Generic Name

Sertraline Hydrochloride

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Classification

FDA Approved Indications

• Major depressive disorder
• Obsessive-compulsive disorder
• Panic disorder
• Post-traumatic stress disorder (PTSD)
• Social anxiety disorder

Mechanism of Action

Sertraline selectively inhibits the reuptake of serotonin in the central nervous system, increasing serotonin levels and balancing neurotransmission.

Dosage and Administration

Adult: Start with 25-50 mg once daily, can be increased gradually to a typical dose of 50-200 mg/day.

Pediatric: For children aged 6-17, doses typically start at 25-50 mg once daily; adjust based on response and tolerability.

Geriatric: Begin at lower doses (25 mg/day) due to increased sensitivity; titrate cautiously.

Renal Impairment: No specific dose adjustment required, but monitor closely.

Hepatic Impairment: Start at lower doses; adjust cautiously and monitor liver function.

Pharmacokinetics

Absorption: Well absorbed, with peak plasma levels at about 4.5 hours.

Distribution: Widely distributed; highly protein bound (~95%).

Metabolism: Primarily hepatic via CYP2B6, CYP2C19, CYP2D6, CYP3A4, and others.

Excretion: Excreted mainly in urine as metabolites; minimal unchanged drug.

Half Life: Approximately 26 hours, allowing once-daily dosing.

Contraindications

• Use with monoamine oxidase inhibitors (MAOIs) or within 14 days of stopping MAOIs.
• Known hypersensitivity to sertraline.

Precautions

• History of seizures.
• Manic episodes or bipolar disorder.
• Concurrent use with pimozide or thioridazine (due to risk of QT prolongation).
• Caution in patients with bleeding disorders or on anticoagulants.
• Pregnancy category C; discuss risks and benefits in pregnant women.

Adverse Reactions - Common

• Nausea (Common)
• Diarrhea (Common)
• Insomnia (Common)
• Sedation or fatigue (Common)
• Dizziness (Common)

Adverse Reactions - Serious

• Serotonin syndrome (Rare but serious)
• Suicidality, especially in young adults and adolescents (Rare)
• QT interval prolongation (Rare)
• Hyponatremia, especially in the elderly (Rare)

Drug-Drug Interactions

• Monoamine oxidase inhibitors (risk of serotonin syndrome)
• NSAIDs, anticoagulants (increased bleeding risk)
• Other serotonergic drugs (risk of serotonin syndrome)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Take medication exactly as prescribed.
• Report worsening depression, suicidality, or unusual side effects.
• Avoid alcohol and other CNS depressants.
• Be cautious about activities requiring alertness until effects are known.

Special Considerations

Black Box Warnings:

• Suicidality risk in children, adolescents, and young adults.

Genetic Factors: Slow metabolizers may have increased plasma levels, require dose adjustment.

Lab Test Interference: May increase INR in patients on warfarin, and cause hyponatremia.

Overdose Management

Signs/Symptoms: Dizziness, tachycardia, hallucinations, seizures, changes in blood pressure.

Treatment: Supportive care, gastric lavage if recent ingestion, activated charcoal, and symptomatic management. No specific antidote.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F), away from moisture and light.

Stability: Stable for at least 2 years under recommended conditions.