Sertraline

1. Mechanism
   1. Selective Serotonin Reuptake Inhibitor (SSRI)
2. Indications
   1. Major Depression
   2. Obsessive Compulsive Disorder
   3. Panic Disorder
   4. Post-Traumatic Stress Disorder (PTSD)
   5. Premenstrual Dysphoric Disorder
3. Background
   1. Cost: $75 per month
4. Preparations
   1. Tablets (Scored): 25, 50, 100 mg
   2. Oral concentrate: 20 mg/ml (60 ml bottle)
5. Dosing
   1. Start
      1. Children (ages 6-12 years of age): 25 mg PO qAM
      2. Adults (and children over age 12): 50 mg PO qAM
      3. Elderly: 25 mg PO qAM
   2. Titrate
      1. Adults: Increase by 50 mg every 2 weeks
   3. Maximum: 200 mg per day
6. Drug Interactions
   1. Significantly raises Pimozide levels
      1. Concurrent use with Pimozide is contraindicated
   2. Inhibits Cytochrome P450-2C and P450-3A4
      1. Clinically Significant interactions are uncommon
   3. Highly protein bound
      1. Interacts with other protein bound medications
   4. Absorption affected by food intake
   5. Raises Tricyclic Antidepressant levels
   6. Allow two week wash-out prior to starting MAO inhibitor
7. Pharmacokinetics
   1. Half Life: 1 to 4 days
   2. Therapeutic Blood level 9.5 to 56 ng/ml
8. Adverse Effects
   1. Neutral on the Sedation to excitation continuum
      1. Less sedating than Paxil or Luvox
   2. Anxiety, Insomnia or other sleep disturbance
      1. Less stimulating than Prozac
      2. Consider Trazodone (Desyrel) at bedtime
   3. Diarrhea or gastrointestinal upset
      1. Diarrhea more common than with Fluoxetine
      2. Usually resolves within 2 weeks
   4. Sexual Dysfunction may be more common
      1. Includes decreased libido
      2. See Antidepressant Induced Sexual Dysfunction
   5. Antidepressant Withdrawal symptoms on stopping
      1. Taper 50 mg per every 5-7 days
      2. Taper to 25-50 mg daily before stopping