Zosert

Indications

Sertraline is used to treat depression and several anxiety-related conditions, including obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD) and social anxiety disorder. It is also used for premenstrual dysphoric disorder (severe mood symptoms before periods). In children and teenagers it is mainly used for OCD, under specialist care.

How It Works

Sertraline is a selective serotonin reuptake inhibitor (SSRI). It increases the level of serotonin, a natural brain chemical that helps regulate mood, anxiety and sleep, by slowing its removal between nerve cells. Benefit usually builds up over 2 to 4 weeks, and full effect can take longer.

Dosage and Administration

Take once a day, in the morning or evening, with or without food, at about the same time each day.

• Depression and OCD in adults: usually 50 mg once a day to start.
• Panic disorder, PTSD and social anxiety in adults: usually 25 mg once a day for the first week, then 50 mg once a day.
• The doctor may increase the dose in 50 mg steps at intervals of at least a week, up to a maximum of 200 mg a day.
• Children, older people and people with liver problems: as prescribed.

Keep taking it even when you feel better; treatment usually continues for at least 6 months after recovery. Do not stop suddenly; the doctor will lower the dose slowly.

Interactions

Do not take it with MAO inhibitors (for example Selegiline) or within 14 days of stopping one, or with Pimozide. Taking it with other medicines that raise serotonin, such as other antidepressants, Tramadol, Fentanyl, Linezolid, Lithium, triptans for migraine or St John's wort, can cause serotonin syndrome. The risk of bleeding rises with Aspirin, painkillers such as Ibuprofen and Diclofenac, and blood thinners such as Warfarin. Avoid alcohol. Tell the doctor about all medicines, including herbal products.

Contraindications

• Allergy to sertraline or any ingredient of the product.
• Taking an MAO inhibitor now or within the last 14 days.
• Taking Pimozide.

Side Effects

Common, often settling in the first few weeks: nausea, diarrhoea, indigestion, dry mouth, headache, dizziness, sleepiness or trouble sleeping, sweating, tremor, and sexual problems such as low desire or delayed orgasm.

Get urgent medical help for: thoughts of harming yourself or suicide, or unusual changes in mood or behaviour (especially in people under 25 and when starting or changing the dose); signs of serotonin syndrome (agitation, confusion, fever, sweating, shaking, stiff or jerking muscles, fast heartbeat); fits; unusual bleeding or bruising, or black stools; very high mood with racing thoughts; confusion, weakness or unsteadiness from low sodium; eye pain with blurred vision; or signs of a severe allergic reaction.

Pregnancy and Lactation

If you are pregnant or planning a pregnancy, talk to your doctor; do not stop taking it suddenly. The doctor will weigh the benefits of treatment against possible risks, such as breathing or feeding problems in the newborn when used late in pregnancy. Only small amounts pass into breast milk, and it is often considered a suitable choice while breastfeeding; watch the baby for unusual sleepiness or poor feeding and tell the doctor.

Precautions and Warnings

Tell the doctor if you have epilepsy, bipolar disorder, liver disease, bleeding problems, heart rhythm problems, diabetes, glaucoma, or a history of low blood sodium. Older people are more prone to low sodium. It may cause drowsiness or dizziness; do not drive until you know how it affects you. Stopping suddenly can cause dizziness, tingling, anxiety, irritability and sleep problems. Family members should watch for worsening mood or suicidal thoughts, especially early in treatment.

Overdose

Overdose can cause drowsiness, vomiting, a fast heartbeat, shaking, agitation, fits and serotonin syndrome. It is more dangerous when taken with alcohol or other medicines. Seek emergency medical help straight away, even if there are no symptoms yet.

Therapeutic Class

Antidepressant; selective serotonin reuptake inhibitor (SSRI).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.