Sertraline: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
Sertraline: clinical details
Prescribing considerations
- Assess suicide risk and monitor clinical worsening, particularly early in treatment and after treatment changes.
- Review for bipolar disorder, seizure history, bleeding risk, glaucoma, cardiac risk factors and interacting medicines.
- Use caution in hepatic impairment; selected product information advises against use in severe hepatic impairment because clinical data are unavailable.
- Avoid abrupt discontinuation.
- Paediatric licensing is limited to OCD in patients aged 6 to 17 years; monitor growth and development during longer-term treatment.
Contraindications and cautions
- Hypersensitivity to sertraline or a product excipient.
- Concomitant irreversible MAOI treatment and unsafe switching intervals around MAOIs.
- Concomitant pimozide.
- Disulfiram with alcohol-containing oral concentrates.
Monitoring
- Mental state, suicidal thinking, behavioural change, mania and akathisia.
- Serum sodium when symptoms arise or risk is increased.
- Bleeding and anticoagulation where appropriate.
- Seizure control in stable epilepsy.
- ECG and electrolytes when cardiac or arrhythmia risks indicate.
- Growth and development in children and adolescents treated for OCD.
- Liver function when clinically indicated.
Clinical pharmacology
Sertraline selectively inhibits neuronal serotonin reuptake, with weak effects on noradrenaline and dopamine reuptake. It is highly protein-bound, undergoes extensive first-pass hepatic metabolism and has a mean elimination half-life of about 26 hours.
Formulation and product differences
- Tablets are ready to swallow; appearance and whether a score line permits division are product-specific.
- The 100 mg/5 ml and 20 mg/ml products are alcohol-containing concentrates that must be diluted only with specified drinks and taken immediately.
- The 50 mg/5 ml oral suspension is ready to measure after vigorous shaking and contains propylene glycol, parabens and sodium.
- Suspension and concentrates are not directly interchangeable by volume; verify the product and concentration.
Sertraline preparations and strengths
Oral solution
Route: Oral
Strengths: 20 mg/mL, 100 mg/5 mL
Oral suspension
Route: Oral
Strengths: 50 mg/5 mL
Tablet
Route: Oral
Strengths: 25 mg, 50 mg, 100 mg, 150 mg, 200 mg
Sertraline interactions
Tell the prescriber or pharmacist about all medicines, supplements and recreational substances. Important examples include:
Monoamine oxidase inhibitors, including selegiline, moclobemide, linezolid and methylene blue
Some combinations are contraindicated because they can cause life-threatening serotonin syndrome.
Pimozide
Concomitant use is contraindicated because sertraline can increase pimozide exposure and cardiac risk.
Other serotonergic medicines
Some antidepressants, triptans, opioids, lithium and amphetamines can increase serotonergic adverse effects.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.