SERTRALINE oral

Last updated: November 2021


Prescription under medical supervision

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, or closed-angle glaucoma.
– May cause:
• gastrointestinal disturbances, drowsiness, fatigue, headache, dizziness, seizures, sexual dysfunction, blurred vision, hyponatraemia especially in older patients;
• mental disorders: anxiety, insomnia, agitation, aggressive behaviour, suicidal ideation;
• withdrawal symptoms very frequent if discontinued abruptly: dizziness, paraesthesia, nightmares, anxiety, tremors and headaches.
– Avoid combination with:
• alcohol (risk of drowsiness); 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.).
– 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 -  -