tremor, dizziness, insomnia, light-headedness, agitation, sedation, abnormal gait, seizures, vision changes, fatigue
·        CV: Hot flashes, palpitations, chest pain
·        Dermatologic: Sweating, rash, pruritus, acne, contact dermatitis
·        GI: Nausea, vomiting, diarrhea, dry mouth, anorexia, dyspepsia, constipation, taste changes, flatulence, gastroenteritis, dysphagia, gingivitis
·        GU: Painful menstruation, sexual dysfunction, frequency, cystitis, impotence, urgency, vaginitis
·        Respiratory: URIs, pharyngitis, cough, dyspnea, bronchitis, rhinitis
·        Other: Hot flashes, fever, back pain, thirst

Interactions
·        WARNING: Serious, sometimes fatal, reactions with MAOIs; allow at least 14 days to elapse between MAOI and sertraline use
·        WARNING: Possible risk of increased QTc interval if combined with pimozide; do not use together
·        Increased serum levels of sertraline with cimetidine
·        Increased rate of absorption with food
·        Increased risk of severe reaction if combined with St. John's wort therapy

Nursing considerations
Assessment
·        History: Hypersensitivity to sertraline; impaired hepatic or renal function; lactation, pregnancy
·        Physical: Weight; T; skin rash, lesions; reflexes, affect; bowel sounds, liver evaluation; P, peripheral perfusion; urinary output, LFTs, renal function tests

Interventions
·        Use lower dose in elderly patients and with hepatic or renal impairment.
·        Dilute oral concentrate in 4 oz water, ginger ale, lemon-lime soda, lemonade, or orange juice only; administer immediately after diluting.
·        WARNING: Establish suicide precautions for severely depressed patients. Limit number of tablets given at any time.
·        Give drug once a day, morning or evening.
·        Increase dosage at intervals of not less than 1 wk.
·        Counsel patient to use nonhormonal contraceptives; pregnancy should be avoided due to risk to fetus.

Teaching points
·        Take this drug once a day, at the same time, morning or evening; do not exceed the prescribed dose. It may take 4–6 weeks to see any improvement.
·        Dilute concentrate immediately before use in 4 ounces water, ginger ale, lemon-lime soda, lemonade, or orange juice only.
·        Consult your health care provider if you think that you are pregnant or wish to become pregnant.
·        You may experience these side effects: Dizziness, drowsiness, nervousness, insomnia (avoid driving or performing hazardous tasks); nausea, vomiting (eat frequent small meals); dry mouth (suck sugarless lozenges, perform frequent mouth care); excessive sweating (monitor temperature; avoid overheating).
·        Report rash, mania, seizures, edema, difficulty breathing, increased depression, thoughts of suicide.

Adverse effects in Italic are most common; those in Bold are life-threatening.

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