SERTRALINE oral

Last updated: March 2024

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 3^rd 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