Sertraline
ZOLOFT
What it isSelective serotonin-reuptake inhibitor; depression, OCD, PTSD and anxiety disorders.
Why this oneIts broad anxiety-spectrum labeling and low interaction burden make it a default SSRI in medical comorbidity.
What limits itEarly diarrhea or nausea and later sexual dysfunction often limit treatment; taper rather than stop abruptly.
FDA-approved for
- depression (1991)
- OCD (1996)
- panic disorder (1997)
- PTSD (1999)
- PMDD (2002)
- social anxiety disorder (2003)
Off-label
- premature ejaculation
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Major depressive disorder | Adults | 150 mg QD | 150-200 mg QD | 200 mg QD |
| Obsessive-compulsive disorder | Adults & peds ≥6 yr | 150 mg QD | 150-200 mg QD | 200 mg QD |
Renal Undefined
Hepatic Not recommended
Do not initiate therapy with this product; only 150 mg and 200 mg strengths available
Instructions
- Swallow capsules whole; do not open, crush, or chew
- Do not initiate with this product; use another sertraline HCl product for initiation, titration, and doses <150 mg
- May start after ≥1 week on 100-125 mg of another sertraline product
- Taper gradually on discontinuation (requires another sertraline product)
- Allow ≥14 days between stopping an MAOI and starting, and between stopping this drug and starting an MAOI
- Screen for bipolar disorder before starting
Contraindications
- MAOIs (concurrently or within 14 days) due to risk of serotonin syndrome
- Concomitant pimozide
Cautions
- Serotonin syndrome
- Increased risk of bleeding
- Activation of mania/hypomania
- Discontinuation syndrome
- Seizures
- Angle-closure glaucoma
- Hyponatremia/SIADH
- QTc prolongation
- Sexual dysfunction
Adverse reactions
- Nausea
- Diarrhea/loose stools
- Tremor
- Dyspepsia
- Decreased appetite
- Hyperhidrosis
- Ejaculation failure
- Decreased libido
Pregnancy Third-trimester exposure may cause PPHN and poor neonatal adaptation; possible postpartum hemorrhage risk
Lactation Low levels in human milk; no adverse reactions observed in breastfed infants
⚠ BOXED WARNING
- Suicidal thoughts and behaviors in patients under 25
Cost, est. cash$4–$80/month
Generic entry2006
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityGI and sexual adverse effects, hyponatremia and additive bleeding risk.
Active metabolites
Mechanism of action: Sertraline ballicule
Open Sertraline in the interactive console ↗
Memory aids: mascots and interaction avatars
“Baby on Board” → preferred antidepressant during pregnancy
“So soft” → may cause diarrhea and erectile dysfunction
