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Sertraline hydrochloride (Zoloft®, Lustral®, Apo-Sertral®, Asentra®, Gladem®, Serlift®, Stimuloton®, Xydep®, Serlain®) is an orally administered antidepressant of the selective serotonin reuptake inhibitor (SSRI) type.
Uses
Sertraline is used medically mainly to treat the symptoms of depression and anxiety. It has also been prescribed for the treatment of obsessive-compulsive disorder, post-traumatic stress disorder, premenstrual dysphoric disorder, panic disorder, and bipolar disorder. It was first approved by the FDA in 1991.
Side effects
Sertraline can have a number of adverse effects, including insomnia, asthenia, gastrointestinal complaints, tremors, confusion, dizziness, anorgasmia, and decreased libido; it can induce mania or hypomania in around 0.5% of patients. It has also been known to cause minor weight loss. One property of sertraline is that it appears to be also a minor inhibitor of dopamine reuptake. It is contraindicated in individuals taking MAOIs or undergoing electroconvulsive therapy.
Forms and dosages
Sertraline is manufactured by Pfizer and sold as Zoloft in the United States as small green 25 mg tablets, blue 50 mg tablets, and orange 100 mg tablets, each of which is scored to allow easy halving. In Australia, only the 50 mg and 100 mg strengths are available, both as white tablets. Sertraline is an odorless, white, sparingly soluble crystalline solid. The minimum effective dose is 50 mg per day, but lower doses may be used in the initial weeks of treatment to acclimate the patient's body, especially the liver, to the drug and to minimize the severity of any side effects. Patients who do not experience relief of symptoms at 50 mg a day may have their dose increased, up to 200 mg a day.
Precautions
Because of its metabolism, liver impairment can affect the elimination of this drug from the body. If someone with liver impairment is treated with sertraline, lower or less frequent dosage should be used. Similarly, patients should limit their alcohol intake while on sertraline (or any antidepressant). Because the liver is doubly taxed with processing both substances (in addition to any other drugs the patient may be taking), alcohol remains in the bloodstream longer, so the effects of alcohol may be more strongly and quickly felt by people taking sertraline or other antidepressants. Also, given the fact that alcohol is a depressant, its abuse in depressed people is generally frowned upon. The recommended limit for alcoholic beverages for people on sertraline is two per day.
Controversy
In June 2003, Britain banned the use of sertraline for children under 18 after studies showed a link to increasing suicidal rates. Similar concern has prevailed in the United States, where only the anti-depressant fluoxetine (an SSRI-like sertraline) is officially endorsed by the FDA for the treatment of depression in minors. However, because the antidepressant-suicide link is correlational, scientists do not know whether the increased suicide risk for people taking antidepressants occurs because the drugs make people suicidal, whether suicide occurs because the drugs un-depress the people enough to motivate the energy required to commit suicide (a popular theory), or because of a third, unknown factor.
The patent for this brand-name drug will expire in December 2005.
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