SertralineSertraline Hydrochloride

About Sertraline

It is presumed to work by blocking serotonin reuptake in the brain. Zoloft is labeled for major depressive disorder, OCD, panic disorder, posttraumatic stress disorder (PTSD), social anxiety disorder and premenstrual dysphoric disorder (PMDD) in adults, and for OCD from age 6. Adults with depression or OCD start at 50 mg once a day, and those with panic disorder, PTSD or social anxiety disorder at 25 mg; the dose can rise in steps of 25 to 50 mg no more than once a week, to at most 200 mg a day. For OCD, children 6 to 12 start at 25 mg and teenagers at 50 mg. PMDD starts at 50 mg, taken every day (up to 150 mg) or only from 14 days before an expected period until it starts (up to 100 mg). Mild liver impairment halves the dose, and use with moderate or severe impairment is not recommended.

The boxed warning says antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies, so everyone taking it is watched for worsening mood, especially early on and after dose changes. It must not be taken with an MAO inhibitor or within 14 days of stopping one, including linezolid or intravenous methylene blue, or with pimozide, and the concentrate is not taken with disulfiram. Other warnings cover serotonin syndrome, bleeding, mania, discontinuation symptoms, seizures, angle-closure glaucoma, low sodium, false-positive urine screens for benzodiazepines, QT prolongation and sexual dysfunction. Nausea, diarrhea, tremor, indigestion, decreased appetite, sweating, ejaculation failure and decreased libido are the most common side effects.

The Zoloft oral concentrate contains alcohol, so its label does not recommend it in pregnancy, and its dropper, marked for 25 and 50 mg only, contains dry natural rubber, a consideration for anyone with a latex sensitivity. The 150 and 200 mg capsules, approved in 2021 and labeled for depression in adults and OCD from age 6, are not used to start treatment, to adjust the dose or for lower doses, and their label warns that they contain tartrazine (FD&C Yellow No. 5), a dye that can cause allergic-type reactions. The dose is lowered gradually when stopping, and false-positive benzodiazepine screens can continue for several days after the last dose. Use in the month before delivery may raise the risk of postpartum hemorrhage, and late-pregnancy exposure may cause complications in the newborn, including persistent pulmonary hypertension and withdrawal symptoms. Low levels pass into breast milk, and published data found no adverse reactions in breastfed infants.

Taking Sertraline

How to take it

Once a day, in the morning or evening; Zoloft tablets can be taken with or without food. Swallow capsules whole without opening, crushing or chewing them. Dilute each concentrate dose just before taking it in 4 ounces (half a cup) of water, ginger ale, lemon-lime soda, lemonade or orange juice only, and drink it straight away; a slight haze is normal.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

At room temperature in the original, tightly closed container, away from excess heat and moisture (not in a bathroom), and out of reach of children.

Interactions to know about

MAO inhibitors, including linezolid and methylene blue, and pimozide are ruled out, as is disulfiram with the concentrate. Triptans, tricyclic antidepressants, fentanyl, tramadol, meperidine, methadone, lithium, buspirone, amphetamines, tryptophan and St. John’s wort raise the risk of serotonin syndrome; aspirin, NSAIDs, clopidogrel and warfarin add to bleeding risk. It can raise levels of phenytoin and of drugs broken down by CYP2D6, such as flecainide, propafenone and metoprolol, and other drugs that prolong the QT interval are avoided. The Medication Guide says not to drink alcohol while taking it.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Sertraline differs from pharmacy to pharmacy

Each pharmacy sets its own cash price for generic sertraline from what it paid its supplier plus its own dispensing fee and markup, so quotes for the same tablets can differ. A prescription that names Zoloft and does not allow substitution has to be filled with the brand.

Tablets, concentrate and capsules are different dosage forms, and the pharmacy fills the form written; a 150 or 200 mg daily dose can be written as capsules or as tablets, each quoted separately.

Ways to pay less for Sertraline without insurance

• Ask for generic sertraline, and make sure the prescription does not block substitution.
• Ask whether sertraline tablets are on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• If you take 150 or 200 mg a day, ask for quotes on both capsules and tablets, and ask your prescriber which to write.
• Once your dose is settled, ask for a ninety-day supply, and refill before you run out, since it should not be stopped suddenly.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Sertraline

1. 1.Does the concentrate’s dropper matter for my latex allergy?
2. 2.Do any of my migraine medicines, pain relievers or blood thinners interact with it?
3. 3.Could it affect a urine drug screen I have coming up?
4. 4.How should my dose be lowered if I need to stop?

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