Zoloft (Sertraline)

What is Zoloft used for?

Zoloft is used in the treatment of:

• depression
• Depressive psychosis
• panic attacks
• obsessive-compulsive disorder
• post-traumatic stress disorder
• social anxiety disorder (social phobia)
• premenstrual syndrome (premenstrual dysphoric disorder)
• Arteriosclerotic Dementia w/ Depressive Features
• Dementia w/ Depressive Features

Taking Zoloft may result in better:

• mood
• sleep
• appetite
• energy levels

It may also reduce:

• fear
• anxiety
• upsetting thoughts
• panic attacks

Zoloft can also help to cut down on compulsions like washing your hands, counting and checking.

Zoloft and premenstrual syndrome (premenstrual dysphoric disorder)

Zoloft may also be prescribed for premenstrual syndrome (premenstrual dysphoric disorder). It can help to reduce symptoms, such as:

• mood swings
• bloating
• irritability
• breast tenderness

How does Zoloft work?

Zoloft works by aiding in the restoration of the balance of serotonin, a neurotransmitter, in the brain. An imbalance of serotonin can affect patients with depression, panic, anxiety, or obsessive-compulsive symptoms. Higher levels of serotonin can aid in:

• improving mood
• reducing panic attacks
• treating obsessive-compulsive disorder (OCD)

The full effects of Zoloft may not be felt until four weeks of continuous treatment or longer.

Appearance

• The 25 mg tablet comes coated with a light green film and has “ZOLOFT” engraved on one side. The other side is scored and engraved with “25 mg”.
• The 50 mg tablet comes coated with a light blue film and has “ZOLOFT” engraved on one side. The other side is scored and engraved with “50 mg”.
• The 100 mg tablet comes coated with a light yellow film and has “ZOLOFT” engraved on one side. The other side is scored and engraved with “100 mg”.

The oral solution is clear and colorless with a menthol scent. It contains sertraline hydrochloride, the equivalent of 20 mg of sertraline per mL and 12% alcohol. It comes in a 60 mL bottle.

Dosage information

Your dosage depends upon your medical condition and may be adjusted based on your response to it. Your doctor may start your treatment with a low dose and gradually increase it, to avoid risking side effects. Always follow your doctor’s recommendations and follow their instructions with care. To benefit the most from it, take Zoloft at the same time of day each day.

You must continue to take the medication, even if your symptoms improve. Do not stop taking Zoloft before asking for your doctor’s advice. Stopping treatment suddenly may result in conditions becoming worse. Symptoms may include:

• mood swings
• headache
• tiredness
• sleep changes
• brief sensations like an electric shock

You should keep your doctor informed of any changes to your condition. If you are suffering side effects from stopping treatment, you should let them know if they continue or worsen.

The typical adult dose for depression:

• Initially, a 50 mg dose is to be taken orally once each day.
• A maintenance dose of 50 to 200 mg is to be taken orally once each day.

The typical dose for an adult with obsessive-compulsive disorder:

• Initially, a 50 mg dose is to be taken orally once each day.
• A maintenance dose of 50 to 200 mg is to be taken orally once each day.

The typical dose for an adult with panic disorder:

• Initially, a 25 mg dose is to be taken orally once each day and increased to 50 mg after one week, also to be taken orally once each day.
• A maintenance dose of 50 to 200 mg is to be taken orally once each day.

The typical dose for an adult with post-traumatic stress disorder:

• Initially, a 25 mg dose is to be taken orally once each day and increased to 50 mg after one week, also to be taken orally once each day.
• A maintenance dose of 50 to 200 mg is to be taken orally once each day.

The typical dose for an adult with social anxiety disorder:

• Initially, a 25 mg dose is to be taken orally once each day and increased to 50 mg after one week, also to be taken orally once each day.
• A maintenance dose of 50 to 200 mg is to be taken orally once each day.

Please note:
Adjustments may be once each week.

These recommendations are based on an anticipation of sustained pharmacological therapy lasting several months or longer after initial treatment.

The typical dose for an adult with premenstrual dysphoric disorder:

Continuous regimen:

• Initially, a 50 mg dose is to be taken orally once each day during the menstrual cycle.

Cyclic regimen:

• Initially, a 50 mg dose is to be taken orally once each day beginning 14 days before the expected beginning of menstruation to the first full day of menses. Treatment should be repeated with each cycle.
• A maintenance dose of 50 to 100 mg is to be taken orally once each day.

Please note:
The dose can be adjusted, increasing by 50 mg per menstrual cycle with each new cycle. Changes can also occur between regimens.

The typical pediatric dose for obsessive-compulsive disorder:

For a child aged between 6 and 12 years:

• Initially, a 25 mg dose is to be taken orally once each day.
• A maintenance dose of 25 to 200 mg is to be taken orally once each day.

For an adolescent aged between 13 and 17 years:

• Initially, a 50 mg dose is to be taken orally once each day.
• A maintenance dose of 50 to 200 mg is to be taken orally once each day.

Please note:
The dose may be adjusted each week.

Also, for children and adolescents, the potential harm of the medication should be weighed against the potential benefits.

Preparing Zoloft Oral Solution

The Zoloft oral solution should be diluted before it is used.

• Patients should use the included dropper to measure out the correct amount of Zoloft solution required.
• The dropper measures out the solution only with 25 mg and 50 mg marks. Do not use a household spoon. Using a household spoon may result in an incorrect dose.
• Patients should mix the solution with 4 ounces (½ cup) of water. After mixing the solution, a faint haze may become visible. There is no need for concern, this is normal.
• The solution can be mixed with other specific drinks. Other than water, it should only be mixed with ginger ale, lemon/lime soda, lemonade or orange juice.

The patients should take the entire dose immediately after it is mixed. It should not be mixed for later use.

Usage

Patients should take care in reading all guides and leaflets supplied with the medication or by the pharmacist before beginning to use Zoloft. Patients should consult their doctor or pharmacist if they have any questions.

The medication should be taken orally and only as instructed by the doctor. Zoloft is usually taken once each day, either in the morning or at night. In tablet or liquid form, Zoloft can be taken with or without food. The 25mg, 50 mg, and 100 mg capsules are usually taken with food. 150 mg and 200 mg capsules can be taken with or without food. The capsules should be swallowed whole and should not be crushed or chewed.

Side Effects

You should seek urgent medical assistance if you notice any allergic reactions after taking Zoloft. These include:

• skin rash
• hives (with or without fever or joint pain)
• difficulty breathing
• swelling of your face, lips, tongue, or throat

Also, make your doctor aware of any symptoms that are new or getting worse, such as:

• mood or behavior changes
• anxiety
• panic attacks
• trouble sleeping
• feeling impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed
• having thoughts about suicide or hurting yourself

Immediately contact your doctor if you have:

• a seizure;
• vision changes, eye pain, redness, or swelling;
• low blood sodium symptoms:
  • headache
  • confusion
  • problems with thinking or memory
  • weakness, feeling unsteady
• manic episodes – racing thoughts, increased energy, unusual risk-taking behavior, extreme happiness, being irritable or talkative.
• symptoms of serotonin syndrome
  • agitation
  • hallucinations
  • fever
  • sweating
  • shivering
  • fast heart rate
  • muscle stiffness
  • twitching
  • loss of coordination
  • nausea
  • vomiting
  • diarrhea

Since sertraline can affect the growth of children, any child taking it should have their height and weight checked often.

These are the common Zoloft side effects you should look out for:

• indigestion, nausea, diarrhea, loss of appetite;
• sweating;
• tremors; or
• sexual problems.

These common side effects necessitate immediate medical attention

• Decreased interest in sexual intercourse
• failure to ejaculate (in men)
• inability to achieve or maintain an erection
• loss in sexual ability, desire, drive, or performance

These side effects are less common or rare

• Aggressive reaction
• breast tenderness or enlargement
• confusion
• convulsions
• diarrhea
• drowsiness
• dryness of the mouth
• fast-talking and excited feelings or actions that are out of control
• fever
• inability to sit still
• increase in body movements
• increased sweating
• increased thirst
• lack of energy
• loss of bladder control
• mood or behavior changes
• muscle spasm or jerking of all extremities
• nosebleeds
• overactive reflexes
• racing heartbeat
• red or purple spots on the skin
• restlessness
• shivering
• skin rash, hives, or itching
• sudden loss of consciousness
• unusual or sudden body or facial movements or postures
• unusual secretion of milk (in females)

These side effects do not require immediate medical attention

Some sertraline side effects do not need medical attention and may go away as you adjust to the treatment. You may have additional support from your doctor to help stop or reduce these side effects. Consult your doctor if these side effects continue:

More common

• Acid or sour stomach
• belching
• decreased appetite or weight loss
• diarrhea or loose stools
• heartburn
• sleepiness or unusual drowsiness
• stomach cramps, gas, or pain
• trouble sleeping

Less common

• Agitation, anxiety, or nervousness
• bladder pain
• burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings
• changes in vision
• cloudy urine
• constipation
• difficult, burning, or painful urination
• flushing or redness of the skin, with a feeling of warmth or heat
• frequent urge to urinate
• increased appetite
• pain or tenderness around the eyes and cheekbones
• stuffy or runny nose

Warnings & Precautions

Do not take Zoloft if you are allergic to sertraline or if you use:

• pimozide
• an MAO inhibitor in the past 14 days, including:
  • isocarboxazid
  • linezolid
  • methylene blue injection
  • phenelzine
  • rasagiline
  • selegiline
  • tranylcypromine

Do not take Zoloft oral solution if you use disulfiram (Antabuse).

Taking Zoloft can result in false results on a urine drugs test. Inform the laboratory staff that you are taking Zoloft.

Some young patients have suicidal thoughts when taking antidepressants for the first time. Look out for mood or symptom changes and let your doctor know of any new or worsening symptoms.

Interactions between Zoloft and Other Medications

Refrain from taking Zoloft 14 days prior or 14 after using an MAO inhibitor, such as

• isocarboxazid
• linezolid
• methylene blue injection
• phenelzine
• tranylcypromine
• and others

Let your doctor know if you take:

• stimulant medicine
• opioid medicine
• herbal products
• medicine for
  • depression
  • mental illness
  • Parkinson’s disease
  • migraine headaches
  • serious infections
  • medicine to prevent nausea and vomiting

Interactions with sertraline can cause serotonin syndrome.

Zoloft can cause a significant heart problem and the risk can be higher with certain other medicines for:

• Infections
• Asthma
• Heart problems
• High blood pressure
• Depression
• Mental illness
• Cancer
• Malaria
• HIV

Using a nonsteroidal anti-inflammatory drug (NSAID) with Zoloft may cause easy bruising or bleeding. Consult your doctor prior to taking an NSAID such as:

• Aspirin
• Ibuprofen
• Naproxen
• Advil
• Aleve
• Motrin
• and others

If you are using any of these, consult your doctor. Depending on your situation, they may suggest:

• you stop one of the medications,
• you switch medications,
• change how you take one or both of the medications,
• or change nothing.

Contraindications

Zoloft is contraindicated for patients:

• Taking, or within 14 days of stopping, MAOIs.
• Taking pimozide.
• With known hypersensitivity to sertraline.

Zoloft oral solution is contraindicated for patients taking disulfiram which contains alcohol. Concomitant use of Zoloft and disulfiram can lead to a disulfiram-alcohol reaction.

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