Sertraline (Systemic)

Brand Names : Zoloft

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For sertraline, the following should be considered:

Allergies - Tell your doctor if you have ever had any unusual or allergic reaction to sertraline. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, dyes, or latex. The dispenser dropper for sertraline oral concentrate contains dry natural rubber.

Pregnancy - Sertraline has not been studied in pregnant women. However, side effects have been reported in babies exposed by their mother during pregnancy. Before taking this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant.

Breast-feeding - Sertraline passes into breast milk. Side effects have been reported in a baby exposed during nursing. Before taking this medicine, make sure your doctor knows if you are nursing your baby.

Children - Sertraline has been tested in children 6 to 17 years of age with obsessive-compulsive disorder. In effective doses, this medicine has not been shown to cause different side effects or problems than it does in adults. However, sertraline can cause a decrease in appetite and children who take this medicine for a long time should have their growth and body weight measured by the doctor at regular visits.

Sertraline must be used with caution in children with depression. Studies have shown occurrences of children thinking about suicide or attempting suicide in clinical trials for this medicine. More study is needed to be sure sertraline is safe and effective in children.

Older adults - In studies done to date that have included elderly people, sertraline did not cause different side effects or problems in older people than it did in younger adults. However, this medicine may be removed from the body more slowly in older adults. An older adult may receive a lower dose of sertraline than a younger adult, especially when first starting treatment.

Other medicines - Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking sertraline, it is especially important that your health care professional know if you are taking any of the following:

• Astemizole (e.g., Hismanal) - Taking this medicine while you are taking sertraline may lead to a serious change in the rhythm of your heartbeat

• Flecainide (e.g., Tambocor) or
• Propafenone (e.g., Rythmol) - Higher blood levels of these medicines may occur, which may increase the chance of developing unwanted effects. Your doctor may change the dose of these medicines.

• Buspirone (e.g., BuSpar) or
• Bromocriptine (e.g., Parlodel) or
• Dextromethorphan (cough medicine) or
• Levodopa (e.g., Sinemet) or
• Lithium (e.g., Eskalith) or
• Meperidine (e.g., Demerol) or
• Nefazodone (e.g., Serzone) or
• Pentazocine (e.g., Talwin) or
• Selective serotonin reuptake inhibitors, other (citalopram [e.g., Celexa], fluoxetine [e.g., Prozac], fluvoxamine [e.g., Luvox], paroxetine [e.g., Paxil]) or
• Street drugs (LSD, MDMA [e.g., ecstasy], marijuana) or
• Sumatriptan (e.g., Imitrex) or
• Tramadol (e.g., Ultram) or
• Trazodone (e.g., Desyrel) or
• Tryptophan or
• Venlafaxine (e.g., Effexor) - Using these medicines with sertraline may increase the chance of developing a rare, but very serious, unwanted effect known as the serotonin syndrome. This syndrome may cause confusion, diarrhea, fever, poor coordination, restlessness, shivering, sweating, talking or acting with excitement you cannot control, trembling or shaking, or twitching. If you develop these symptoms, contact your doctor as soon as possible

• Digitoxin (e.g., Crystodigin) or
• Warfarin (e.g., Coumadin) - Higher or lower blood levels of these medicines or sertraline may occur, which may increase the chance of having unwanted effects. Your doctor may need to change the dose of either these medicines or sertraline

• Disulfiram (e.g., Antabuse) - Disulfiram will react with the alcohol in sertraline oral concentrate and may cause serious problems

• Moclobemide (e.g., Manerex) - The risk of developing serious unwanted effects, including the serotonin syndrome, is increased. Use of moclobemide with sertraline is not recommended. Also, it is recommended that 3 to 7 days be allowed between stopping treatment with moclobemide and starting treatment with sertraline, and it is recommended that 2 weeks be allowed between stopping treatment with sertraline and starting treatment with moclobemide

• Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate]) - Do not take sertraline while you are taking or within 2 weeks of taking an MAO inhibitor . If you do, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, sudden high body temperature, extremely high blood pressure, severe convulsions, or the serotonin syndrome. At least 14 days should be allowed between stopping treatment with one medicine (sertraline or the MAO inhibitor) and starting treatment with the other

• Pimozide (e.g., ORAP) - This medicine should not be taken together with sertraline; tell your doctor if you are taking pimozide

• St. John's wort (Hypericum perforatum ) - Use of this medicine with sertraline may increase your chance of getting serious side effects.

• Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil]) - Higher blood levels of these medicines may occur, which may increase the chance of developing unwanted effects. Your doctor may check the blood level of the tricyclic antidepressant, and may change the dose of either these medicines or sertraline. Also, taking sertraline with amitriptyline, clomipramine, or imipramine may increase the chance of developing the serotonin syndrome

Other medical problems - The presence of other medical problems may affect the use of sertraline. Make sure you tell your doctor if you have any other medical problems, especially:

• Bleeding problems, abnormal or
• Purpura, or history of (purplish or brownish-red discoloration of skin) - Sertraline may make these problems worse.

• Brain disease or damage or
• Mental retardation or
• Seizure disorders (history of) - The risk of seizures may be increased

• Dehydration or
• Hyponatremia (condition in which your body has too little sodium) - Sertraline may make these problems worse, especially in older adults.

• Heart attack, recent or
• Heart disease, unstable - The medicine has not been studied in patients with these medical problems.

• Kidney disease - It is not known whether the chance of side effects will be increased

• Liver disease - Higher blood levels of sertraline may occur, increasing the chance of side effects. Your doctor may want you to take a lower dose or to take your doses less often than a person without liver disease

• Mania (history of) - May be activated

• Weight loss - Sertraline may cause weight loss. This weight loss is usually small, but if a large weight loss occurs, it may be harmful in some patients