sertraline hydrochloride

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 norepinephrine, muscarinic, histaminergic, 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; T_1/2: 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

Drug-drug

·        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

Drug-food

·        Increased rate of absorption with food

Drug-alternative therapy

·        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.