Sertraline Oral: Dosing and Tapering Guidance

Therapeutic action

Antidepressant, selective serotonin re-uptake inhibitor (SSRI).

Indications

• Major depression, if fluoxetine or paroxetine are poorly tolerated or contra-indicated.
• Severe post-traumatic stress disorder.

Forms and strengths

• 50 mg tablet.
• 100 mg tablet.

Dose

Duration

• Major depression: at least 9 months. Discontinue treatment gradually; if signs of relapse or withdrawal occur, increase the dose and decrease it more gradually.
• Severe post-traumatic stress disorder: 2 to 3 months after symptoms resolve. Discontinue treatment gradually over at least 2 weeks.

Contra-indications, adverse effects, precautions

• Do not administer to patients with severe hepatic impairment. Reduce the dose by half in patients with mild to moderate hepatic impairment.
• Administer with caution and monitor use in patients with epilepsy, diabetes, history of gastrointestinal bleeding, bipolar disorders, suicidal ideation in young adults, or closed-angle glaucoma.
• May cause gastrointestinal disturbances, drowsiness, fatigue, headache, dizziness, seizures, sexual dysfunction, blurred vision, and hyponatraemia especially in older patients.
• May also cause anxiety, insomnia, agitation, aggressive behaviour, and suicidal ideation in young adults.
• Withdrawal symptoms are very frequent if discontinued abruptly, including dizziness, paraesthesia, nightmares, anxiety, tremors, and headaches.
• Avoid combination with aspirin, NSAIDs, warfarin, and serotonergic drugs such as other SSRIs, tricyclic antidepressants, ondansetron, and tramadol.
• Monitor combination with risperidone and drugs that lower the seizure threshold.
• Avoid alcohol during treatment.
• Pregnancy and breast-feeding: no contra-indication; re-evaluate whether treatment is still necessary. If continued, maintain sertraline at effective dose and observe the neonate if exposure occurred in the third trimester.