Antidepressant SSRI
Therapeutic actions
Acts as an antidepressant by inhibiting CNS neuronal uptake of serotonin; blocks uptake of serotonin with little effect on norepinephrine, muscarinic, histaminergic, and alpha1adrenergic or dopaminergic receptors.
Indications
Treatment of major depressive disorder Treatment of obsessive-compulsive disorders (OCD) Treatment of panic disorder with or without agoraphobia Treatment of posttraumatic stress disorder; long-term use to prevent relapse and sustain symptom improvement Treatment of premenstrual dysphoric disorder (PMDD) Treatment of social anxiety disorder (social phobia) Contraindicated with hypersensitivity to sertraline. Use cautiously with impaired hepatic or renal function, lactation, pregnancy.
Available forms
Major depressive disorder and OCD: Administer once a day, morning or evening. 50 mg PO daily; may be increased to up to 200 mg/day; dosage increases should not occur at intervals < 1 wk. Panic disorder and posttraumatic stress disorder: 25 mg PO daily. After 1 wk increase to 50 mg once daily. PMDD: 50 mg/day PO daily or just during luteal phase of menstrual cycle. Social anxiety disorder: 25 mg/day PO; increase to 50 mg/day after 1 wk. Range, 50200 mg/day. OCD: 612 yr: 25 mg PO once daily. May be increased slowly as needed. 1317 yr: 50 mg PO once daily. May be increased slowly as needed.
PEDIATRIC PATIENTS
Metabolism: Hepatic; T1/2: 26 hr Distribution: Crosses placenta; may enter breast milk Excretion: Urine and feces
Adverse effects
CNS: Headache, nervousness, drowsiness, anxiety, tremor, dizziness, insomnia, light-headedness, agitation, sedation, abnormal gait, seizures, vision changes, fatigue CV: Hot flashes, palpitations, chest pain Dermatologic: Sweating, rash, pruritus, acne, contact dermatitis GI: Nausea, vomiting, diarrhea, dry mouth, anorexia, dyspepsia, constipation, taste changes, flatulence, gastroenteritis, dysphagia, gingivitis GU: Painful menstruation, sexual dysfunction, frequency, cystitis, impotence, urgency, vaginitis Respiratory: Upper respiratory infections, pharyngitis, cough, dyspnea, bronchitis, rhinitis Other: Hot flashes, fever, back pain, thirst
Interactions
Drug-drug Serious, sometimes fatal, reactions with MAOIs; allow at least 14 days to elapse between MAOI and sertraline use Increased serum levels of sertraline with cimetidine Possible risk of increased QTc interval if combined with pimozide; do not use together Drug-food Increased rate of absorption with food Drug-alternative therapy Increased risk of severe reaction if combined with St. John's wort therapy
Nursing considerations Assessment
History: Hypersensitivity to sertraline; impaired hepatic or renal function; lactation, pregnancy Physical: Weight; T; skin rash, lesions; reflexes, affect; bowel sounds, liver evaluation; P, peripheral perfusion; urinary output, renal and liver function tests Use lower dose in elderly patients and with hepatic or renal impairment.
Interventions
Dilute oral concentrate in 4 oz water, ginger ale, lemon-lime soda, lemonade, or orange juice only; administer immediately after diluting. Establish suicide precautions for severely depressed patients. Limit number of tablets given at any time. Give drug once a day, morning or evening. Increase dosage at intervals of not less than 1 wk. Counsel patient to use nonhormonal contraceptives; pregnancy should be avoided due to risk to fetus. Take this drug once a day, at the same time, morning or evening; do not exceed the prescribed dose. It may take 46 wk to see any improvement. Dilute concentrate immediately before use in 4 oz water, ginger ale, lemonlime soda, lemonade, or orange juice only. Consult with your physician if you think that you are pregnant or wish to become pregnant. These side effects may occur: Dizziness, drowsiness, nervousness, insomnia (avoid driving or performing hazardous tasks); nausea, vomiting (eat frequent small meals); dry mouth (suck sugarless lozenges, perform frequent mouth care); excessive sweating (monitor temperature; avoid overheating). Report rash, mania, seizures, edema, difficulty breathing.
Teaching points
Adverse effects in Italic are most common; those in Bold are life-threatening.