A Brief Overview:
Zoloft (sertraline HCl)
(SER-tra-leen)
J. Patrick Bertroche, DO
B. Lehmann MS-III
Guide:
What is Zoloft?
What should I discuss with my healthcare provider prior to using Zoloft?
How should I take Zoloft?
What happens if I miss a dose?
What happens if I overdose?
Are there any contraindications to this medication?
Effects with other medications?
Possible side effects?
Where Can I get more information?
What is Zoloft?
Zoloft® (sertraline HCl) is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI). It's approved to treat depression, social anxiety disorder, posttraumatic stress disorder (PTSD), panic disorder, obsessive-compulsive disorder (OCD), and premenstrual dysphoric disorder (PMDD) in adults over age 18. It is also approved for OCD in children and adolescents age 6-17 years.
Length of treatment is different from person to person. The American Psychiatric Association (APA) recommends all medicines for depression should be taken for 6 months to 1 year to prevent symptoms from returning. Your doctor will decide how long you need to be on Zoloft. It's important to keep taking Zoloft as directed. Even if you feel better, you shouldn't stop taking Zoloft without talking to your doctor first.
You should tell your doctor if you are pregnant or plan to become pregnant, as there is always a potential risk to the fetus with any medications. Like many antidepressants, Zoloft can be present in breast milk so tell your doctor if you are nursing.
Zoloft is not habit-forming and is not associated with weight gain. So talk to your doctor about how Zoloft might help you. Zoloft comes in 25-mg, 50-mg, and 100-mg tablets. You and your doctor can discuss the right dose for you.
The health information contained herein is provided for educational purposes only and is not intended to replace discussions with a healthcare provider. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient.
This product information is intended only for residents of the
What should I discuss with my healthcare provider prior to using Zoloft?
Depression is a serious medical condition, which can lead to suicidal thoughts and behavior. Children, adolescents, and young adults taking antidepressants may be at increased risk for suicidal thoughts and behavior within the first few months of treatment, if they have been misdiagnosed and have bipolar disorder instead of depression. This risk must be balanced with the medical need. Those starting medication or changing doses should be watched closely for suicidal thoughts, worsening of depression, or unusual changes in mood or behavior. In children and teens, Zoloft is only approved for use in those with obsessive-compulsive disorder. A patient Medication Guide about "Antidepressant Medicines, Depression and Other Serious Mental Illnesses, and Suicidal Thoughts or Actions" is available.
Before taking Zoloft, tell your doctor if you have:
· seizures or epilepsy;
· bipolar disorder (manic depression); or
· a history of drug abuse or suicidal thoughts.
Zoloft is not for everyone. People taking MAOIs or pimozide shouldn't take Zoloft. Concomitant use of Zoloft with NSAIDs or aspirin may be associated with an increased risk of bleeding.
How should I take Zoloft?
Take Zoloft exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from the medication.
Take the Zoloft tablet with water.
Zoloft may be taken with or without food.
Try to take the medicine at the same time each day. Follow the directions on your prescription label.
The oral liquid form of this medicine must be diluted before you take it. To be sure you get the correct dose, measure the liquid with medicine dropper provided, not with a regular table spoon. Mix the dose with 4 ounces (one-half cup) of water, ginger ale, lemon/lime soda, lemonade, or orange juice. Do not use any other liquids to dilute the medicine. Stir this mixture and drink all of it right away. To make sure you get the entire dose, add a little more water to the same glass, swirl gently and drink right away.
It may take 4 weeks or longer before you start feeling better. Do not stop using Zoloft without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly. Store Zoloft at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. However, if it is almost time for the next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
The most common signs and symptoms associated with non-fatal sertraline hydrochloride overdosage were somnolence, vomiting, tachycardia, nausea, dizziness, agitation and tremor.
Treatment should consist of those general measures employed in the management of overdosage with any antidepressant.
Ensure an adequate airway, oxygenation and ventilation. Monitor cardiac rhythm and vital signs. General supportive and symptomatic measures are also recommended. Induction of emesis is not recommended. Gastric lavage with a large-bore orogastric tube with appropriate airway protection, if needed, may be indicated if performed soon after ingestion, or in symptomatic patients.
Activated charcoal should be administered. Due to large volume of distribution of this drug, forced diuresis, dialysis, hemoperfusion and exchange transfusion are unlikely to be of benefit. No specific antidotes for sertraline are known.
In managing overdosage, consider the possibility of multiple drug involvement. The physician should consider contacting a poison control center on the treatment of any overdose. Telephone numbers for certified poison control centers are listed in the Physicians' Desk Reference® (PDR®).
Are there any contraindications to this medication?
Concomitant use in patients taking monoamine oxidase inhibitors (MAOIs) is contraindicated. Concomitant use in patients taking pimozide is contraindicated.
Zoloft is contraindicated in patients with a hypersensitivity to sertraline or any of the inactive ingredients in Zoloft.
Zoloft oral concentrate is contraindicated with ANTABUSE (disulfiram) due to the alcohol content of the concentrate.
Effects with other medications:
Because sertraline is tightly bound to plasma protein, the administration of Zoloft (sertraline hydrochloride) to a patient taking another drug which is tightly bound to protein (e.g., warfarin, digitoxin) may cause a shift in plasma concentrations potentially resulting in an adverse effect. Conversely, adverse effects may result from displacement of protein bound Zoloft by other tightly bound drugs.
Many drugs effective in the treatment of major depressive disorder, e.g., the SSRIs, including sertraline, and most tricyclic antidepressant drugs effective in the treatment of major depressive disorder inhibit the biochemical activity of the drug metabolizing isozyme cytochrome P450 2D6 (debrisoquin hydroxylase), and, thus, may increase the plasma concentrations of co-administered drugs that are metabolized by P450 2D6. The drugs for which this potential interaction is of greatest concern are those metabolized primarily by 2D6 and which have a narrow therapeutic index, e.g., the tricyclic antidepressant drugs effective in the treatment of major depressive disorder and the Type 1C antiarrhythmics propafenone and flecainide.
Although Zoloft did not potentiate the cognitive and psychomotor effects of alcohol in experiments with normal subjects, the concomitant use of Zoloft and alcohol is not recommended.
So, before taking Zoloft, tell your doctor if you are using any of the following medicines:
· tramadol (Ultram, Ultram ER, Ultracet);
· digitoxin (Crystodigin);
· phenytoin (Dilantin), valproate (Depacon, Depakene);
· lithium (Lithobid, Eskalith);
· a blood thinner such as warfarin (Coumadin);
· any other antidepressant such as amitriptyline (Elavil), citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), imipramine (Tofranil), nortriptyline (Pamelor), or paroxetine (Paxil);
· almotriptan (Axert), frovatriptan (Frova), sumatriptan (Imitrex), naratriptan (Amerge), rizatriptan (Maxalt), or zolmitriptan (Zomig); or
· heart rhythm medication such as flecainide (Tambocor), propafenone (Rhythmol), and others.
Possible side effects of Zoloft (sertraline HCl):
Some people taking Zoloft might have some side effects. The most common Zoloft side effects are dry mouth, insomnia, sexual side effects, diarrhea, nausea, and sleepiness. Not everyone gets side effects. In studies, few people were bothered enough by side effects to stop taking Zoloft. Side effects may result from stopping Zoloft particularly when abrupt. You should, however, stop taking Zoloft if you get any of the following symptoms of Serotonin Syndrome, a rare but life-threatening reaction, such as fever, sweating, muscle stiffness, trouble thinking clearly, a change in mental functioning, sleepiness, or change in your breathing, heartbeat and blood pressure.
So, make sure to call your doctor at once if you have any of these serious side effects:
· very stiff (rigid) muscles, high fever, sweating, fast or uneven heartbeats, tremors, overactive reflexes;
· nausea, vomiting, diarrhea, loss of appetite, feeling unsteady, loss of coordination; or
· headache, trouble concentrating, memory problems, weakness, confusion, hallucinations, fainting, seizure, shallow breathing or breathing that stops.
Less serious Zoloft side effects may include:
· drowsiness, dizziness, tired feeling;
· mild nausea, stomach pain, upset stomach, constipation;
· dry mouth;
· changes in appetite or weight;
· sleep problems (insomnia); or
· decreased sex drive, impotence, or difficulty having an orgasm.
Where Can I get more information?
Your pharmacist has additional information about Zoloft (sertraline HCl) written for health professionals that you may read.
Remember, keep this and all other medications out of reach of children, never share medicines with others, and use this medication only for the indication prescribed.
