The drug called Zoloft or Sertraline is quite well known in our country.
It is an antidepressant that is a serotonin reuptake inhibitor. The dosage of the drug is selected strictly individually based on examinations, the person’s health status, clinical picture and diagnosis. The drug is often prescribed in combination with antipsychotics to treat depression and other disorders such as obsessive-compulsive disorder.
It is important that this drug can only be combined with antidepressants belonging to different groups.
Composition and form of the product
The active ingredient in the product is sertraline hydrochloride. The component has a powerful antidepressant effect, but does not have a sedative effect, and also does not have anticholinergic or stimulating properties.
Zoloft is produced in tablet form. One biconvex film-coated tablet contains 50 mg or 100 mg of active substance. Distinctive features of the tablets are their oval shape, white color, and the presence of “Pfizer” and “ZLT-50” engravings on different sides.
Other ingradienites are also used to produce the medicine. Their list is indicated in the instructions for use.
Pharmacodynamics and pharmacokinetics
The substance sertraline is a powerful antidepressant, with a powerful specific inhibitor of serotonin reuptake in neurons. At the same time, there is a slight effect on the reuptake of dopamine and norepinephrine . Therapeutic dosages of sertraline block the uptake of serotonin within platelets. This drug does not have a stimulating, sedative or anticholinergic effect, and does not increase adrenergic activity. In addition, sertraline does not contribute to drug dependence, weight gain and other undesirable effects.
The drug has a fairly high, but slow absorption. An increase in bioavailability occurs when taken simultaneously with food. Thus, food may increase the maximum concentration but reduce the therapeutic effect. Almost 98% of the active substance is protein bound. Undergoing biotransformation in the liver, sertraline forms the main metabolite - N-desmethylsertraline , which is less active. Excretion from the body occurs in urine and feces.
What does the drug treat?
Zoloft, the instructions for use confirm this, is indicated for the treatment and prevention of major depressive episodes. Such conditions are characterized by mental disorders with characteristic symptoms: loss of strength, increased fatigue, loss of interest in life, and a general deterioration in well-being.
In addition, the drug helps relieve:
- Obsessive-compulsive disorder, characterized by obsessive thoughts and actions.
- Panic attacks, which may be associated with various phobias.
- Post-traumatic stress disorders, which are caused by mental disorders against the background of a certain traumatic situation, which can be repeated or have an isolated character.
- The body's reactions to social phobias.
Overdose
While taking Zoloft in high doses, the development of severe symptoms was not noted. But if treatment with other drugs is carried out simultaneously, the following may develop: nausea, vomiting, tachycardia, agitation, drowsiness, dizziness, psychomotor agitation, increased sweating, diarrhea, myoclonus and hyperreflexia .
In such cases, symptomatic therapy is required, with careful monitoring of important body functions, especially respiratory.
Zoloft: contraindications
A contraindication to taking the drug is hypersensitivity to sertraline and other components that make up the drug. Their list is indicated in the instructions for use.
Drug treatment is not prescribed for people under 18 years of age. The exception is cases of treatment of obsessive-compulsive disorders. In such cases, it is allowed to use the medicine after 6 years. Treatment with the drug is contraindicated during pregnancy and lactation, since studies that confirm the absence of a negative effect of the drug on the fetus and newborn child have not been conducted.
It is prohibited to use Zoloft, the instructions emphasize this, in combination with MAO inhibitors. This may cause serotonin toxicity. This syndrome leads to malfunctions in many systems of the human body and can be fatal.
Contraindications also include the combination of the drug with the psychotropic drug pimozide.
The drug should be taken with extreme caution when diagnosing epilepsy and organic diseases of the brain. Their development can be caused by both congenital pathologies and various negative external influences, in particular injury or infection.
Zoloft®
Sertraline should not be co-administered with MAOIs, within 14 days before starting an IMAO and for 14 days after their discontinuation.
Blood concentrations of tricyclic antidepressants should be monitored to assess the need for dose adjustment.
When using sertraline and golbutamide simultaneously, it is necessary to monitor blood glucose levels (see section “Interaction with other drugs”).
Serotonin syndrome
Cases of the development of serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) have been described with the use of SSRIs. The risk of these complications increases with simultaneous use of SSRIs with other serotonergic drugs (including trintanes and fentanyl and their analogues, tramadol, dexomstorphan, tapentadol, meperedine, methadone, pentazocine), as well as drugs that affect the metabolism of serotonin (including monoamine oxidase inhibitors ), antipsychotics and other dopamine receptor antagonists. Manifestations of SS may include changes in mental status (in particular, agitation, hallucinations, coma), autonomic lability (tachycardia, blood pressure fluctuations, hyperthermia), changes in neuromuscular transmission (hyperreflexia, impaired motor coordination) and/or gastrointestinal disorders (nausea, vomiting and diarrhea). Some manifestations of SS, including hyperthermia, muscle rigidity, autonomic lability with possible rapid fluctuations in vital signs, as well as changes in mental status, may resemble symptoms that develop in NMS. It is necessary to monitor patients for the development of clinical manifestations of SS and PVD.
Prolongation of the OTc interval or arrhythmia ventricular tachysystolic tina “pirouette” (torsade de pointes)
During post-marketing use of sertraline, cases of prolongation of the QTc interval on the ECG and the development of ventricular tachysystolic arrhythmia of the torsades de pointes type have been reported. Most cases were observed in patients with risk factors for developing such conditions. Therefore, caution should be exercised when using sertraline in patients with risk factors for prolongation of the QTc interval on the ECG or the development of torsade dc pointes.
Switching from other SSRIs, antidepressants or anti-obsessive medications
The required interval between stopping one SSRI and starting another similar drug has not been established. Caution should be exercised when switching to sertraline from other SSRIs, antidepressants or anti-obsessive medications, especially from long-acting medications such as fluoxetine.
When replacing one neuronal serotonin uptake inhibitor with another, there is no need for a washout period. However, caution is required when changing the course of treatment.
Other serotonergic drugs, such as tryptophan, (fenfluramine and 5-HT agonists
The simultaneous use of sertraline with other drugs with a pronounced effect on neurotransmitter transmission (such as tryptophan, fenfluramine, 5-HT agonists or herbal medicines, St. John's wort) should be used with caution and, if possible, avoided, given the potential pharmacodynamic interaction.
Suicidal behavior
Depression is associated with an increased risk of suicidal ideation, self-harm, and suicide. This risk persists until stable remission. Given that improvement in the patient's condition may not occur in the first few weeks of therapy or longer, patients should be closely monitored until such improvement occurs. It is also common for the risk of suicide to increase during the early stages of recovery.
Other medical conditions for which sertraline may be prescribed may also be associated with an increased risk of suicidal events. In addition, these diseases may accompany major depressive disorder. In this regard, the same precautions should be taken as in the treatment of major depressive disorder.
Patients with a history of suicidal tendencies or patients prone to suicidal ideation before starting therapy have a higher risk of suicidal thoughts or suicide attempts. Such patients should also be under close medical supervision during therapy.
All patients, especially those at risk, receiving sertraline therapy should be carefully monitored to detect the development or worsening of symptoms of suicidal behavior. Patients, their relatives and guardians should be warned of the need to monitor the condition for the emergence or worsening of depression, the emergence of suicidal thoughts or behavior, as well as for any changes in behavior, especially at the beginning of therapy and with any change in the dose of the drug. The risk of suicide attempts should also be kept in mind, especially in patients with depression. In this regard, in order to reduce the risk of overdose, it is necessary to take the minimum dose of the drug that provides a sufficient therapeutic effect.
Patients with depression and other mental disorders are at risk of suicidal behavior. These diseases themselves are strong predisposing factors for such behavior. In children, adolescents and young adults (ages 18–24 years) with depression or other mental disorders, antidepressants (SSRIs and others) have been found to increase the risk of suicidal ideation and behavior compared with placebo. Therefore, when using sertraline or any other antidepressants in children, adolescents and young adults (under 24 years of age), the risk of suicide should be weighed against the benefits of their use. In addition, there was no increase in the risk of suicidal behavior in adult patients over 24 years of age, and a decrease in this risk was noted in patients aged 65 years and older.
Use in children and adolescents under 18 years of age
Sertraline should not be used to treat children and adolescents under the age of 18 years, with the exception of patients with OCD aged 6-17 years. Suicidality (suicide attempts or suicidal thoughts) and hostility (primarily aggressiveness, oppositional behavior and anger) were observed more often in patients receiving antidepressant therapy than in patients receiving placebo. If a decision is made to proceed with therapy based on the clinical assessment of the patient, the patient should be carefully monitored for symptoms of suicidal behavior. In addition, it should be borne in mind that data on the effect of the drug on growth, puberty and cognitive and behavioral development of the child are limited. During long-term therapy of pediatric patients, clinicians should monitor for abnormal developmental abnormalities.
Withdrawal syndrome
When stopping a drug, withdrawal symptoms often occur, especially if the drug is stopped abruptly. Withdrawal symptoms were observed in 23% of patients who stopped taking sertraline and in 12% of patients who continued taking the drug. The risk of these symptoms depends on several factors, including the duration of therapy and dosage, and the rate of dose reduction. The most common reactions are dizziness, sensory disturbances (including paresthesia), sleep disturbances (including insomnia and deep sleep), agitation or anxiety, nausea and/or vomiting, tremor and headache. These symptoms are usually mild to moderate in severity; however, in some cases they can be severe. Typically, these symptoms occur during the first few days of discontinuation of therapy, but there are very rare reports of the development of such symptoms in patients who inadvertently missed a dose. Typically these symptoms do not get worse and resolve within two weeks, except in some cases where they may last longer (2-3 months or more). In this regard, it is recommended to discontinue the drug gradually, reducing the dose over several weeks or months, depending on the patient's condition.
Akathisia/nsychomotor agitation
The use of sertraline may be associated with the development of akathisia, characterized by a subjective feeling of discomfort or restlessness and a need to move, accompanied by an inability to sit or stand still. Most often, such symptoms are observed in the first weeks of treatment. Increasing the dose in these patients may be harmful.
Liver dysfunction
If it is necessary to use sertraline in patients with impaired liver function, consider reducing the dose of the drug or the frequency of administration. Sertraline should not be taken in patients with severe hepatic impairment.
Renal dysfunction
It was found that. As expected, given the insignificant renal excretion of sertraline, no dose adjustment is required depending on the severity of renal failure.
Electroconvulsive therapy
The possible success or risk of this combination treatment has not been studied (clinical data are not available).
Convulsions
There is no experience with the use of sertraline in patients with convulsive syndrome, so its use should be avoided in patients with unstable epilepsy, and patients with controlled epilepsy should be carefully monitored during treatment. If seizures occur, the drug should be discontinued.
Activation of mania/hypomania
During clinical studies prior to the marketing of sertraline, hypomania and mania were observed in approximately 0.4% of patients receiving sertraline. Cases of activation of mania/hypomania have also been described in a small proportion of patients with manic-depressive psychosis who received other anti-depressive or anti-obsessive drugs. Sertraline should be used with caution in patients with a history of mania or hypomania. Close medical supervision is necessary and sertraline should be discontinued if the patient exhibits any signs of mania.
Schizophrenia
Patients with schizophrenia may experience exacerbation of psychotic symptoms.
Pathological bleeding/hemorrhage
There are reports of the development of bleeding or hemorrhage from ecchymosis and purpura or life-threatening bleeding/hemorrhage) during the use of SSRIs. Caution should be exercised when prescribing SSRIs in combination with drugs that have an established ability to affect platelet function (for example, atypical antipsychotics and phenothiazines, most tricyclic antidepressants, acetylsalicylic acid and non-steroidal anti-inflammatory drugs), as well as in patients with a history of hemorrhagic diseases.
In addition, when using sertraline with indirect anticoagulants, it is recommended to monitor the prothrombin time at the beginning of treatment with sertraline and after its discontinuation.
Hyponatremia
Transient hyponatremia occurs more often in older patients, in patients with dehydration, or when taking diuretics. This side effect is associated with the syndrome of inappropriate secretion of antidiuretic hormone. Cases of decreased plasma sodium concentrations below 110 mmol/L have been reported. If automatic hyonatremia develops, sertraline should be discontinued and adequate therapy aimed at correcting the concentration of sodium in the blood should be prescribed. Signs and symptoms of hyponatremia include headache, difficulty concentrating, memory loss, weakness and unsteadiness, which can lead to falls. In more severe cases, hallucinations, fainting, seizures, coma, respiratory arrest, and death may occur.
Due to the fact that there is a clear relationship between the development of depression and OCD, depression and panic disorders, depression and PTSD. depression and social phobia, when treating patients with OCD, panic disorders, PTSD and social phobia, the same precautions should be taken as when treating depression.
Fractures
Based on epidemiological studies, it has been established that the use of serotonin reuptake inhibitors, including sertraline, increases the risk of fractures. The mechanism leading to the increased risk is not completely clear.
Elderly patients
The profile of adverse reactions in elderly and young patients is not different. In old age, the drug should be used with caution due to the increased risk of developing hyponatremia.
Diabetes mellitus/impaired blood glucose control When using SSRIs, including Zoloft®, cases of exacerbation of diabetes mellitus and/or impaired glucose control (hyperglycemia and hypoglycemia) have been reported in patients with or without diabetes mellitus. In this regard, glucose levels should be monitored. Particular attention is required in patients with diabetes mellitus, as they may require dose adjustment of oral hypoglycemic agents and/or insulin.
Angle-closure glaucoma
SSRIs, including sertraline, affect pupil size, leading to mydriasis. In this case, a narrowing of the angle of the eye is observed, which leads to an increase in intraocular pressure and the development of closed-angle glaucoma, especially in patients with a predisposition. The drug should be used with caution in patients with angle-closure glaucoma or a history of glaucoma.
Laboratory methods
False-positive urine immunoassays for benzodiazepines have been reported in patients taking sertraline. This is due to the low specificity of screening tests. False-positive results may also occur for several days after discontinuation of sertraline therapy. Additional tests, such as gas chromatography and mass spectrometry, can help distinguish sertraline from benzodiazepines.
Grapefruit juice
The simultaneous use of sertraline and grapefruit juice is not recommended.
Negative effects
Negative reactions when taking the drug were observed in various systems of the human body. But most often problems arise with the digestive system. Dyspeptic disorders, abdominal pain, and dry mouth are observed. In severe cases, pancreatitis may develop.
During treatment, disturbances in the functioning of the central nervous system may also occur, which are expressed by headaches, dizziness, insomnia and other unpleasant symptoms. Dangerous reactions include disruptions in the functioning of the cardiovascular system, such as arterial hypertension or tachycardia. Sometimes taking medication provokes muscle cramps.
The instructions for using Zoloft focus on the risks of many other side effects. Warnings should be read carefully before starting treatment. If any negative manifestations occur, the antidepressant should be discontinued.
Rules of application
The effectiveness of the drug is not affected by food intake. The medicine is taken once a day, the initial dose for treatment is:
- Depressive conditions and obsessive-compulsive disorders are 50 mg.
- Panic disorders, post-traumatic stress disorders and social phobias – 25 mg.
During therapy, the dosage of the medicine can be increased according to the doctor’s recommendation. In this way, the optimal treatment regimen is selected.
A noticeable positive effect from taking the drug is observed after about a week. But in most cases, a course of treatment lasting 2-4 weeks is required to obtain a lasting result. For major depressive episodes, therapy can be continued for six months or more to prevent relapses.
The drug can also be prescribed for maintenance therapy. In this case, the minimum dose is prescribed, which provides the desired effect. This requires periodic dosage adjustments depending on the therapeutic effect.
special instructions
Zoloft 100 mg, buy in Moscow or other cities, only with a prescription. The tablets are packaged in blisters and placed in cardboard boxes along with instructions. It is important to understand that if you take Zoloft, the side effects of which are extensive, without following the doctor's recommendations, it can cause serious consequences.
The drug does not affect psychomotor reactions. This means that there are no restrictions on driving a car during the treatment period.
The price of the drug Zoloft is affordable. In most cases, one package is enough for a course of treatment. The exception is complex pathological conditions that require long-term therapy. Cheaper analogues of Zoloft can be purchased in pharmacies. The most famous of them are Stimuloton and Surlift.
Zoloft price, where to buy
Prices for Zoloft 100 mg, film-coated tablets, for 28 pieces in a pack vary between 1100-1350 rubles.
You can buy Zoloft 50 mg, film-coated tablets, for 14 pieces in a pack for 520-550 rubles.
- Online pharmacies in RussiaRussia
- Online pharmacies in UkraineUkraine
Pharmacy Dialogue
- Zoloft tablets 50mg No. 14Pfizer
146 RUR order - Zoloft tablets 50 mg No. 28)Haupt Pharma Latina SrL
RUB 285 order
- Zoloft tablets 100 mg No. 28)Haupt Pharma Latina SrL
RUR 523 order
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Pharmacy24
- Zoloft 50 mg N28 tablets Haupt Pharma Latina S.r.l., Italy
459 UAH.order
