Sertraline: Difference between revisions

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| intro = '''Sertraline''' is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for depression, anxiety disorders, OCD, PTSD, and panic disorder. In the US, it is one of the [https://www.definitivehc.com/resources/healthcare-insights/top-antidepressants-by-prescription-volume most frequently utilized SSRIs at this time].

| pharmacokinetics = Well-absorbed orally, ~44% bioavailability. Metabolized hepatically via CYP3A4/CYP2C19/CYP2D6 to N-desmethylsertraline (less active). Half-life ~26h; steady state in ~1 week.

| pharmacodynamics = Highly selective inhibitor of the serotonin reuptake transporter (SERT). Mild dopamine reuptake inhibition at higher doses. Minimal affinity for muscarinic, histaminic, or adrenergic receptors — hence cleaner adverse effect profile than TCAs.

| pharmacodynamics = Highly selective inhibitor of the serotonin reuptake transporter (SERT). Mild dopamine reuptake inhibition at higher doses. Minimal affinity for muscarinic, histaminic, or adrenergic receptors, hence cleaner adverse effect profile than TCAs.

| indications = * Major depressive disorder

* Generalized anxiety disorder

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* <effect ref="discontinuation-syndrome">"Brain zaps," dizziness, irritability, flu-like symptoms with abrupt cessation. Taper to avoid.</effect>

| adverse = Serotonin syndrome (especially with other serotonergic agents), QT prolongation at high doses, hyponatremia (SIADH, esp. elderly), bleeding risk, suicidality warning in young adults, discontinuation syndrome.

| interactions = MAOIs (serotonin syndrome — contraindicated), triptans, tramadol, linezolid, lithium, NSAIDs/anticoagulants (bleeding), CYP2D6 substrates.

| interactions = MAOIs (serotonin syndrome, contraindicated), triptans, tramadol, linezolid, lithium, NSAIDs/anticoagulants (bleeding), CYP2D6 substrates.

| pregnancy_details = Category C. SSRIs in third trimester associated with persistent pulmonary hypertension of the newborn (PPHN) and neonatal adaptation syndrome. Risk-benefit decision; sertraline often preferred in pregnancy among SSRIs.

| monitoring = Mood/suicidality (especially first 4 weeks), sodium (elderly), QT in cardiac risk, response and side effects.

| counseling = Take with or without food. Effect emerges over 2–4 weeks. Don't stop abruptly — taper to avoid withdrawal. Report serotonin-syndrome symptoms.

| counseling = Take with or without food. Effect emerges over 2–4 weeks. Don't stop abruptly, taper to avoid withdrawal. Report serotonin-syndrome symptoms.

| anecdotes =

| seealso = [[Fluoxetine]], [[Paroxetine]], [[Citalopram]], [[Escitalopram]]

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}}<h2 id="Pharmacokinetics">Pharmacokinetics</h2>

Well-absorbed orally, ~44% bioavailability. Metabolized hepatically via CYP3A4/CYP2C19/CYP2D6 to N-desmethylsertraline (less active). Half-life ~26h; steady state in ~1 week.<h2 id="Pharmacodynamics">Pharmacodynamics</h2>

Highly selective inhibitor of the serotonin reuptake transporter (SERT). Mild dopamine reuptake inhibition at higher doses. Minimal affinity for muscarinic, histaminic, or adrenergic receptors — hence cleaner adverse effect profile than TCAs.<h2 id="Problems">Problems</h2>

Highly selective inhibitor of the serotonin reuptake transporter (SERT). Mild dopamine reuptake inhibition at higher doses. Minimal affinity for muscarinic, histaminic, or adrenergic receptors, hence cleaner adverse effect profile than TCAs.<h2 id="Problems">Problems</h2>

*Major depressive disorder

*Generalized anxiety disorder

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Serotonin syndrome (especially with other serotonergic agents), QT prolongation at high doses, hyponatremia (SIADH, esp. elderly), bleeding risk, suicidality warning in young adults, discontinuation syndrome.<h2 id="Contraindications">Contraindications</h2>

MAOIs (within 14 days), pimozide, severe hepatic impairment. Caution: bipolar disorder (mood switching risk), seizure disorders.<h2 id="Interactions">Interactions</h2>

MAOIs (serotonin syndrome — contraindicated), triptans, tramadol, linezolid, lithium, NSAIDs/anticoagulants (bleeding), CYP2D6 substrates.<h2 id="Pregnancy">Pregnancy and lactation</h2>

MAOIs (serotonin syndrome, contraindicated), triptans, tramadol, linezolid, lithium, NSAIDs/anticoagulants (bleeding), CYP2D6 substrates.<h2 id="Pregnancy">Pregnancy and lactation</h2>

Category C. SSRIs in third trimester associated with persistent pulmonary hypertension of the newborn (PPHN) and neonatal adaptation syndrome. Risk-benefit decision; sertraline often preferred in pregnancy among SSRIs.<h2 id="Monitoring">Monitoring</h2>

Mood/suicidality (especially first 4 weeks), sodium (elderly), QT in cardiac risk, response and side effects.<h2 id="Counseling">Patient counseling</h2>

Take with or without food. Effect emerges over 2–4 weeks. Don't stop abruptly — taper to avoid withdrawal. Report serotonin-syndrome symptoms.<h2 id="SeeAlso">See also</h2><span></span>

Take with or without food. Effect emerges over 2–4 weeks. Don't stop abruptly, taper to avoid withdrawal. Report serotonin-syndrome symptoms.<h2 id="SeeAlso">See also</h2><span></span>

[[Fluoxetine]], [[Paroxetine]], [[Citalopram]], [[Escitalopram]]

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<h2 id="Pharmacokinetics">Pharmacokinetics</h2>

Well-absorbed orally, ~44% bioavailability. Metabolized hepatically via CYP3A4/CYP2C19/CYP2D6 to N-desmethylsertraline (less active). Half-life ~26h; steady state in ~1 week.<h2 id="Pharmacodynamics">Pharmacodynamics</h2>

Highly selective inhibitor of the serotonin reuptake transporter (SERT). Mild dopamine reuptake inhibition at higher doses. Minimal affinity for muscarinic, histaminic, or adrenergic receptors — hence cleaner adverse effect profile than TCAs.<h2 id="Problems">Problems</h2>

Highly selective inhibitor of the serotonin reuptake transporter (SERT). Mild dopamine reuptake inhibition at higher doses. Minimal affinity for muscarinic, histaminic, or adrenergic receptors, hence cleaner adverse effect profile than TCAs.<h2 id="Problems">Problems</h2>

*Major depressive disorder

*Generalized anxiety disorder

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