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What is zoloft medicine used for: Zoloft oral Interactions with Other Medication

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Zoloft (sertraline) Uses, Side Effects, Dosage & Interactions

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Sertraline 100 mg 167290217

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Sertraline 100 mg-APO

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Sertraline 100 mg-GRE

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Sertraline 100 mg-IVA

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Sertraline 100 mg-MYL

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Sertraline 100 mg-TEV

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Sertraline 25 mg-APO

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Sertraline 25 mg-IVA

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Sertraline 25 mg-MYL

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Sertraline 25 mg-TEV

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Sertraline 50 mg 167290216

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Sertraline 50 mg-APO

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Sertraline 50 mg-MYL

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Sertraline Hcl 100mg 009046926

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Sertraline Hcl 25mg 009046924

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Sertraline Hcl 50mg 009046925

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Zoloft 100 mg

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Zoloft 25 mg

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Zoloft 50 mg

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Sertraline: Uses, Interactions, Mechanism of Action

Indication

Sertraline is indicated for the management of major depressive disorder (MDD), post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), panic disorder (PD), premenstrual dysphoric disorder (PMDD), and social anxiety disorder (SAD). 21 Common off-label uses for sertraline include the prevention of post stroke depression11, generalized anxiety disorder (GAD), fibromyalgia, premature ejaculation, migraine prophylaxis, diabetic neuropathy, and neurocardiogenic syncope.23

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Pharmacodynamics

Sertraline improves or relieves the symptoms of depression, OCD, post-traumatic stress disorder, obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder via the inhibition of serotonin reuptake. 10,21 Clinical studies have shown that it improves cognition in depressed patients.6 It has less sedative, anticholinergic, and cardiovascular effects than the tricyclic antidepressant drugs because it does not exert significant anticholinergic, antihistamine, or adrenergic (alpha1, alpha2, beta) blocking activity.5 The onset of action and beneficial effects are usually noticed after 4-6 weeks, for reasons that are not fully understood and currently under investigation.17,27

Mechanism of action

Sertraline selectively inhibits the reuptake of serotonin (5-HT) at the presynaptic neuronal membrane, thereby increasing serotonergic activity. This results in an increased synaptic concentration of serotonin in the CNS, which leads to numerous functional changes associated with enhanced serotonergic neurotransmission.19,21 These changes are believed to be responsible for the antidepressant action and beneficial effects in obsessive-compulsive (and other anxiety related disorders). It has been hypothesized that obsessive-compulsive disorder, like depression, is also caused by the disregulation of serotonin.16

In animal studies, chronic administration of sertraline results in down-regulation of brain norepinephrine receptors.21 Sertraline displays affinity for sigma-1 and 2 receptor binding sites13, but binds with stronger affinity to sigma-1 binding sites.12 In vitro, sertraline shows little to no affinity for GABA, dopaminergic, serotonergic (5HT1A, 5HT1B, 5HT2), or benzodiazepine receptors.21 It exerts weak inhibitory actions on the neuronal uptake of norepinephrine and dopamine5 and exhibits no inhibitory effects on the monoamine oxidase enzyme.21

Absorption

Following once-daily administration of 50 to 200 mg for two weeks, the mean peak plasma concentrations (Cmax) of sertraline occurred between 4.5 to 8.4 hours after administration, and measured at 20 to 55 μg/L. 6,21 Steady-state concentrations are reached after 1 week following once-daily administration, and vary greatly depending on the patient.7,21 Bioavailability has been estimated to be above 44%. The area under the curve in healthy volunteers after a 100mg dose of sertraline was 456 μg × h/mL in one study.7

Effects of food on absorption

The effects of food on the bioavailability of the sertraline tablet and oral concentrate were studied in subjects given a single dose with and without food. For the tablet, AUC was slightly increased when sertraline was administered with food, the Cmax was 25% greater, and the time to peak plasma concentration was shortened by about 2.5 hours. For the oral concentrate preparation of sertraline, peak concentration was prolonged by approximately 1 hour with the ingestion of food.21

Volume of distribution

Sertraline is widely distributed, and its volume of distribution is estimated to be more than 20L/kg. 6 Post-mortem studies in humans have measured liver tissue concentrations of 3.9–20 mg/kg for sertraline and between 1.4 to 11 mg/kg for its active metabolite, N-desmethyl-sertraline (DMS).7 Studies have also determined sertraline distributes into the brain, plasma, and serum.7

Protein binding

Sertraline is highly bound to serum proteins, at about 98%-99%.15,21

Metabolism

Sertraline is heavily metabolized in the liver and has one major active metabolite. It undergoes N-demethylation to form N-desmethylsertraline, which is much less potent in its pharmacological activity than sertraline.7 In addition to N-demethylation, sertraline metabolism involves N-hydroxylation, oxidative deamination, and finally, glucuronidation.21 The metabolism of sertraline is mainly catalyzed by CYP3A4 and CYP2B6, with some activity accounted for by CYP2C19 and CYP2D6.22

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Route of elimination

Since sertraline is extensively metabolized, excretion of unchanged drug in the urine is a minor route of elimination, with 12-14% of unchanged sertraline excreted in the feces. 6,7,21

Half-life

The elimination half-life of sertraline is approximately 26 hours.6,21 One reference mentions an elimination half-life ranging from 22-36 hours.7

Clearance

In pharmacokinetic studies, the clearance of a 200mg dose of sertraline in studies of both young and elderly patients ranged between 1.09 ± 0.38 L/h/kg – 1.35 ± 0.67 L/h/kg.7

Adverse Effects

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Toxicity

The LD50 of sertraline is >2000 mg/kg in rats according to the FDA label.25 One other references indicates an oral LD50 of in mice and rats of 419 – 548 mg/kg and 1327 – 1591mg/kg, respectively. MSDS

The most common signs and symptoms associated with a non-fatal sertraline overdose are somnolence, vomiting, tachycardia, nausea, dizziness, agitation, and tremor.21 No cases of fatal overdose with only sertraline have been reported. Most fatal cases are associated with the ingestion of sertraline with other drugs.18 Consequences of a sertraline overdose may include serotonin syndrome, hypertension, hypotension, syncope, stupor, coma, bradycardia, bundle branch block, QT-prolongation, torsade de pointes, delirium, hallucinations, and pancreatitis.21

Pathways
Not Available
Pharmacogenomic Effects/ADRs
Interacting Gene/Enzyme Allele name Genotype(s) Defining Change(s) Type(s) Description Details
Cytochrome P450 2C19 CYP2C19*2 Not Available 681G>A Effect Directly Studied The presence of this polymorphism in CYP2C19 is associated with poor metabolism of sertraline. Details
Cytochrome P450 2C19 CYP2C19*3 Not Available 636G>A Effect Directly Studied The presence of this polymorphism in CYP2C19 is associated with reduced or poor metabolism of sertraline. Details
Cytochrome P450 2C19 CYP2C19*2A Not Available 681G>A Effect Inferred Poor drug metabolizer. For individual with two non-functional alleles, alternative drug or dose reduction recommended. Details
Cytochrome P450 2C19 CYP2C19*2B Not Available 681G>A Effect Inferred Poor drug metabolizer. For individual with two non-functional alleles, alternative drug or dose reduction recommended. Details
Cytochrome P450 2C19 CYP2C19*4 Not Available 1A>G Effect Inferred Poor drug metabolizer. For individual with two non-functional alleles, alternative drug or dose reduction recommended. Details
Cytochrome P450 2C19 CYP2C19*5 Not Available 1297C>T Effect Inferred Poor drug metabolizer. For individual with two non-functional alleles, alternative drug or dose reduction recommended. Details
Cytochrome P450 2C19 CYP2C19*6 Not Available 395G>A Effect Inferred Poor drug metabolizer. For individual with two non-functional alleles, alternative drug or dose reduction recommended. Details
Cytochrome P450 2C19 CYP2C19*7 Not Available 19294T>A Effect Inferred Poor drug metabolizer. For individual with two non-functional alleles, alternative drug or dose reduction recommended. Details
Cytochrome P450 2C19 CYP2C19*22 Not Available 557G>C / 991A>G Effect Inferred Poor drug metabolizer. For individual with two non-functional alleles, alternative drug or dose reduction recommended. Details
Cytochrome P450 2C19 CYP2C19*24 Not Available 99C>T / 991A>G  … show all Effect Inferred Poor drug metabolizer. For individual with two non-functional alleles, alternative drug or dose reduction recommended. Details
Cytochrome P450 2C19 CYP2C19*35 Not Available 12662A>G Effect Inferred Poor drug metabolizer. For individual with two non-functional alleles, alternative drug or dose reduction recommended. Details

Zoloft (sertraline hydrochloride) for Depression

What is Zoloft?

Zoloft is a medication known as a selective serotonin reuptake inhibitor. The mediation is used to treat major depressive disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder.


When did the U.S. Food and Drug Administration (FDA) approve the medication?

Zoloft was first approved by the FDA in 1991.


Is there a generic version of Zoloft?

Yes, the generic version of Zoloft is known as sertraline and is sold in the U.S.


Are there any major differences between Zoloft and other mental health medications?

Zoloft is a selective serotonin reuptake inhibitor (SSRI). SSRIs are the most commonly prescribed type of antidepressants, and they work by increasing levels of serotonin in the brain. They are also sometimes prescribed to treat anxiety and other conditions. If you have bipolar disorder and take an SSRI, you may be at risk for triggering a manic episode if you are not also taking a mood stabilizer. Talk to your doctor about your specific symptoms, other health concerns, and other medications you take so they can make the best recommendation for your condition and symptoms.

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Can children take Zoloft?

The safety and efficacy of the medication has only been established to treat children ages 6 to 17 specifically for obsessive-compulsive disorder. Talk to your child’s doctor about the risks of the medication.


Are there potential interaction issues for people taking Zoloft and any other drugs?

There are hundreds of drugs which are known to interact with Zoloft in major, moderate, or mild ways, so let your doctor know what other medications you are taking before you begin taking the medication. Talk to your doctor if you take MAO inhibitors, pimozide, or disulfiram.


Are there any other medical conditions that would make someone ineligible for Zoloft therapy?

Talk to your doctor about other medical conditions before you take Zoloft, such as heart attack, heart disease, liver disease, and low sodium levels. If you’re allergic to latex tell your doctor before you take the liquid concentrate version of the medication.


What is the typical dose that would be prescribed to someone taking Zoloft?

Dosage will vary depending on the condition being treated. The maximum recommended dosage is 200 mg per day.


What do I do if I miss a dose?

Take the dose of Zoloft when you remember, but skip the missed dose if it is almost time for your next dose. You should never take extra doses of the medication to make up for missed doses.


How long does it take for Zoloft to reach full efficacy?

It may take several weeks or longer for the medication to be fully effective and for initial side effects to decrease.


What side effects can

Zoloft cause?

Common side effects can include:
• constipation
• nausea
• diarrhea
• sleep problems
• heartburn
• dizziness
• sweating
• dry mouth
• loss of appetite
• fatigue
• headache
• uncontrollable shaking
• changes in sex drive

It also is recommended that you wait to drive or operate machinery until you know how the medication affects you. It is also recommended that people avoid alcohol and illegal drugs while on the medication, as they can worsen adverse effects. Report side effects to your doctor immediately. Serious side effects can include seizures, bleeding or bruising, swelling, hives, rash, trouble breathing, agitation, fever, fast heartbeat, vomiting, muscle stiffness, loss of coordination, or hallucinations. You can also report side effects to the FDA at 1-800-FDA-1088 or online.


What are the potential psychological side effects of taking Zoloft?

Zoloft may increase the risk of suicidal thoughts and behaviors particularly in children, teens, and young adults who take the medication. Seek medical help if you or your child experience these thoughts or other changes in behavior or mood.


What are the potential long-term effects of taking Zoloft?

Zoloft may cause weight loss in children. It can also cause angle-closure glaucoma, so talk to your doctor about the risks.


Is it safe for a woman who is pregnant, about to become pregnant, or nursing to take Zoloft?

Birth defects and fetal harm are possible when Zoloft is taken during pregnancy, but the risk is very low. The drug may be transferred via breast milk. Therefore, talk to your doctor about the risks and benefits if you are pregnant, planning to become pregnant, or are nursing before you take Zoloft.


Can symptoms occur if Zoloft is discontinued?

It’s important not to discontinue use of the drug before talking with your doctor. Withdrawal symptoms of Zoloft can include anxiety, dizziness, headaches, fatigue, irritability, insomnia, flu-like symptoms, nausea, and the return of depressive symptoms.


What should I do if I overdose on Zoloft?

An overdose of Zoloft could be fatal, so seek immediate help or call the Poison Help Line at 1-800-222-1222 if you overdose. Overdose symptoms can include fatigue, drowsiness, agitation, dizziness, fever, vomiting, fast heartbeat, sweating, shivering, confusion, muscle stiffness, nausea, loss of coordination, diarrhea, seizures hallucinations, mania, or loss of consciousness.


Is Zoloft habit-forming?

Zoloft is not habit-forming, but it is not recommended that you discontinue use of the drug before talking with your doctor, as withdrawal symptoms can occur.


How much does Zoloft cost?

According to goodrx.com, 30 tablets of 100 mg generic sertraline cost approximately $36. 30 tablets of 100 mg Zoloft cost approximately $325.


Are there any disadvantages to Zoloft?

The biggest disadvantages of Zoloft are the potential side effects. Talk to your doctor about what medication is best for you.

DISCLAIMER: The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other healthcare providers. This article mentions drugs that were FDA-approved and available at the time of publication and may not include all possible drug interactions or all FDA warnings or alerts. The author of this page explicitly does not endorse this drug or any specific treatment method. If you have health questions or concerns about interactions, please check with your physician or go to the FDA site for a comprehensive list of warnings.

Article Sources

FDA – Zoloft
NIH – Sertraline

Last Updated: Jan 8, 2021

Sertraline – Lustral | Patient

About sertraline

Type of medicine A selective serotonin reuptake inhibitor (SSRI) antidepressant
Used for Depression, and anxiety disorders (such as panic disorder, social anxiety disorder, post-traumatic stress disorder), and obsessive-compulsive disorder (OCD)
Also called (UK) Lustral®
Also called (USA) Zoloft®
Available as Tablets, oral liquid medicine (USA)

Sertraline is prescribed for depression, anxiety disorders, and obsessive-compulsive disorder (OCD). An anxiety disorder is a condition where anxiety is a major symptom. Panic disorder, social anxiety disorder, and post-traumatic stress disorder are all anxiety disorders. OCD is a condition where you have recurring and persistent ideas that make you do repetitive actions.

Brain cells, called neurons, release a number of chemicals which go on to stimulate other neurons. This leads to electrical impulses which result in many functions controlled by the brain. Serotonin is one such chemical in the brain. Once released, it stimulates other neurons and is then taken back up into the neuron cells and recycled. Selective serotonin reuptake inhibitors (SSRIs) like sertraline increase the amount of circulating serotonin available in your brain. This can help the symptoms of depression, anxiety disorders, and OCD.

Before taking sertraline

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking sertraline it is important that your doctor knows:

  • If you are pregnant, trying for a baby or breastfeeding.
  • If you have a heart condition, or a liver or kidney disorder.
  • If you have epilepsy.
  • If you have high blood sugar levels (diabetes mellitus).
  • If you have an eye problem called glaucoma.
  • If you have ever had a bleeding disorder.
  • If you have ever had abnormally ‘high’ moods, called mania.
  • If you are being treated with electroconvulsive therapy (ECT).
  • If you have ever had an allergic reaction to a medicine.
  • If you have taken an antidepressant known as a monoamine-oxidase inhibitor (MAOI) within the previous two weeks.
  • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.

How to take sertraline

  • Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about sertraline and will provide you with a full list of the side-effects which you may experience from taking it.
  • Take sertraline exactly as your doctor tells you to – it is taken once daily. Most doctors recommend that it is taken either in the morning or in the evening. Try to take your doses at the same time of day each day. There are two strengths of tablet available – 50 mg and 100 mg. Your doctor will tell you which strength is right for you.
  • If you are being treated for an anxiety disorder, your doctor may prescribe a low dose for you to begin with, and then gradually increase it. This is because slowly increasing the dose helps to reduce the risk of side-effects.
  • You can take sertraline before or after food.
  • If you forget to take a dose, take it as soon as you remember. If you do not remember until the following day, skip the missed dose. Do not take two doses together to make up for a forgotten dose.

Getting the most from sertraline

  • You may feel that sertraline is not working for you straightaway. It can take a week or two after starting this treatment before the effect begins to build up, and 4-6 weeks before you feel the full benefit. Do not stop taking it after a week or two, feeling it is not helping.
  • Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress.
  • Do not drink grapefruit juice while you are on sertraline. This is because a chemical in grapefruit juice increases the amount of sertraline in your bloodstream. This makes side-effects more likely.
  • If you drink alcohol, ask your doctor for advice. Your doctor is likely to recommend that you do not drink alcohol while you are on sertraline, as it increases the risk of side-effects, such as feeling sleepy.
  • If you buy any medicines, check with a pharmacist that they are safe to take with sertraline. This is because several medicines which are available from general retail outlets can interfere with this treatment. In particular, do not take the herbal remedy St John’s wort, and ask for advice before buying any anti-inflammatory painkillers.
  • While you are taking sertraline, you may have thoughts about harming yourself or ending your life. These thoughts may also be associated with your condition. It is very important that you tell your doctor about this if it happens.
  • Do not stop taking sertraline unless your doctor tells you to do so. Stopping treatment suddenly can cause problems and your doctor will probably want you to reduce your dose gradually when this becomes necessary. You should expect that a course of treatment will last for several months. This is normal and helps to prevent your symptoms from recurring.
  • If you have diabetes, you may need to check your blood glucose more frequently, as sertraline may affect the levels of sugar in your blood. Your doctor will be able to advise you about this.
  • A few people taking sertraline find that their skin is more sensitive to sunlight than normal. Until you know how your skin reacts, use a sun cream with a high sun protection factor (SPF) in strong sunlight.
  • There are several types of antidepressants and they differ in their possible side-effects. If you find that sertraline does not suit you then let your doctor know, as another may be found that will.

Can sertraline cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with sertraline. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Common sertraline side-effects What can I do if I experience this?
Feeling sleepy, dizzy or weak If this happens, do not drive and do not use tools or machines
Feeling sick (nausea) or being sick (vomiting), constipation or diarrhoea, indigestion Stick to simple foods
Headache Drink plenty of water and ask your pharmacist to recommend a suitable painkiller. If the headaches continue, let your doctor know
Mood changes such as feeling anxious, nervous or agitated. Feeling restless or shaky This may happen when you first start taking sertraline but it usually settles within a few days. If it becomes troublesome or severe, speak with your doctor
Dry mouth, difficulty sleeping, bad dreams, sore throat, tingling feelings, lack of concentration, eyesight problems, ringing noises, flushing, sweating, yawning, reduced sexual drive or ability, change in appetite, aches or pains, swallowing problems Speak with your doctor if any of these become troublesome

Important: a few people taking sertraline have developed an allergic-type reaction. You should contact your doctor straightaway if you develop any swelling around your face, any difficulties breathing, or a severe rash.

If you experience any other symptoms that you think may be due to this medicine, speak with your doctor or pharmacist for further advice.

How to store sertraline

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.

Important information about all medicines

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

If you are having an operation or any dental treatment, tell the person carrying out the treatment which medicines you are taking.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Zoloft (Sertraline hydrochloride) Drug / Medicine Information

Sertraline (sir-tra-leen) hydrochloride

Consumer Medicine Information

What is in this leaflet

This leaflet answers some common questions about Zoloft.

It does not contain all the available information.

It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits.

Your doctor has weighed the risks of you taking Zoloft against the benefits it is
expected to have for you.

If you have any concerns about taking this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine.

You may need to read it again.

What ZOLOFT is used for

Zoloft is used to treat depression and conditions called obsessive compulsive disorder
(OCD), panic disorder, social phobia (social anxiety disorder) and premenstrual dysphoric
disorder (PMDD).

PMDD affects some women in the days before their period. PMDD is different from premenstrual
syndrome (PMS). The mood symptoms (anger, sadness, tension, etc) in PMDD are more
severe than in PMS and affect the woman’s daily activities and relationships with
others.

Zoloft belongs to a group of medicines called selective serotonin reuptake inhibitors
(SSRIs). They are thought to work by blocking the uptake of a chemical called serotonin
into nerve cells in the brain. Serotonin and other chemicals called amines are involved
in controlling mood.

Your doctor, however, may prescribe Zoloft for another purpose.

Ask your doctor if you have any questions about why Zoloft has been prescribed for
you.

Zoloft should not be used in children and adolescents under the age of 18 years for
the treatment of any medical condition other than obsessive compulsive disorder (OCD).
The safety and efficacy of Zoloft for the treatment of medical conditions (other than
OCD) in this age group has not been satisfactorily established.

For the treatment of OCD, Zoloft is not recommended for use in children under the
age of 6, as the safety and efficacy in children of this age group has not been established.

This medicine is only available with a doctor’s prescription.

There is no evidence that Zoloft is addictive.

Before you take ZOLOFT

When you must not take it

Do not take Zoloft if you have an allergy to:

any medicine containing sertraline

any of the ingredients listed at the end of this leaflet.

Some of the symptoms of an allergic reaction may include:

shortness of breath

wheezing or difficulty breathing

swelling of the face, lips, tongue or other parts of the body

rash, itching or hives on the skin.

Do not take Zoloft if you have epilepsy not properly controlled by medication.

Do not take Zoloft if you are taking another medicine for depression called a monoamine
oxidase inhibitor (MAOI) or have been taking it within the last 14 days.

Taking Zoloft with a MAOI (e.g. Aurorix, Eldepryl, Nardil, Parnate) may cause a serious
reaction with a sudden increase in body temperature, extremely high blood pressure
and convulsions (fits).

Do not take Zoloft if you are taking phentermine (used to help weight loss), tryptophan
(contained in protein-based foods or dietary proteins), methadone (used to treat drug
addiction), medicines used to treat migraine, e.g. sumatriptan (Imigran), dextromethorphan
(used as a cough suppressant in cold and ‘flu medications), medicines used for pain
management such as fentanyl, tapentadol (Palexia), tramadol or pethidine.

These medicines can cause an exaggerated response to Zoloft.

Do not take Zoloft if you are taking pimozide (used to treat disturbances in thinking,
feeling and behaviour).

Ask your doctor or pharmacist if you are not sure if you have been taking one of these
medicines.

Do not give Zoloft to children or adolescents under the age of 18 unless the doctor
has prescribed it for the treatment of OCD. Do not give Zoloft to children under the
age of 6 for the treatment of OCD.

If you are not sure whether you should be taking Zoloft, talk to your doctor.

Do not take Zoloft if:

the expiry date marked on the packaging has passed, even though the tablets may look
alright

the packaging is torn or shows signs of tampering.

If it has expired or is damaged, return it to your pharmacist for disposal.

Before you start to take it

Tell your doctor if you have any allergies to any foods, dyes, preservatives or any
other medicines.

Tell your doctor if you have or have had any of the following medical conditions:

any other mental illness

epilepsy or seizures

liver or kidney problems

heart conditions causing irregular heartbeats

a tendency to bleed more than normal

diabetes mellitus

glaucoma, an eye condition.

Tell your doctor if you are pregnant or intend to become pregnant.

There have been reports that babies exposed to Zoloft and other antidepressants during
the third trimester of pregnancy may develop complications immediately after birth.

Tell your doctor if you are breastfeeding or wish to breastfeed.

Zoloft passes into breast milk and may affect your baby.

Your doctor will discuss the risks and benefits of taking Zoloft when pregnant or
breastfeeding.

Taking other medicines

Tell your doctor or pharmacist if you are taking any other medicines, including:

all prescription medicines

all medicines, vitamins, herbal supplements or natural therapies you buy without
a prescription from a pharmacy, supermarket, naturopath or health food shop.

Some medicines may be affected by Zoloft or may affect how well it works. You may
need different amounts of your medicines, or you may need to take different medicines.
Your doctor will advise you.

Tell your doctor or pharmacist if you are taking any of the following:

other medicines for the treatment of depression called monoamine oxidase inhibitors
(MAOIs).

Taking Zoloft with, or within 14 days of stopping a MAOI may cause a serious reaction
with a sudden increase in body temperature, extremely high blood pressure and convulsions.

other MAOI drugs such as linezolid, an antibiotic used to treat pneumonia and certain
skin infections

other medicines for depression, panic disorder, social anxiety disorder or obsessive
illnesses (e.g. Prothiaden, Prozac, Aropax, Luvox, Cipramil, Efexor XR, Xydep)

lithium (e.g. Lithicarb), a medicine used to treat mood swings

other medicines for PMDD (e.g. Prozac, Lovan, Xydep)

tryptophan (contained in protein-based foods or dietary proteins)

phentermine (weight-reducing medicines)

dextromethorphan (used in cold and ‘flu medicines to suppress cough)

medicines for strong pain management such as fentanyl, tapentadol (Palexia), tramadol
or pethidine

methadone (used to treat drug addiction)

other medicines used to relieve pain, swelling and other symptoms of inflammation,
including arthritis (e.g. aspirin or NSAIDs such as ibuprofen or diclofenac)

pimozide (used to treat disturbances in thinking, feeling and behaviour)

St John’s wort, a herbal remedy used to treat mood disorders

medicines for treating psychotic illness such as clozapine (e.g. Clozaril) which is
used to treat schizophrenia

medicines for irregular heartbeats (e.g. Tambocor)

warfarin (e.g. Marevan, Coumadin) or other medicines that stop the blood from clotting

phenytoin (e.g. Dilantin), a medicine used to treat epilepsy

sumatriptan (e.g. Imigran), a medicine used to treat migraine

diazepam or other medicines that act on the brain or nervous system (e.g. Serepax,
Valium)

cimetidine (e.g. Tagamet), a medicine used to treat reflux and ulcers

Medicines used to treat Attention Deficit Hyperactivity Disorder (ADHD) such as dexamphetamine
and lisdexamphetamine

antibiotics.

Not all brand names are given for the medicines listed above. Your doctor or pharmacist
has more information on these medicines or other medicines to be careful with or avoid
while taking Zoloft.

If you have not told your doctor or pharmacist about these things, tell them before
you start taking Zoloft.

Some combinations of medicines may increase the risk of serious side effects and are
potentially life-threatening.

How to take ZOLOFT

Follow all directions given to you by your doctor.

They may differ from the information contained in this leaflet.

If you do not understand the instructions on the box, ask your doctor or pharmacist
for help.

How much to take

Your doctor will tell you how many tablets you need to take each day. This may depend
on your age, your condition and whether or not you are taking any other medicines.

Depression – Adults

The usual starting dose is one 50 mg tablet each day. The dose can be increased gradually
up to 200 mg a day if necessary.

Obsessive Compulsive Disorder – Children (6-12 Years)

The usual starting dose is 25 mg a day which is half a 50 mg tablet. Increase to one
50 mg tablet a day after one week.

Obsessive Compulsive Disorder – Adults and Adolescents (13-18 Years)

The usual starting dose is one 50 mg tablet each day.

Panic Disorder – Adults

The usual starting dose is 25 mg day which is half a 50 mg tablet. Increase to one
50 mg tablet a day after one week.

Social Phobia (Social Anxiety Disorder) – Adults

The usual starting dose is 25 mg a day which is half a 50 mg tablet. Increase to one
50 mg a day after one week.

Do not take more than 200 mg a day for the conditions listed above.

Premenstrual Dysphoric Disorder (PMDD)

If taking throughout the menstrual cycle

The usual starting dose is one 50 mg tablet a day. This may be increased to a maximum
of 150 mg a day if needed. Increase the dose in a step wise fashion. If you are unclear
how to do this ask your pharmacist or doctor for advice.

If taking in the last 14 days of the menstrual cycle

The usual starting dose is one 50 mg tablet a day. This may be increased to a maximum
of 100 mg a day.

Do not take more than the maximum doses recommended above for PMDD.

How to take ZOLOFT

Swallow the tablets with a glass of water.

Try to take your tablet at the same time each day, either morning or evening.

Taking it at the same time each day will have the best effect. It will also help you
remember when to take it.

It does not matter if you take this medicine before or after food.

How long to take ZOLOFT for

Most medicines for depression and obsessive illnesses take time to work so do not
be discouraged if you do not feel better straight away.

It may take 2 to 4 weeks or even longer to feel the full benefit of Zoloft.

Continue taking Zoloft until your doctor tells you to stop.

Even when you feel well, you may need to take Zoloft for several months or longer.

If you have PMDD, your doctor may ask you to take this medicine only at certain times
of the month.

Do not stop taking Zoloft, or change the dose, without first checking with your doctor.

Occasionally the symptoms of depression or other psychiatric conditions may include
thoughts of harming yourself or committing suicide. It is possible that these symptoms
may continue or increase until the full anti-depressant effect of your medicine becomes
apparent (i.e. one to two months).

You or anyone close to you or caring for you should watch for these symptoms and tell
your doctor immediately or go to the nearest hospital if you have any distressing
thoughts or experiences during this initial period or at any other time.

Contact your doctor if you experience any worsening of your depression or other symptoms
at any time during your treatment.

If you forget to take ZOLOFT

Do not take a double dose to make up for the dose that you missed.

Wait until the next day and take your normal dose then.

If you are not sure what to do in this situation, ask your doctor or pharmacist.

If you have trouble remembering to take your medicine, ask your pharmacist for some
hints.

If you take too much ZOLOFT (overdose)

Immediately telephone your doctor or Poisons Information Centre (telephone 13 11 26)
for advice, or go to Accident and Emergency at your nearest hospital if you think
you or anyone else may have taken too much Zoloft.

Do this even if there are no signs of discomfort or poisoning.

You may need urgent medical attention.

Symptoms of an overdose may include:

feeling drowsy

nausea, diarrhoea, vomiting

fast or irregular heartbeats

tremors

feeling agitated or dizzy.

While you are taking ZOLOFT

Things you must do

Tell all doctors, dentists and pharmacists who are treating you that you are taking
Zoloft.

Tell your doctor or pharmacist that you are taking Zoloft if you are about to be started
on any new medicines.

Tell your doctor if you become pregnant while taking Zoloft.

If you are a woman of child-bearing age, you should avoid becoming pregnant while
taking Zoloft.

Tell your doctor immediately if you have any suicidal thoughts or other mental/mood
changes.

A worsening of depressive symptoms including thoughts of suicide or self-harm may
occur in the first one or two months of you taking Zoloft or when the doctor changes
your dose. These symptoms should subside when the full effect of Zoloft takes place.

Children, adolescents or young adults under 24 years of age are more likely to experience
these effects during the first few months of treatment.

Patients and caregivers should be alert and monitor for these effects.

Signs and symptoms of suicide include:

thoughts or talk of death or suicide

thoughts or talk of self-harm or harm to others

any recent attempts of suicide or self-harm

increase in aggressive behaviour, irritability or agitation

worsening of depression.

All mention of suicide or violence must be taken seriously.

If you or someone you know is demonstrating these warning signs of suicide while taking
Zoloft, contact your doctor or a mental health professional right away.

Children should have regular check-ups with the doctor to monitor growth and development.

If you are going to have surgery, tell the surgeon or anaesthetist that you are taking
this medicine.

It may interact with other medicines used during surgery and cause unwanted side effects.

If you are about to have any urine tests, tell your doctor that you are taking this
medicine.

It may interfere with the results of some tests.

Things you must not do

Do not stop taking Zoloft, or change the dose, without first checking with your doctor.

Do not let yourself run out of tablets over the weekend or on holidays.

Suddenly stopping Zoloft may cause dizziness, light headedness, numbness, unusual
tingling feelings or shakiness.

Do not give this medicine to anyone else, even if their symptoms seem similar to yours.

Do not take Zoloft to treat any other complaints unless your doctor says to.

Things to be careful of

Be careful driving or operating machinery until you know how Zoloft affects you.

Some medicines for depression may affect your ability to drive or operate machinery
or do things that could be dangerous if you are not alert.

Although drinking moderate amounts of alcohol is unlikely to affect your response
to Zoloft, your doctor may suggest avoiding alcohol while you are taking Zoloft.

If you are feeling drowsy or are uncoordinated, be careful that you do not fall over.

Zoloft, like other medicines in this class, may increase your risk of bone fracture.

You should wait at least 14 days after stopping Zoloft before starting any other medicines
for depression or obsessive illnesses from the MAOI group, such as Aurorix, Eldepryl,
Nardil, and Parnate.

All of the above precautions are important even after you have stopped taking Zoloft.

The effects of Zoloft may last for some days after you have stopped taking it.

Side effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you
are taking Zoloft.

All medicines can have side effects. Sometimes they are serious, most of the time
they are not. You may need medical attention if you get some of the side effects.

It can be difficult to tell whether side effects are the result of taking Zoloft,
effects of your condition or side effects of other medicines you may be taking. For
this reason it is important to tell your doctor of any change in your condition.

Do not be alarmed by the list of side effects.

You may not experience any of them.

Ask your doctor or pharmacist to answer any questions you may have.

Tell your doctor if…

Tell your doctor or pharmacist if you notice any of the following and they worry you:

headache, dizziness, shaking or tremors, unusually overactive, muscle stiffness or
weakness, decrease or loss of touch or other senses, sleepiness, drowsiness, impaired
concentration

dry mouth, nausea, feeling sick, diarrhoea, indigestion, vomiting, stomach pain, constipation

increased sweating, rash and hives

tiredness, fever, feeling unwell

hot flush, high blood pressure

weight increase or loss

increased or decreased appetite

sleeping difficulties, sexual problems,

vision disturbance

menstrual irregularities, sexual dysfunction including impaired sexual function in
males, difficulty in passing urine, or increased frequency

persistent noise in the ears

tingling and numbness of hands and feet

inflammation of the colon (causing diarrhoea)

Tell your doctor as soon as possible if…

Tell your doctor as soon as possible if you notice any of the following:

agitation, nervousness, anxiety, frightening dreams, yawning, abnormal thinking, teeth
grinding, symptoms of agitation, anxiety dizziness, headache, nausea and tingling
or numbness of the hands and feet after stopping Zoloft

uncontrollable muscle spasms affecting the eyes, head, neck and body, temporary paralysis
or weakness of muscles

lockjaw

painful, swollen joints

difficulty in breathing, wheezing or coughing

uncontrollable movements of the body, shuffling walk, unusual weakness

palpitations, fainting or chest pain

irregular heartbeats

abnormal bleeding including vaginal bleeding

sudden onset of severe headache.

Go to hospital if…

Tell your doctor immediately or go to Accident and Emergency at your nearest hospital,
if you notice any of the following:

fits or seizures

signs of allergy such as rash or hives, swelling of the face, lips or tongue, wheezing
or difficulty breathing

symptoms of sudden fever with sweating, fast heartbeat and muscle stiffness, which
may lead to loss of consciousness

thoughts of suicide or attempting suicide or self-harm.

The above list includes very serious side effects. You may need urgent medical attention
or hospitalisation.

Tell your doctor or pharmacist if you notice anything else that is making you feel
unwell.

Other side effects not listed above may also occur in some people.

Some of these side effects (e.g., changes in thyroid function, liver function or glucose
control) can only be found when your doctor does tests from time to time to check
your progress.

After taking ZOLOFT

Storage

Keep your tablets where young children cannot reach them.

A locked cupboard at least 1and a half metres above the ground is a good place to
store medicines.

Keep Zoloft in a cool, dry place where the temperature stays below 30°C.

Do not store it or any other medicine in the bathroom or near a sink. Do not leave
it in the car or on window sills.

Heat and dampness can destroy some medicines.

Keep your tablets in their blister pack until it is time to take them.

Disposal

If your doctor tells you to stop taking Zoloft, or the tablets have passed their expiry
date, ask your pharmacist what to do with any left over.

Product description

What it looks like

Zoloft tablets come in two strengths:

Zoloft 50 mg – white, capsule-shaped scored tablets embossed with ZLT 50 on one side
and the Pfizer logo on the other.

Zoloft 100 mg – white, capsule-shaped tablets embossed with ZLT 100 on one side and
the Pfizer logo on the other.

A box contains 30 tablets.

Ingredients

Zoloft contains 50 mg or 100 mg of sertraline as the active ingredient.

It also contains:

microcrystalline cellulose

calcium hydrogen phosphate dihydrate

hyprolose

sodium starch glycollate

magnesium stearate

White Opadry

Clear Opadry

Zoloft does not contain gluten, lactose or sugar.

Supplier

Zoloft is supplied in Australia by:

Upjohn Australia Pty Ltd

Sydney NSW, Australia

Toll Free Number: 1800 875 646

Australian registration numbers:

Zoloft 50 mg – AUST R 42979, 321601

Zoloft 100 mg – AUST R 42950, 321602

This leaflet was prepared in September 2020.

 

® Registered Trademark

 

ujczolot10920

 

Zoloft® (sertraline HCL)

ZOLOFT is available by prescription only in 25 mg, 50 mg, and 100 mg tablets.

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Antidepressants increased the risk of suicidal thoughts and behavior in pediatric and young adult patients in short-term studies. Closely monitor all antidepressant-treated patients for clinical worsening, and for emergence of suicidal thoughts and behaviors.

Contraindications

ZOLOFT is contraindicated in patients:

  • Taking, or within 14 days of stopping MAOIs (including the MAOIs linezolid and intravenous methylene blue) because of an increased risk of serotonin syndrome
  • Taking pimozide
  • With known hypersensitivity to sertraline (eg, anaphylaxis, angioedema)

In addition to the contraindications for all ZOLOFT formulations listed above, ZOLOFT oral solution is contraindicated in patients taking disulfiram. ZOLOFT oral solution contains alcohol, and concomitant use of ZOLOFT and disulfiram may result in a disulfiram-alcohol reaction.

Warnings and Precautions

Suicidal Thoughts and Behaviors in Pediatric and Young Adult Patients:

  • Monitor all antidepressant-treated patients closely for clinical worsening and emergence of suicidal thoughts and behaviors, especially during the initial few months of drug therapy and at times of dosage changes
  • Counsel family members or caregivers of patients to monitor for the emergence of agitation, irritability, unusual changes in behavior, as well as the emergence of suicidality, and to report such symptoms immediately to health care providers. Such monitoring should include daily observation by families and caregivers
  • Consider changing the therapeutic regimen, including possibly discontinuing ZOLOFT, in patients whose depression is persistently worse or who are experiencing emergent suicidal thoughts or behaviors

Serotonin Syndrome: Patients on ZOLOFT should be monitored for the emergence of a potentially life-threatening serotonin syndrome, particularly with concomitant use of serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort) and with drugs that impair metabolism of serotonin (in particular, MAOIs, both those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue). If concomitant use of ZOLOFT with other serotonergic drugs is clinically warranted, inform patients of the increased risk of serotonin syndrome and monitor for symptoms.

Increased Risk of Bleeding: SNRIs and SSRIs, including ZOLOFT, may increase the risk of bleeding events. Patients should be cautioned about the risk of bleeding associated with the concomitant use of ZOLOFT and NSAIDs, aspirin, warfarin, or other drugs that affect coagulation.

Activation of Mania or Hypomania: Prior to initiating treatment with ZOLOFT, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder. It should be noted that ZOLOFT is not approved for use in treating bipolar disorder.

Discontinuation Syndrome: Adverse reactions after discontinuation of serotonergic antidepressants, particularly after abrupt discontinuation, include nausea, sweating, dysphoric mood, irritability, agitation, dizziness, sensory disturbances, tremor, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible.

Seizures: ZOLOFT should be introduced with care in patients with a seizure disorder. ZOLOFT should be prescribed with caution in patients with a seizure disorder.

Angle Closure Glaucoma: The pupillary dilation that occurs following use of many antidepressant drugs including ZOLOFT may trigger an angle closure attack in a patient with anatomically narrow angles who does not have a patent iridectomy. Avoid use of antidepressants, including ZOLOFT, in patients with untreated anatomically narrow angles.

Hyponatremia: Hyponatremia may occur as a result of treatment with SSRIs and SNRIs, including ZOLOFT. Discontinuation of ZOLOFT should be considered in patients with symptomatic hyponatremia, and appropriate medical intervention should be instituted.

QTc Prolongation: ZOLOFT should be used with caution in patients with risk factors for QTc prolongation.

Prescriptions for ZOLOFT should be written for the smallest quantity of tablets consistent with good patient management in order to reduce the risk of overdose.

Patients should be told that until they learn how they respond to ZOLOFT, they should be careful doing activities during which they need to be alert, such as driving a car or operating machinery.

The use of ZOLOFT in patients with liver disease must be approached with caution.

Adverse Reactions

  • The most commonly observed adverse reactions in patients treated with ZOLOFT (incidence of 5% or greater and at least twice the incidence in placebo patients) were nausea, diarrhea/loose stool, tremor, dyspepsia, decreased appetite, hyperhidrosis, ejaculation failure, and decreased libido
  • In pediatric patients treated with ZOLOFT, the overall profile of adverse events was generally similar to that seen in adult studies. The following additional adverse events were reported at an incidence of at least 2% and occurred at a rate of at least twice the placebo rate: fever, hyperkinesia, urinary incontinence, aggression, epistaxis, purpura, arthralgia, decreased weight, muscle twitching, and anxiety. Safety and effectiveness of ZOLOFT in pediatric patients other than those with OCD have not been established

Drug Interactions

  • Protein-bound drugs: Monitor for drug reactions and reduce dosage of ZOLOFT or other protein-bound drugs (eg, warfarin) as warranted
  • CYP2D6 substrates: Reduce dosage of drugs metabolized by CYP2D6

 

Caution is advised if the concomitant administration of ZOLOFT and CNS-active drugs is required.

Patients should be advised that the use of any OTC product should be initiated cautiously according to the directions of use given for the OTC product.

Use in Specific Populations

Pregnancy: Third trimester use may increase risk for persistent pulmonary hypertension and withdrawal in the neonate. Neonates exposed to ZOLOFT and other SSRIs or SNRIs late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. When treating pregnant women with ZOLOFT during the third trimester, the physician should carefully consider the potential risks and benefits of treatment. Patients should be advised to notify their physician if they become pregnant or intend to become pregnant during therapy, or if they are breastfeeding an infant while on ZOLOFT.

Zoloft – Uses, Side Effects, Interactions

How does this medication work? What will it do for me?

Sertraline belongs to a class of medications known as selective serotonin reuptake inhibitors (SSRIs). It is used to treat depression, panic disorder, and obsessive-compulsive disorder (OCD). Sertraline works by affecting the balance of chemicals in the brain. Specifically, it increases the level of a neurotransmitter called serotonin in the brain. Increased serotonin levels can help improve mood, reduce panic attacks, and treat OCD.

Although improvements may occur earlier, the full response to the medication may not appear until after 4 weeks of treatment or longer.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

25 mg
Each yellow capsule contains sertraline HCl equivalent to 25 mg of sertraline. Nonmedicinal ingredients: cornstarch, lactose (anhydrous), magnesium stearate, and sodium lauryl sulfate; capsule shell: D&C Yellow No. 10, FD&C Yellow No. 6, gelatin, and titanium dioxide. This medication does not contain gluten or tartrazine.

50 mg
Each white and yellow capsule contains sertraline HCl equivalent to 50 mg of sertraline. Nonmedicinal ingredients: cornstarch, lactose (anhydrous), magnesium stearate, and sodium lauryl sulfate; capsule shell: D&C Yellow No. 10, FD&C Yellow No. 6, gelatin, and titanium dioxide. This medication does not contain gluten or tartrazine.

100 mg
Each orange capsule contains sertraline HCl equivalent to 100 mg of sertraline. Nonmedicinal ingredients: cornstarch, lactose (anhydrous), magnesium stearate, and sodium lauryl sulfate; capsule shell: D&C Yellow No. 10, FD&C Red No. 40, gelatin, and titanium dioxide. This medication does not contain gluten or tartrazine.

How should I use this medication?

For depression and obsessive-compulsive disorder, the recommended doses range from 50 mg to 200 mg once daily, taken with food.

For panic disorder, the recommended doses range from 25 mg to 200 mg once daily.

Your doctor may start you on a lower dose and gradually increase your dose to one that’s appropriate for you.

Sertraline should be taken with food, preferably in the evening. But if you prefer to take it in the morning, take it with breakfast. Swallow the capsule whole. Do not crush, chew, or divide the capsules.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor.

If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take sertraline if you:

  • are allergic to sertraline or any ingredients of the medication
  • are taking a MAO inhibitor (e.g., phenelzine, tranylcypromine, moclobemide) or have taken a MAO inhibitor within the last 14 days
  • are taking pimozide







  • What side effects are possible with this medication?


    Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

    The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

    The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

    Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

    • decreased sexual desire or ability
    • diarrhea
    • dizziness
    • drowsiness
    • dry mouth
    • headache
    • loss of appetite
    • nausea
    • nervousness
    • sleep disturbance
    • tremor (shakiness)

    Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

    Check with your doctor as soon as possible if any of the following side effects occur:

    • behaviour changes (e.g., anger, anxiety, violent thoughts)
    • changes in vision, including blurred vision or eye pain
    • fast talking and excited feelings or actions that are out of control
    • inability to sit still
    • liver problems (yellowing of the eyes or skin, abdominal pain, nausea, vomiting, dark urine)
    • low blood sodium (e.g., tiredness, weakness, and confusion combined with achy, stiff, or uncoordinated muscles)
    • symptoms of low blood sugar (weakness, hunger, sweating, anxiety, numbness/tingling in arms/legs)
    • paranoia (suspicions of people, organizations, or situations, with no basis in reality)
    • restlessness
    • signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don’t stop bleeding)
    • symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)
    • symptoms of mania (e.g., decreased need for sleep, elevated or irritable mood, racing thoughts)
    • unusual or sudden body or facial movements or postures

    Stop taking the medication and seek immediate medical attention if any of the following occur:

    • seizure
    • serotonin syndrome (diarrhea, fever, increased sweating, mood or behaviour changes, overactive reflexes, racing heartbeat, restlessness, shivering, or shaking)
    • signs of an allergic reaction (hives; difficulty breathing; swelling of the face, tongue, or throat)
    • signs of bleeding in the stomach (e.g., bloody, black, or tarry stools; spitting up of blood; vomiting blood or material that looks like coffee grounds)
    • symptoms of irregular heartbeat (e.g., chest pain, dizziness, rapid, pounding heartbeat, shortness of breath)
    • thoughts of suicide or self-harm

    After you stop taking sertraline, your body may need time to adjust. The length of time this takes depends on the amount of medication you were using and how long you used it. During this period of time, check with your doctor if you notice any of the following side effects:

    • abnormal dreams
    • agitation
    • anxiety
    • difficulty concentrating
    • dizziness
    • headache
    • increased sweating
    • nausea
    • trembling or shaking
    • sensations similar to electric shocks

    Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.







    Are there any other precautions or warnings for this medication?


    Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

    Bleeding: This medication may increase the risk of bleeding, especially if you are also taking medications such as acetylsalicylic acid (ASA), nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, naproxen, ketoprofen), or warfarin. If you experience easy bruising, pinpoint-sized red spots on the skin, or unusual bleeding while taking this medication, contact your doctor immediately.

    Bones: Sertraline may increase the risk of bone fracture, especially if you are a senior or have osteoporosis or other major risk factors for breaking a bone. Take extra care to avoid falls, especially if you get dizzy or have low blood pressure. Your doctor may monitor your bones while you are taking this medication.

    Diabetes: Sertraline may cause a loss of blood sugar control (increased or decreased blood sugar) for some people who have diabetes and glucose tolerance may change. If you have diabetes, monitor your blood sugar closely and report any changes to your doctor.

    If you have diabetes or are at risk for developing diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

    Drowsiness/reduced alertness: This medication may impair judgment, thinking, or motor skills. People using sertraline should avoid driving a car or operating hazardous machinery until they determine whether or not the medication affects them in this way.

    Glaucoma: Sertraline may cause an increase in pressure in the eyes. It can cause symptoms of glaucoma to become worse. If you have glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

    Heart rhythm: Sertraline can cause changes to the normal rhythm of the heart, including an irregular heartbeat called QT prolongation. QT prolongation is a serious life-threatening condition that can cause fainting, seizures, and sudden death. If you are at risk for heart rhythm problems (e.g., people with heart failure, angina, low potassium or magnesium levels, family history of QT prolongation), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

    Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

    If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

    Mania: Sertraline may cause activation of mania. This means that people who are prone to mania may be more likely to have their mania start up again. If you have a history of mania or bipolar disorder, your doctor should closely monitor your condition while you are taking this medication.

    Seizures: If you have a history of seizures, your doctor should closely monitor your condition while you are taking sertraline. If you develop seizures, stop taking the medication and contact your doctor.

    Serotonin syndrome: This medication may cause a rare but potentially life-threatening condition called serotonin syndrome, especially when used with other medications that increase serotonin levels (e.g., sumatriptan, rizatriptan, tramadol, St. John’s wort). If you experience symptoms such as agitation, confusion, hallucinations, fast heart rate, fever, lack of coordination, increased body temperature, overactive reflexes, nausea, vomiting, and diarrhea, get immediate medical attention.

    Sodium levels: Sertraline can occasionally cause low levels of sodium in the blood (hyponatremia). This is more likely to happen to seniors or people who are also taking diuretics (water pills). If you experience confusion, weakness, headache, and memory problems, talk to your doctor as soon as possible. If too much sodium is lost from the body, it can cause hallucinations, confusion, seizures, coma, breathing, and even death.

    Stopping the medication: Stopping this medication suddenly may lead to side effects. If you are thinking of stopping the medication, check with your doctor or pharmacist first. See also “What side effects are possible with this medication?”

    Suicidal or agitated behaviour: People taking this medication may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after people start taking this medication. Your doctor will monitor you closely for emotional and behavioural changes. If you feel suicidal or agitated or notice any other changes in behaviour, talk to your doctor. Family members or caregivers of people who are taking this medication should contact the person’s doctor immediately if they notice unusual behaviour changes.

    Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately. There have been some reports that women taking SSRIs such as sertraline during the second half of pregnancy may be associated with lung disorders in newborns. Talk to your doctor if you have any concerns.

    Breast-feeding: It is not known if sertraline passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

    Children and adolescents: The safety and effectiveness of using this medication have not been established for people under the age of 18 years. The use of this medication by children below the age of 18 may cause behavioural and emotional changes, such as suicidal thoughts and behaviour.

    Seniors: Seniors who take sertraline appear to be more likely to experience low sodium in their blood, which can cause problems with coordination, achy muscles, or confusion. If you experience anything unusual while taking sertraline, contact your doctor.





    What other drugs could interact with this medication?


    There may be an interaction between sertraline and any of the following:

    • acetylsalicylic acid (ASA)
    • alcohol
    • amiodarone
    • amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
    • antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
    • antipsychotic medications (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, pimozide, quetiapine, risperidone)
    • apalutamide
    • apixaban
    • barbiturates (e.g., butalbital, pentobarbital, phenobarbital)
    • benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
    • beta-blockers (e.g. pindolol, propranolol, sotalol)
    • bromocriptine
    • bupropion
    • buspirone
    • celecoxib
    • chloral hydrate
    • chloroquine
    • clopidogrel
    • dabigatran
    • degarelix
    • desmopressin
    • dexmethylphenidate
    • dextromethorphan
    • diabetes medications (e.g., chlorpropamide, glyburide, insulin, metformin, rosiglitazone)
    • dipyridamole
    • disopyramide
    • disulfiram
    • dofetilide
    • domperidone
    • dronedarone
    • edoxaban
    • efavirenz
    • enzalutamide
    • ergot alkaloids (e.g., ergotamine, dihydroergotamine)
    • flecainide
    • glucosamine
    • grapefruit juice
    • heparin
    • linezolid
    • lithium
    • low molecular weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
    • macrolide antibiotics (e.g., clarithromycin, erythromycin)
    • methadone
    • methylene blue
    • methamphetamine
    • metoclopramide
    • mifepristone
    • mirtazapine
    • monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, rasagiline, selegiline, tranylcypromine)
    • multivitamins
    • muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine)
    • narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone)
    • non-steroidal anti-inflammatory medications (NSAIDs; e.g., diclofenac, ibuprofen, naproxen)
    • obinutuzumab
    • octreotide
    • omega-3 fatty acids
    • pentoxifylline
    • prasugrel
    • procainamide
    • quinidine
    • quinine
    • quinolone antibiotics (e.g., ciprofloxacin, ofloxacin, sparfloxacin)
    • rifabutin
    • rifampin
    • rivaroxaban
    • St. John’s wort
    • scopolamine
    • seizure medications (e.g., carbamazepine, clobazam, levetiracetam, phenobarbital, phenytoin, primidone, topiramate, valproic acid, zonisamide)
    • serotonin antagonists (anti-emetic medications; e.g., granisetron, ondansetron)
    • serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine, venlafaxine)
    • other selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
    • sotalol
    • tapentadol
    • tetrabenazine
    • thiazide diuretics (water pills; e.g., hydrochlorothiazide, indapamide, metolazone)
    • thyroid replacements (e.g., desiccated thyroid, levothyroxine)
    • ticagrelor
    • ticlopidine
    • tizanidine
    • tramadol
    • trazodone
    • tricyclic antidepressants (e.g., amitriptyline, imipramine, nortriptyline)
    • “triptan” migraine medications (e.g., eletriptan, sumatriptan)
    • tryptophan
    • tyrosine kinase inhibitors (e.g., dasatinib, lapatinib, nilotinib, pazopanib, sunitinib)
    • vitamin E
    • warfarin
    • zolpidem
    • zopiclone

    If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

    • stop taking one of the medications,
    • change one of the medications to another,
    • change how you are taking one or both of the medications, or
    • leave everything as is.

    An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

    Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

    All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Zoloft










90,000 A popular antidepressant has disappeared from pharmacies in Novosibirsk

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14 Apr 2021, 10:26

Disruptions in the supply of the antidepressant Zoloft began in Novosibirsk. Experts said that the increase in sales of the drug could be influenced by the coronavirus pandemic.

Disruptions in the supply of the antidepressant “Zoloft” began in Novosibirsk, reports the NGS with reference to the deputy director of the Novosibirsk pharmacy chain Maxim Lesnikov. He stated that he sent a request to the manufacturer, but has not yet received a response.

According to Lesnikov, other drugs with the same active agent remained in pharmacies. As psychiatrist Daria Lepikhova explained, Zoloft has high-quality generics – serenate and stimuloton, so she does not see a problem in the lack of a medicine.

“There are analogues of zoloft from the sertraline group, for example, the drug Surlift. These drugs are quite popular: they are often prescribed for depression, anxiety. In spring, the need for antidepressants may indeed be higher, ”said Vera Poddubnikova, an otoneurologist at the Zdravitsa Family Medicine Center. – In addition, the coronavirus could have influenced the increase in sales of this drug. But it must also be borne in mind that often these conditions can be caused by deficiencies of any elements or some concomitant pathologies. “

Viatris confirmed the absence of ash in the warehouses back in March, but they promised to replenish the stocks soon. According to Pharmaceutical Bulletin, sales of the drug in 2020 increased by 42% compared to 2019, and in January 2021 they grew by another 35% compared to the same period in 2020. This is associated with the pandemic and increased anxiety.

Vedomosti previously reported that pharmacy chains want to stop selling the tranquilizer Phenazepam.DSM Group CEO Sergei Shulyak linked this with the tightening of the rules for its sale by the Ministry of Health. The ministry classified the drug as a potent one and introduced quantitative accounting for it.

Zoloft – an effective antidepressant

Zoloft is an effective antidepressant. It helps stabilize depression and panic attacks of various forms. An important feature of the drug is that when it is used for treatment, addiction does not occur.

Contents:

Composition and form of the product

The active ingredient in the product is sertraline hydrochloride. The component has a powerful antidepressant effect, but it does not have a sedative effect, and also does not have anticholinergic or stimulating properties.

Zoloft is produced in tablet form. One biconvex film-coated tablet contains 50 mg or 100 mg of active ingredient.Distinctive features of tablets – oval shape, white color, presence of engraving “Pfizer” and “ZLT-50” on different sides.

Other ingredients are also used for the production of the medicine. Their list is indicated in the instructions for use.

What does the drug

cure?

Zoloft, the instruction for use confirms this, is indicated for the treatment and prevention of major depressive episodes. Such conditions are characterized by mental disorders with characteristic symptoms: loss of strength, increased fatigue, loss of interest in life, and a general deterioration in well-being.

In addition, the drug helps to remove:

  • Obsessive-compulsive disorder characterized by obsessive thoughts and actions.

  • Panic attacks, which can be associated with various phobias.

  • Post-traumatic stress disorders, which are caused by a mental disorder against the background of a certain traumatic situation, which can be repeated or have a single character.

  • Reactions of the body with social phobias.

Zoloft: contraindications

A contraindication to taking the drug is hypersensitivity to sertraline and other components that are part of the drug. Their list is indicated in the instructions for use.

Do not prescribe medication until the age of 18. An exception is the treatment of obsessive-compulsive disorders.In such cases, it is allowed to use the medicine after 6 years. Treatment with the drug during pregnancy and lactation is contraindicated, since studies that confirm the absence of a negative effect of the drug on the fetus and newborn child have not been carried out.

It is forbidden to use zoloft, the instruction focuses on this, in combination with MAO inhibitors. This can cause serotonin toxicity. This syndrome leads to malfunctions in many systems of the human body and can be fatal.

Also contraindications include the combination of a drug with the psychotropic drug pimozide.

Take the drug with increased caution when diagnosing epilepsy and organic brain diseases. Their development can be caused by both congenital pathologies and various negative external influences, in particular, injury or infection.

Negative Effects

Negative reactions when taking the drug were noted from various systems of the human body.But the most common problems are with the digestive system. There are dyspeptic disorders, pain in the abdomen, dry mouth. In severe cases, pancreatitis may develop.

Disorders in the work of the central nervous system, which are expressed by headaches, dizziness, insomnia and other unpleasant symptoms, can also occur during treatment. Dangerous reactions are malfunctions of the cardiovascular system, such as arterial hypertension or tachycardia.Sometimes taking the medicine provokes the onset of muscle cramps.

The instructions for using zoloft focus on the risks of many other side effects. The warnings should be read carefully before starting treatment. In case of any negative manifestations, the antidepressant should be discontinued.

Application rules

Food intake does not affect the effectiveness of the drug. The medicine is taken once a day, the initial dose for treatment:

  • Depressive states and obsessive-compulsive disorders is 50 mg.

  • Panic disorder, PTSD and social phobias – 25 mg.

In the course of therapy, the dosage of the drug can be increased on the recommendation of the doctor. In this way, the optimal treatment regimen is selected.

A noticeable positive effect on the background of taking the drug is noted in about a week. But in most cases, a course of treatment lasting 2-4 weeks is required to obtain a stable result.In case of major depressive episodes, therapy is allowed to continue for six months or more in order to exclude relapses.

Also, the drug can be prescribed for maintenance therapy. In this case, the minimum dose is prescribed that provides the desired effect. This requires periodic adjustment of the dosage depending on the therapeutic effect.

Special instructions

Zoloft 100 mg, you can buy in Moscow or other cities only with a prescription.The tablets are packed in blisters and placed in cardboard boxes along with instructions. It is important to understand that if you take Zoloft, the side effects of which are extensive, without following the doctor’s recommendations, then this can cause serious consequences.

The drug does not affect psychomotor reactions. This means that there are no restrictions on driving a car during the treatment period.

The price of the drug Zoloft is affordable. One package is sufficient in most cases for a course of treatment.The exception is complex pathological conditions requiring long-term therapy. In pharmacies, you can buy cheaper analogues of zoloft. The most famous of them are stimuloton and serlift.

Several imported drugs in demand disappeared from pharmacies

Four highly demanded imported drugs disappeared from retail at once in the spring and summer of 2020. All of them are produced by two companies – French Sanofi and Swiss Roche. This is evidenced by the data of the analytical agency DSM Group and the aggregator of pharmacies “Megapteka.RU”. The absence of some of the drugs was also confirmed by representatives of the pharmaceutical companies themselves.

Analysts from Megapteka.ru analyzed data from 15,000 pharmacies cooperating with the aggregator, which is 20% of the Russian retail market, according to the company. They identified the most popular user requests for which they cannot find the drugs they need, since drugs are not available in all or almost all partner pharmacies.

DSM experts also analyzed sales of the resulting list of disappeared drugs for May 2019 and 2020.A 90-100% drop in sales indicates that there is no medicine in pharmacies, a spokesman for the agency said. DSM’s representative sample includes 28,000 pharmacies, or 40% of the retail market.

Among the missing drugs is Madopar, used to treat Parkinson’s disease, and Roche’s Roaccutane, used for severe acne. According to Megapteka.ru data as of June 29, these drugs were available only in 0.06% of 15,000 partner pharmacies. Sales of madopar in May 2020 fell 60% yoy, and sales of roaccutane fell 97%, according to DSM.

At the beginning of the summer, a Roche representative also confirmed to Vedomosti the deficit of madopar in Russia. There were also problems in June with the availability of Roaccutane. Now, according to him, batches of both drugs have already been delivered to the country and will soon appear in circulation. So far, there have been no supplies of madopar and roaccutane, says Anton Buzdalin, general director of eapteka.ru.

As of June 30, Sanofi’s antimalarial plaquenil was found in only 0.1% of retail outlets connected to Megapteka.ru, and diuretic lasix in ampoules – in 0.08%.Their sales in May, according to DSM, fell 64% and 98% yoy, respectively.

Director of Corporate Relations of Sanofi in Eurasia Yuri Mochalin confirmed the shortage of lasix in Russia, saying that its production was closed – the company notified Roszdravnadzor about this in August 2019. Plaquenil, according to him, is in the company’s warehouse in sufficient quantities.

The reasons for the disappearance of drugs from the Russian market are different and depend on the specific drug, Mochalin and a Roche representative explain.

The shortage of Madopar is due to the growing demand for the drug, which is due to the reduction in the availability of alternative treatment options, primarily analog or generic drugs, a spokesman for Roche said. Additional demand was also triggered by the pandemic and quarantine measures, he adds: in a number of countries, patients were advised to stock up on medicine so as not to go to pharmacies or medical facilities again.

In the second quarter of 2020, Roche also faced a shortage of one of the pharmaceutical substances used in the production of Madopar, a company representative complains.This is not related to the pandemic, the problem has been resolved, he assures.

Madopar disappeared from the suppliers’ warehouses due to the renewal of the registration certificate, believes Dmitry Chirkov, general director of Megapteka.ru, about two months have passed since the filing of the application, most likely the drug will appear in pharmacies in the near future.

Plaquenil deficiency is associated with a rush in March for antimalarial drugs. Then the media reported on their effectiveness in the treatment of coronavirus, Chirkov recalls.Mochalin agrees with this. There is currently no sufficient clinical basis to talk about the efficacy and safety of Plaquenil in the treatment of COVID-2019, he emphasizes.

Foreign drugs disappear from the Russian market, as they often cannot compete with cheaper generics, DSM CEO Sergei Shulyak believes. Due to the higher price, imported drugs lose out on government auctions, which generate a significant portion of the proceeds. It makes no sense to produce a drug in small quantities for Russian retail – it is expensive: you need to make Russian-language packaging for the product, comply with all regulations, etc.There are cases when generics force the original medicine out of the pharmacy market, sums up Shulyak.

Manufacturers themselves speak of a large number of generics in their drugs. A Roche spokesman reported at least three replacement drugs for Roaccutane. Lasix has a total of 25 generics in various forms, Mochalin said.

Representatives of the Ministry of Health and Roszdravnadzor did not respond to Vedomosti’s inquiries.

Zoloft tablets 50 mg No. 28: instructions, prices, analogs, order with delivery

Instruction:

Composition

active substance: sertraline;

one film-coated tablet contains sertraline hydrochloride in an amount equivalent to 50 mg of sertraline;

Excipients: calcium hydrogen phosphate dihydrate, microcrystalline cellulose, hydroxypropyl cellulose, sodium starch, magnesium stearate, Opadry white (hypromellose, titanium dioxide (E 171), polyethylene glycol, polysorbate 80), Opadry transparent (hydroxypropyl methylcellulose), polyethylene glycol.

Indications.

Sertraline is indicated for the treatment of the following disorders:

Major depressive episodes. Prevention of recurrence of major depressive episodes.
Panic disorder with or without agoraphobia.
Obsessive-compulsive disorder (OCD) in adults and children 6-17 years old.
Social anxiety disorder.
Post-traumatic stress disorder (PTSD).

Contraindications.

Hypersensitivity to the active substance or to any of the excipients listed in the “Composition” section.

Simultaneous use of sertraline with MAO inhibitors (MAO) of irreversible action is contraindicated due to the risk of developing serotonin syndrome with manifestations of symptoms such as agitation, tremor and hyperthermia. Sertraline therapy should not be started for at least 14 days after stopping treatment with an irreversible MAO inhibitor. The use of sertraline should be discontinued at least 7 days before starting therapy with an irreversible MAO inhibitor.

The simultaneous use of sertraline and pimozide is contraindicated (see.Section “Interaction with other medicinal products and other types of interactions”).

Route of administration and dosage.

method of application

Sertraline should be taken once a day (morning or evening).

Sertraline tablets can be taken with or without food.

start of treatment

Depression and OCD

Treatment with sertraline should be started with a dose of 50 mg / day.

Panic disorder, PTSD and social anxiety disorder

Treatment should be started with a dose of 25 mg / day.After 1 week, the dose should be increased to 50 mg once a day. This dosing regimen has been shown to reduce the incidence of side effects associated with panic disorder during the initial phase of treatment.

dose titration

Depression, OCD, Panic Disorder, Social Anxiety Disorder and PTSD

In patients not responding to the 50 mg dose, the effect can be achieved by increasing the dose. Dose adjustments should be made in 50 mg increments at intervals of at least one week until a maximum dose of 200 mg / day is reached.Dose adjustment should be carried out no more than 1 time per week, taking into account the half-life of sertraline, which is 24 hours.

The first manifestations of the therapeutic effect can be observed within 7 days of treatment. However, it usually takes a long time to achieve a therapeutic response, especially in patients with OCD.

maintenance dose

Dosage during long-term therapy should be kept at a low effective level with subsequent adjustment depending on the therapeutic response.

depression

Long-term therapy can be used to prevent recurrence of major depressive episodes (RES). In most cases, the recommended dose to prevent recurrence of RES is the same as the dose that was used during the treatment of this depressive episode. Patients with depression should receive therapy for a sufficient period of time, for at least 6 months, to ensure that there are no symptoms at all.

Panic disorder and OCD

For long-term therapy in patients with panic disorder and OCD, therapy should be regularly evaluated because the drug has not been demonstrated to be effective in preventing relapse for these disorders.

application for children

Children and adolescents with obsessive-compulsive disorder

Adolescents aged 13-17 years: the initial dose is 50 mg once a day.

Children 6-12 years old: the initial dose is 25 mg once a day. After 1 week, the dose can be increased to 50 mg once a day.

If necessary, in case of insufficient effect, it is possible to further increase the dose with an increase of 50 mg 1 time over a period of several weeks.The maximum dose is 200 mg / day. However, when increasing the dose of 50 mg, one should take into account the generally low body weight of children compared to adults. Do not change the dose more often than once a week.

The effectiveness of the drug in children with major depressive disorder has not been demonstrated.

There are no data on the use of the drug in children under 6 years of age (see also the section “Peculiarities of use”).

Use in elderly patients

In elderly patients, the dose of the drug should be selected with caution, since these patients may have an increased risk of developing hyponatremia (see.Section “Features of application”).

Application for liver failure

Care should be taken when using sertraline in patients with liver disease. In case of impaired liver function, it is necessary to reduce the dose or frequency of taking the drug to patients. Sertraline should not be used in patients with severe hepatic impairment, since there are no clinical data on the use of the drug in such a patient (see section “Peculiarities of use”).

Application for renal failure

In case of impaired renal function, dose adjustment of the drug is not required (see.Section “Features of application”).

Withdrawal symptoms observed upon discontinuation of sertraline therapy

Sudden discontinuation of the drug should be avoided. When discontinuing treatment with sertraline, in order to reduce the risk of withdrawal reactions, the dose should be gradually reduced over a period of at least 1-2 weeks (see Sections “Peculiarities of use” and “Adverse reactions”). If unbearable symptoms appear after discontinuation of the drug or discontinuation of its use, reinstatement of the drug at the previously prescribed dose may be considered.In the future, the doctor may continue to reduce the dose, but more gradually.

Children.

Sertraline should not be used to treat children, except for children with obsessive-compulsive disorder at the age of 6 years (see section “Dosage and Administration”).

90,000 a list of the best drugs without a prescription

Can you buy antidepressants without a prescription? What mood aids are most effective, when lighter drugs will help, and when powerful drugs are needed, how do they work on the body, and can you take it yourself? The main thing when choosing a medicine is not to harm your health.

I’m depressed!

This can often be heard from friends or read on the forum. But, as a rule, the person making such statements is mistaken. After all, what is meant by “depression” in a colloquial environment? Usually we mean just a short-term deterioration in mood, irritability, fatigue under the influence of circumstances. Sometimes a person just has a “bad day” or “got up on the wrong foot,” and he calls it depression.

Nowadays, people are constantly faced with stress: overload at work, a frantic pace of life, excessive demands on themselves, a huge amount of information that flows from all sources.Not surprisingly, many do not cope with so many stressors, and this can manifest itself in a variety of symptoms:

  • alarm;
  • 90,042 irritability;

  • fatigue;
  • 90,042 sleep disorders;

  • obsessive thoughts;
  • panic attacks.

If these symptoms are short-lived and go away on their own, do not be very upset. In most cases, just a good rest will help to defeat them. But sometimes vacation is not enough, and the body needs a little help.It is very important to choose the right medication for this.

What is depression really

This is a long-term (2 weeks or more) pronounced decrease in mood, which is accompanied by a few more additional symptoms: decreased activity, slowed down of mental activity, lack of joy in life. That is, if you have ceased to be touched by the usual joys – hobbies, family, gatherings with friends, then this is a reason to think, observe your condition and, possibly, consult a doctor.

If you have ceased to be touched by the usual joys, then this is a reason to think about it and, possibly, consult a doctor.

True depression is a serious and often severe illness that requires compulsory treatment by a psychiatrist with the prescription of special medications.

What drugs are used to treat depression?

They are collectively known as antidepressants. It should be noted that in recent years, the indications for the prescription of antidepressants have expanded significantly.Numerous studies have been conducted that have shown the effectiveness of antidepressants not only for depression, but also for anxiety, sleep disorders (insomnia), neuroses and even neuropathic pain. Today, drugs from different groups of antidepressants are widely prescribed by psychiatrists, neurologists and even therapists.

The most commonly used drugs are of two groups.

Tricyclic antidepressants

These are the oldest drugs considered to be the strongest:

  • Amitriptyline is a drug with a strong sedative and powerful antidepressant effect.In large doses it is used to treat severe depression, in small doses – for milder disorders. It relieves anxiety well and has a hypnotic effect.
  • Anafranil is a balanced drug, usually easier to tolerate than amitriptyline, also relieves anxiety well. It is prescribed for the treatment of depression from mild to severe, various anxiety disorders.
  • Melipramine – has a stimulating effect, it is used to treat apathetic depression.

Selective serotonin reuptake inhibitors (SSRIs)

This is a more modern group of drugs.Their advantages are good tolerance and few or no side effects.

Often assigned from this group:

  • Fevarin – has an anti-anxiety and good antidepressant effect. With prolonged use, it normalizes sleep if it has been disturbed.
  • Zoloft is a fairly strong daytime antidepressant. Relieves anxiety, obsessive thoughts, while not causing drowsiness.
  • Paxil – relieves anxiety, often prescribed for the treatment of panic attacks.

There are many more modern antidepressants that have few side effects and are well tolerated:

But No prescription strong antidepressants are available . They can only be prescribed by a doctor: a psychiatrist, a neurologist, sometimes a therapist.

Why can’t you take antidepressants without a prescription?

  • Only a physician will be able to assess the risk of side effects for a particular patient.
  • Different antidepressants have different therapeutic effects.If the medicine is chosen incorrectly, at best it will not help, at worst it will harm.
  • Dose selection is carried out individually. If you increase the dose yourself too quickly, you can feel a lot of unpleasant consequences.
  • Cancellation should also be carried out gradually and under the supervision of a physician. Otherwise, you risk getting withdrawal.

What to do?

There are a number of over-the-counter drugs available.They are ineffective for clinical depression, but can help manage stress, short-term sleep disturbances, and irritability. With their help, you can try to alleviate your psycho-emotional state a little:

  • Glycine is one of the most popular products. It is prescribed, starting from childhood, with stress, overwork, emotional overstrain. Sometimes effective for minor sleep disturbances.
  • Afobazole . Has an anti-anxiety effect, eliminates fear, tearfulness, irritability. It is used in the treatment of vegetative-vascular dystonia and even with alcoholism, to relieve the symptoms of alcohol withdrawal. Not addictive. It should be borne in mind that children under 18 are contraindicated.
  • Novo-Passite . Quite a strong sedative for nervousness and irritability. Effective in reducing concentration, memory, fatigue. Helps restore the nervous system during periods of increased stress.

Over-the-counter drugs will not treat clinical depression, but can relieve psycho-emotional states.

  • Stressovite . Well soothes, relieves irritability, anxiety, improves sleep. Driving and other activities that require increased concentration are not recommended during the treatment period.
  • Persen is a herbal medicine. Contains valerian, lemon balm and peppermint extracts.Has a calming and anti-anxiety effect. It helps well with increased excitability, emotional lability, tearfulness. It can be used in the complex therapy of mild anxiety depressive disorders, facilitates the withdrawal of potent drugs.
  • Magne B6 . Increases the body’s resistance to stress. Magnesium deficiency can lead to an imbalance of the nervous system, irritability, sleep disturbances, therefore Magne B6 has a positive effect in these cases.
  • Tenoten . Provides anti-anxiety, sedative, anti-asthenic effect, helps to cope with stress and psycho-emotional stress. Relieves irritability and tension. It can be used for neurotic conditions.

When should I see a doctor?

  • If there is a decrease in mood for more than two weeks, and attempts to self-treatment have been ineffective.
  • If you have thoughts of unwillingness to live or suicidal thoughts.
  • If a depressive state significantly disrupts the usual course of life: you cannot work, fully communicate with your family, enjoy what used to bring joy.

You can contact a psychiatrist in confidence. Information about the very fact of treatment, not to mention the diagnosis and treatment, is a medical secret: they are not reported to work, are not disclosed. It is better to diagnose depression on time and start treatment than to bring it to advanced stages.

Literature

  1. BAUER M., A. Pfennig, Severus E., VAYBRAU PS, Angst J., H. MULLER-Yu CLINICAL RECOMMENDATIONS OF THE WORLD FEDERATION OF BIOLOGICAL PSYCHIATRY IN BIOLOGICAL THERAPY unipolar depressive disorders Part 1: Acute and continuation of treatment unipolar depressive disorders AS AT 2013 // MODERN THERAPY OF MENTAL DISORDERS Issue: 4 Year: 2015 Pages: 33-40
  2. Antidepressant therapy and other treatments for depressive disorders. Report of the CINP Working Group based on a review of evidence.M., 2008; 215 s.
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90,000 zoloft composition, instructions, reviews – People’s Doctor

Zoloft is an antidepressant that belongs to the group of serotonin reuptake inhibitors.According to patients and pharmacists, it is one of the most popular and most commonly used antidepressants.

The active ingredient of the drug is sertraline, which belongs to the group of serotonin reuptake inhibitors (for this group of drugs you can find the abbreviation SSRI, which comes from the English selective serotonin reuptake inhibitor). The leaflet details the action of serotonin as a neurotransmitter. Zoloft is manufactured by PFIZER S.A. EUROPEAN SERVICE CENTERS.

Depression, anxiety attack syndromes, agoraphobia, obsessive-compulsive disorder, social anxiety disorder and post-traumatic stress disorder are the most common indications for Zoloft patients. Adults can take the drug and children over 6 years old who suffer from any of the above disorders. Medicines can only be purchased with a prescription ,

the action of sertraline is to inhibit the process of reuptake of serotonin, which is called the hormone of happiness, which means that the duration of the action of serotonin in the synapse and the time of stimulation of the receiving cell is prolonged.So you can say it Zoloft works to maintain serotonin levels in the body. Setralin blocks the reuptake of serotonin, maintaining its optimal level necessary for maintaining a good mental state. The thoughts of patients taking Zoloft are unanimous – just a few days after you start taking the medication, your mental well-being will improve. Setralin is not addictive, making it easier to finish treatment than with other antidepressants.The clinical effects of the drug may appear after 7 days of treatment. Optimal treatment effects occur, as with other antidepressants, after 2-4 weeks of using the drug ,

The use of MAO inhibitors and pimozide in parallel with sertraline is contraindicated. If, when using the drug, symptoms such as agitation, muscle twitching or cramps appear, you should immediately consult a doctor, as neuroleptic syndrome may occur.

The starting dose is 25 mg daily However, your doctor may decide to increase the dose (for at least 7 days) by 50 mg to a maximum of 200 mg daily for obsessive-compulsive disorder. Children aged 6 to 12 years cannot take a higher dose than 25 mg daily , The drug is in the form of oral tablets, do not exceed the recommended daily dose, as it poses a threat to health and life.

Before use, read the leaflet, which contains indications, contraindications, data on side effects and dosages, as well as information on the use of the medicinal product, or consult your doctor or pharmacist, since any drug used in an improper way threatens your life or health.

Medicines for mental illnesses

The effectiveness of drug therapy with psychotropic drugs is determined by the correspondence of the choice of the drug to the clinical picture of the disease, the correctness of its dosage regimen, the method of administration and the duration of the therapeutic course. As in any field of medicine, in psychiatry it is necessary to take into account the entire complex of drugs that the patient takes, since their mutual action can lead not only to a change in the nature of the effects of each of them, but also to the occurrence of undesirable consequences.

There are several approaches to the classification of psychotropic drugs. Table 1 shows the classification proposed by WHO in 1990, adapted to include some domestic remedies.

Table 1. Classification of psychopharmacological drugs.

Class Chemical group Generic and common commercial names

Neuroleptics

Phenothiazines

Chlorpromazine (aminazine), promazine, thioproperazine (mazheptil), trifluperazine (stelazine, triftazine), pericyazine (neuleptyl), alimemazine (teralen)

Xanthenes and thioxanthenes

Chlorprothixene, clopentixol (clopexol), flupenthixol (fluanksol)

Butyrophenones

Haloperidol, trifluperidol (trisedil, triperidol), droperidol

Piperidine derivatives

Flushpirilene (imap), pimozide (orap), penfluridol (semap)

Cyclic derivatives

Risperidone (rispolept), ritanserin, clozapine (leponex, azaleptin)

Indole and naphthol derivatives

Molindol (moban)

Benzamide derivatives

Sulpiride (eglonil), metoclopramide, racloprid, amisulpiride, sultopride, tiapride (tiapridal)

Derivatives of other substances

Olanzapine (Zyprexa)

Tranquilizers

Benzodiazepines

Diazepam (Valium, Seduxen, Relanium), Chlordiazepoxide (Librium, Elenium), Nitrazampam (Radedorm, Eunoctin)

Triazolobenzodiazepines

Alprazolam (Xanax), Triazolam (Chalcion), Madizopam (Dormicum)

Heterocyclic

Brotizopam (lendormin)

Diphenylmethane derivatives

Benaktizin (staurodorm), hydroxyzine (atarax)

Heterocyclic derivatives

Busperone (buspar), zopiclone (imovan), clomethizole, hemeneurin, zolpidem (ivadal)

Antidepressants

Tricyclic

Amitriptyline (triptisol, elivel), imipramine (melipramine), clomipramine (anafranil), tianeptine (coaxil)

Tetracyclic

Mianserin (lerivon), maprotiline (ludiomil), pirlindol (pyrazidol),

Serotonergic

Citalopram (Seroprax), Sertraline (Zoloft), Paroxetine (Paxil), Viloxazine (Vivalan), Fluoxetine (Prozac), Fluvoxamine (Fevarin),

Noradrenergic and specific serotonergic antidepressants (NaSSA)

Mirtazapine (Remeron), Milnacipran (Ixel)

MAO inhibitors (reversible)

Moclobemide (Aurorix)

Nootropics (as well as substances with a nootropic component of action)

Derivatives of pyrrolidone

Piracetam (nootropil)

Cyclic derivatives, GABA

Pantogam, Phenibut, Gammalon (Aminalon)

Precursors of acetylcholine

Deanol (akti-5)

Pyridoxine derivatives

Pyritinol

Devinkan derivatives

Vincamine, Vinpocetine (Cavinton)

Neuropeptides

Vasopressin, oxytocin, thyroliberin, cholecystokinin

Antioxidants

Ionol, mexidol, tocopherol

Stimulants

Phenylethylamine derivatives

Amphetamine, salbutamol, methamphetamine (pervitin)

Sydnone imine derivatives

Sydnocarb

Heterocyclic

Methylfnidate (Ritalin)

Purine derivatives

Caffeine

Normotimics

Metal salts

Lithium salts (lithium carbonate, lithium oxybutyrate, lithonite, micalite), rubidium chloride, cesium chloride

Combined group

Carbamazepine (finlepsin, tegretol), valpromide (depamid), sodium valproate (depakin, konvulex)

Additional group

Combined group

Amino acids (glycine), opium receptor antagonists (naloxone, naltrexone), neuropeptides (bromocriptine, thyroliberin)

Below are the main clinical characteristics and side effects of the listed classes of pharmacological drugs.

Neuroleptics

Clinical characteristics. Drugs in this class are central to the treatment of psychosis. However, this does not exhaust the scope of their application, since in small doses in combination with other psychotropic drugs, they can be used in the treatment of disorders of the affective circle, anxiety-phobic, obsessive-compulsive and somatoform disorders, with decompensation of personality disorders.

Regardless of the characteristics of the chemical structure and mechanism of action, all drugs in this group have similar clinical properties: they have a pronounced antipsychotic effect , reduce psychomotor activity and reduce mental agitation, neurotropic action manifested in the development of extrapyramidal and vegetative vascular disorders, many of they also have antiemetic properties .

Side effects. The main side effects of neuroleptic treatment are neuroleptic syndrome. The leading clinical manifestations of this syndrome are considered extrapyramidal disorders with a predominance of either hypo- or hyperkinetic disorders. Hypokinetic disorders include drug parkinsonism, manifested by increased muscle tone, trismus, rigidity, stiffness and slowness of movement and speech. Hyperkinetic disorders include tremors and hyperkinesis.Usually in the clinical picture, in certain combinations, there are both hypo- and hyperkinetic disorders. The phenomena of dyskinesia can be paroxysmal in nature, localized in the mouth and manifested by spasmodic contractions of the muscles of the pharynx, tongue, lips, jaws. The phenomena of akathisia are often observed – a feeling of restlessness, “restlessness in the legs”, combined with tasikinesia (the need to move, change position). A special group of dyskinesias includes tardive dyskinesia, which occurs after 2-3 years of taking neuroleptics and is expressed in involuntary movements of the lips, tongue, and face.

Among the disorders of the autonomic nervous system, orthostatic hypotension, sweating, weight gain, changes in appetite, constipation, and diarrhea are most often observed. Sometimes anticholinergic effects are noted – visual disturbances, dysuric phenomena. Possible functional disorders of the cardiovascular system with changes in the ECG in the form of an increase in the Q-T interval, a decrease in the T wave or its inversion, tachy- or bradycardia. Sometimes there are side effects in the form of photosensitization, dermatitis, skin pigmentation; allergic skin reactions are possible.

New generation antipsychotics in comparison with traditional derivatives of phenothiazines and butyrophenones cause significantly fewer side effects and complications.

Tranquilizers

Clinical characteristics. This group includes psychopharmacological agents that relieve anxiety, emotional tension, fear of non-psychotic origin, facilitating the process of adaptation to stress factors.Many of them have anticonvulsant and muscle relaxant properties. Their use in therapeutic doses does not cause significant changes in cognitive activity and perception. Many of the drugs in this group have a pronounced hypnotic effect and are used primarily as hypnotics. Unlike antipsychotics, tranquilizers do not have a pronounced antipsychotic activity and are used as an additional agent in the treatment of psychoses – to stop psychomotor agitation and to correct the side effects of antipsychotics.

Side effects of during treatment with tranquilizers are most often manifested by daytime sleepiness, lethargy, muscle weakness, impaired concentration, short-term memory, and a slowdown in the speed of mental reactions. In some cases, paradoxical reactions develop in the form of anxiety, insomnia, psychomotor agitation, hallucinations. Among the dysfunctions of the autonomic nervous system and other organs and systems, hypotension, constipation, nausea, retention or incontinence of urine, decreased libido are noted.Long-term use of tranquilizers is dangerous due to the possibility of developing addiction to them, i.e. physical and mental dependence.

Antidepressants

Clinical characteristics. This class of drugs includes drugs that increase pathological hypothymic affect, as well as reduce somatovegetative disorders caused by depression. There is a growing body of scientific evidence that antidepressants are effective for anxiety-phobic and obsessive-compulsive disorders.It is assumed that, in these cases, it is not the antidepressant effect itself, but the antiobsessive and antiphobic effects that are realized. There is evidence supporting the ability of many antidepressants to increase the threshold of pain sensitivity, to provide a preventive effect in migraines and vegetative crises.

Side effects. Side effects related to the central nervous system and the autonomic nervous system are expressed by dizziness, tremors, dysarthria, impaired consciousness in the form of delirium, epileptiform seizures.Possible exacerbation of anxiety disorders, activation of suicidal tendencies, inversion of affect, drowsiness or, on the contrary, insomnia. Side effects can be manifested by hypotension, sinus tachycardia, arrhythmia, atrioventricular conduction disorder.

When taking tricyclic antidepressants, various anticholinergic phenomena are often observed, as well as increased appetite. With the simultaneous use of MAO inhibitors with food products containing tyramine or its precursor tyrosine (cheeses, etc.) there is a “cheese effect”, manifested by hypertension, hyperthermia, convulsions and sometimes fatal.

When prescribing serotonin reuptake inhibitors (SSRI) and reversible MAO-A inhibitors, disorders of the gastrointestinal tract, headaches, insomnia, anxiety can be observed, against the background of SSRI, impotence may develop. In the case of a combination of SSRIs with drugs of the tricyclic group, the formation of the so-called serotonin syndrome is possible, manifested by an increase in body temperature and signs of intoxication.

Normative

Clinical characteristics. Normotimics include drugs that regulate affective manifestations and have a prophylactic effect in phase affective psychoses. Some of these drugs are anticonvulsants.

Side effects with lithium salts are most often represented by tremors. Often there are dysfunctions of the gastrointestinal tract – nausea, vomiting, loss of appetite, diarrhea.Weight gain, polydipsia, polyuria, hypothyroidism are often observed. The appearance of acne, maculopapular rash, alopecia, and worsening of the course of psoriasis are possible.

Signs of severe toxic conditions and drug overdose are metallic taste in the mouth, thirst, severe tremor, dysarthria, ataxia; in these cases, the drug should be stopped immediately.

It should also be noted that side effects may be associated with non-compliance with the diet – a large intake of liquid, salt, smoked meats, cheeses.

Side effects anticonvulsants are most often associated with functional disorders of the central nervous system and are manifested in the form of lethargy, drowsiness, ataxia. Hyperreflexia, myoclonus, tremor can be observed much less frequently. The severity of these phenomena decreases significantly with a gradual increase in doses.

With a pronounced cardiotoxic effect, an atrioventricular block may develop.

Nootropics

Clinical characteristics. Nootropics include drugs that can positively affect cognitive functions, stimulate learning, enhance memory processes, increase the brain’s resistance to various adverse factors (in particular, to hypoxia) and extreme stress. However, they do not have a direct stimulating effect on mental activity, although in some cases they can cause anxiety and sleep disturbance.

Side effects are rare.Sometimes nervousness, irritability, elements of psychomotor agitation and disinhibition of drives, as well as anxiety and insomnia appear. Dizziness, headache, nausea, and abdominal pain are possible.

Psychostimulants

Clinical characteristics.