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|Sertraline Hydrochloride |
Drugs search, click the first letter of a drug name: | A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | 1 | 2 | 3 | 4 | 5 | 6 | 8 | 9 Home Sertraline HydrochloridePronouncation: (SIR-truh-leen HIGH-droe-KLOR-ide)Class: Selective serotonin reuptake inhibitor Trade Names: Novo-Sertraline (Canada) ratio-Sertraline (Canada) Mechanism of ActionPharmacologySelectively blocks reuptake of serotonin, enhancing serotonergic function. PharmacokineticsAbsorptionT max is 4.5 to 8.4 hr postdose. Steady state should be achieved after approximately 1 wk of once daily dosing. Tablet bioavailabilityAUC was slightly increased when the drug was given with food and C max was 25% greater while T max decreased from 8 hr postdosing to 5.5 hr. Oral concentrate bioavailabilityT max was prolonged from 5.9 to 7 hr with food. DistributionSertraline is 98% protein bound. MetabolismSertraline undergoes extensive first-pass metabolism. The principal initial metabolic pathway is N-demethylation. The liver is the primary site of metabolism. EliminationSertraline t ½ is 26 to 104 hr. Special PopulationsHepatic Function ImpairmentLiver impairment can affect the elimination of sertraline. Give a lower, less frequent dose. ChildrenPediatric patients metabolize sertraline with slightly greater efficacy than adults. Indications and UsageAdultsTreatment of major depression; treatment of obsessions and compulsions in patients with obsessive-compulsive disorder (OCD), as defined in the DSM-III-R; treatment of panic disorder with or without agoraphobia, as defined in DSM-IV; posttraumatic stress disorder (PTSD); treatment of premenstrual dysphoric disorder, treatment of social anxiety disorder (social phobia). ChildrenTreatment of obsessions and compulsions in patients with obsessive-compulsive disorder. ContraindicationsHypersensitivity to any components; concomitant use in patients taking MAO inhibitors, pimozide, or disulfiram (because of alcohol content in oral concentrate). Dosage and AdministrationMajor Depressive DisordersAdults PO 50 mg once daily (max, 200 mg/day). Dose changes should not occur at intervals of less than 1 wk. OCDAdults and Children 13 to 17 yr of age PO 50 mg once daily (max, 200 mg/day). Dose changes should not occur at intervals of less than 1 wk. Children 6 to 12 yr of agePO 25 mg once daily (max, 200 mg/day). Dose changes should not occur at intervals of less than 1 wk. Panic Disorder, Social Anxiety Disorder, and PTSDAdults PO 25 mg once daily; the dose should be increased to 50 mg once daily after 1 wk (max, 200 mg/day). Dose changes should not occur at intervals of less than 1 wk. Premenstrual Dysphoric DisorderAdults PO 50 mg/day, either daily throughout the menstrual cycle or limited to the luteal phase of the menstrual cycle, depending on physician assessment. Patients not responding to 50 mg/day may benefit from increases (at 50 mg increments/menstrual cycle) up to 150 mg/day when dosing throughout the menstrual cycle, or 100 mg/day when dosing during the luteal phase of the menstrual cycle. If a 100 mg/day dose has been established with luteal dosing, use a 50 mg/day titration step for 3 days at the beginning of each luteal phase dosing period. Switching Patients To or From MAO InhibitorsAt least 14 days should elapse between discontinuation of an MAO inhibitor and initiation of therapy with sertraline. In addition, at least 14 days should be allowed after stopping sertraline before starting an MAO inhibitor. Storage/StabilityStore tablets and oral concentrate at controlled room temperature (59° to 86°F). Drug Interactions5-HT 1 agonists (eg, naratriptan, rizatriptan, sumatriptan, zolmitriptan)Weakness, hyperreflexia, and incoordination reported rarely. Alcohol, CNS depressantsMay enhance CNS depressant effects. Alcohol use is not recommended. CarbamazepineSertraline plasma levels may be reduced, decreasing the pharmacologic effects. CimetidineIncreased sertraline AUC (50%), C max (24%), and t ½ (26%). Clinical significance is unknown. ClozapineElevated serum clozapine levels occurred. Closely monitor patients on coadministration. CyclosporineElevated cyclosporine levels may occur. CyproheptadineCyproheptadine is a serotonin antagonist and may decrease the pharmacologic effects of sertraline. Drugs highly bound to plasma proteins (eg warfarin, digitoxin)May cause a shift in plasma concentrations resulting in adverse effects. Drugs interfering with hemostasis (eg, aspirin, non-selective NSAIDs [eg, ibuprofen], warfarin)Risk of bleeding may be increased. Drugs metabolized by CYP2D6 (eg, carvedilol, risperidone)Plasma concentrations of these drugs may be elevated, increasing the pharmacologic and adverse effects. Hydantoins (eg, phenytoin)Plasma levels may be increased by sertraline, increasing the pharmacologic and adverse effects. Macrolide antibiotics (eg, erythromycin), metoclopramide, tramadol, trazodoneRisk of serotonin syndrome may be increased. MAO inhibitorsMay cause serious, even fatal reactions. Concomitant use is contraindicated. Discontinue MAO inhibitors at least 14 days before starting sertraline. PimozideIncrease in pimozide AUC and C max of about 40%; concomitant administration is contraindicated. SibutramineSerotonin syndrome may occur. St. John"s wortSedative-hypnotic effects of sertraline may be increased. TolbutamideSertraline significantly decreased the Cl of tolbutamide (16%). Clinical significance is unknown. Tricyclic antidepressants (eg, amitriptyline)Pharmacologic and toxic effects may be increased by sertraline; “serotonin syndrome” has been reported. Type 1C antiarrhythmics (eg, flecainide, propafenone)Plasma levels may be increased. Monitor cardiac function. ZolpidemOnset of action of zolpidem may be shortened and the effect increased. Laboratory Test InteractionsNone well documented. Adverse ReactionsCardiovascularHot flushes, hypotension (postural), hypertension, syncope, tachycardia (at least 2%); palpitations, chest pain (at least 1%); increased coagulation times, bradycardia, AV block, atrial arrhythmias, QT-interval prolongation, ventricular tachycardia (including torsades de pointes) (postmarketing). CNSAgitation, anxiety, nervousness, headache, insomnia, dizziness, tremor, fatigue, tingling, diminished sensation, twitching, confusion, somnolence, depression, decreased libido, emotional lability, vertigo, apathy, hypokinesia/hyperkinesia, abnormal dreams (at least 2%); asthenia, hypertonia, hypoesthesia, malaise (at least 1%); extrapyramidal symptoms, neuroleptic malignant syndrome, oculogyric crisis, serotonin syndrome, psychosis (postmarketing). DermatologicSweating, rash, pruritus, acne (at least 2%); Stevens-Johnson syndrome, vasculitis, photosensitivity (postmarketing). EENTAbnormal vision, ringing in the ears, pharyngitis (at least 2%); blindness, optic neuritis, cataract (postmarketing). GINausea, diarrhea, dry mouth, anorexia, vomiting, constipation, abdominal pain, dyspepsia, gastroenteritis, tooth disorder/caries, dysphagia (at least 2%); increased appetite (at least 1%); pancreatitis (postmarketing). GenitourinarySexual dysfunction, urinary frequency, urinary disorder, menstrual disorder, abnormal ejaculation, impotence (at least 2%); acute renal failure (postmarketing). HematologicPurpura (at least 2%); agranulocytosis, aplastic anemia, pancytopenia, leukopenia, thrombocytopenia, lupus-like syndrome, serum sickness (postmarketing). HepaticElevated liver enzymes, increased bilirubin, hepatomegaly, hepatitis, jaundice, liver failure (postmarketing). Lab TestsIncrease in total cholesterol and triglycerides, decrease in serum uric acid (at least 2%). MetabolicIncreased weight (at least 1%); hypothyroidism, hyperglycemia (postmarketing). RespiratorySinusitis, increased cough, dyspnea, rhinitis, epistaxis (at least 2%). MiscellaneousWeight loss or gain, pain, arthralgia, asthenia, fever, chills, edema, yawning (at least 2%); back pain, myalgia (at least 1%); anaphylaxis, angioedema, galactorrhea, hyperprolactinemia, pulmonary hypertension (postmarketing). Precautions
PregnancyCategory C . LactationUndetermined. ChildrenExcept in children with OCD, 6 to 18 yr of age, safety and efficacy not established. Hepatic FunctionUse drug with caution. Lower or less frequent dosing schedule may be required. Abnormal bleedingBleeding episodes have been reported in patients taking psychotropic drugs that interfere with serotonin reuptake. Activation of mania/hypomaniaActivation of mania/hypomania occurs infrequently in patients taking selective serotonin reuptake inhibitors. DiscontinuationSerious adverse reactions (eg, dysphoric mood, irritability, anxiety, emotional lability, insomnia, hypomania) may occur upon sertraline discontinuation, particularly when abrupt. HyponatremiaSeveral cases of sertraline-induced hyponatremia have occurred. MAO inhibitorsCases of serious, sometimes fatal, reactions have been reported when an MAO inhibitor is used in combination with sertraline. SeizuresUse drug with caution in patients with history of seizures. Uricosuric effectMay cause a decrease in serum uric acid. Weight lossWeight loss has been reported. OverdosageSymptomsAlopecia, decreased libido, diarrhea, ejaculation disorder, fatigue, insomnia, somnolence, vomiting, tachycardia, nausea, dizziness, agitation, tremor, serotonin syndrome, bradycardia, bundle branch block, coma, convulsions, delirium, hallucinations, hypertension, hypotension, manic reaction, pancreatitis, QT-interval prolongation, stupor, syncope. Patient Information
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