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 most frequently utilized SSRIs at this time.
"Brain zaps," dizziness, irritability, flu-like symptoms with abrupt cessation. Taper to avoid.
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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.
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.
CPIC rec 8094918 [Moderate]: Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. CPIC pair-level A (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 25974703, 37032427]
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Clinical relevance: does this interaction matter in practice?trivialcritical
CPIC rec 8094921 [Moderate]: Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. CPIC pair-level B (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 37032427]
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Clinical relevance: does this interaction matter in practice?trivialcritical
CPIC rec 8094922 [Moderate]: Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. CPIC pair-level B (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 37032427]
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Clinical relevance: does this interaction matter in practice?trivialcritical
CPIC rec 8094925 [Moderate]: Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. CPIC pair-level A (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 25974703, 37032427]
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Clinical relevance: does this interaction matter in practice?trivialcritical
CPIC rec 8094909 [Optional]: Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2B6 normal metabolizers CPIC pair-level B (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 37032427]
Rate this interaction. Reports are anonymous and help curate the page.
Clinical relevance: does this interaction matter in practice?trivialcritical
CPIC rec 8094909 [Optional]: Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2B6 normal metabolizers CPIC pair-level A (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 25974703, 37032427]
Rate this interaction. Reports are anonymous and help curate the page.
Clinical relevance: does this interaction matter in practice?trivialcritical
CPIC rec 8094916 [Optional]: Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2B6 normal metabolizers CPIC pair-level A (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 25974703, 37032427]
Rate this interaction. Reports are anonymous and help curate the page.
Clinical relevance: does this interaction matter in practice?trivialcritical
CPIC rec 8094919 [Optional]: Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. CPIC pair-level B (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 37032427]
Rate this interaction. Reports are anonymous and help curate the page.
Clinical relevance: does this interaction matter in practice?trivialcritical
CPIC rec 8094920 [Optional]: Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. CPIC pair-level B (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 37032427]
Rate this interaction. Reports are anonymous and help curate the page.
Clinical relevance: does this interaction matter in practice?trivialcritical
CPIC rec 8094902 [Optional]: Consider a lower starting dose, slower titration schedule and 25% reduction of standard maintenance dose as compared to CYP2B6 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2B6. CPIC pair-level B (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 37032427]
Rate this interaction. Reports are anonymous and help curate the page.
Clinical relevance: does this interaction matter in practice?trivialcritical
CPIC rec 8094902 [Optional]: Consider a lower starting dose, slower titration schedule and 25% reduction of standard maintenance dose as compared to CYP2B6 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2B6. CPIC pair-level A (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 25974703, 37032427]
Rate this interaction. Reports are anonymous and help curate the page.
Clinical relevance: does this interaction matter in practice?trivialcritical
CPIC rec 8094923 [Optional]: Select an alternative antidepressant not primarily metabolized by CYP2C19 or CYP2B6. CPIC pair-level A (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 25974703, 37032427]
Rate this interaction. Reports are anonymous and help curate the page.
Clinical relevance: does this interaction matter in practice?trivialcritical
CPIC rec 8094930 [Optional]: Select an alternative antidepressant not primarily metabolized by CYP2C19 or CYP2B6. CPIC pair-level A (CYP2D6, CYP2C19, CYP2B6, SLC6A4, HTR2A and Serotonin Reuptake Inhibitor Antidepressants) [PMID 25974703, 37032427]
Rate this interaction. Reports are anonymous and help curate the page.
Clinical relevance: does this interaction matter in practice?trivialcritical
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.
Patient counseling
Take with or without food. Effect emerges over 2–4 weeks. Don't stop abruptly — taper to avoid withdrawal. Report serotonin-syndrome symptoms.
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.
Problems
Major depressive disorder
Generalized anxiety disorder
Obsessive-compulsive disorder
Post-traumatic stress disorder
Panic disorder
Premenstrual dysphoric disorder
Dosing and titration
Start 25–50 mg PO daily. Titrate by 25–50 mg every 1–2 weeks based on response. Typical effective dose 50–200 mg/day; max 200 mg/day.
Common adverse: nausea, diarrhea, sexual dysfunction, insomnia, somnolence, sweating.
Adverse effects
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.
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.
Patient counseling
Take with or without food. Effect emerges over 2–4 weeks. Don't stop abruptly — taper to avoid withdrawal. Report serotonin-syndrome symptoms.
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.
Problems
Major depressive disorder
Generalized anxiety disorder
Obsessive-compulsive disorder
Post-traumatic stress disorder
Panic disorder
Premenstrual dysphoric disorder
Dosing and titration
Start 25–50 mg PO daily. Titrate by 25–50 mg every 1–2 weeks based on response. Typical effective dose 50–200 mg/day; max 200 mg/day.
Common adverse: nausea, diarrhea, sexual dysfunction, insomnia, somnolence, sweating.
Adverse effects
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.
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.
Patient counseling
Take with or without food. Effect emerges over 2–4 weeks. Don't stop abruptly — taper to avoid withdrawal. Report serotonin-syndrome symptoms.
