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Drugs, Supplies and Delivery
Sertraline (Lustral)
Sertraline, marketed under the brand name Lustral, is a selective serotonin reuptake inhibitor (SSRI) widely prescribed for depression, anxiety disorders, and other psychiatric conditions. Known for its efficacy, tolerability, and relatively mild side effect profile, sertraline is a first-line treatment for many patients. This article synthesizes information from the British National Formulary (BNF), Lippincott Textbook of Pharmacology, and Lange Basic & Clinical Pharmacology to provide a detailed overview of sertraline, including its mechanism of action, therapeutic uses, dosing, side effects, precautions, drug interactions, and availability.
Sertraline selectively inhibits the reuptake of serotonin (5-HT) at the presynaptic neuronal membrane, increasing serotonin availability in the synaptic cleft. This enhances serotonergic neurotransmission, which is associated with improved mood and emotional regulation (Lippincott Textbook of Pharmacology). Sertraline also has mild effects on dopamine reuptake, which may contribute to its efficacy in certain conditions (Lange Basic & Clinical Pharmacology).
- Major Depressive Disorder (MDD):
- First-line treatment for acute episodes and maintenance therapy to prevent relapse (BNF).
- Generalized Anxiety Disorder (GAD):
- Approved for managing chronic anxiety symptoms.
- Panic Disorder:
- Reduces the frequency and severity of panic attacks.
- Obsessive-Compulsive Disorder (OCD):
- Reduces intrusive thoughts and compulsive behaviors.
- Post-Traumatic Stress Disorder (PTSD):
- Alleviates symptoms such as flashbacks and hyperarousal (Lange Basic & Clinical Pharmacology).
- Premenstrual Dysphoric Disorder (PMDD):
- Improves mood swings, irritability, and physical symptoms (BNF).
- Adults:
- Initial Dose: 50 mg once daily, preferably in the morning or evening.
- Maintenance Dose: 50–200 mg daily; maximum 200 mg/day (BNF).
- Elderly or Hepatically Impaired Patients:
- Lower Initial Dose: 25 mg/day, adjusted based on response (Lippincott).
- Children (≥6 years):
- OCD: 25 mg/day, increased to 50–200 mg/day as needed (Lange Basic & Clinical Pharmacology).
Administration:
- Can be taken with or without food.
- Avoid abrupt discontinuation; taper gradually over weeks to prevent withdrawal symptoms (BNF).
- Common: Nausea, diarrhea, insomnia, dry mouth, and dizziness (BNF).
- Serious:
- Serotonin Syndrome: Agitation, hyperthermia, and autonomic instability (rare but life-threatening).
- QT Prolongation: Risk of arrhythmias, particularly at high doses.
- Hyponatremia: Especially in elderly patients (Lippincott).
- Suicidal Ideation: Increased risk in adolescents and young adults (Lange Basic & Clinical Pharmacology).
- Contraindications:
- Concurrent use of MAO inhibitors (risk of serotonin syndrome).
- Known hypersensitivity to sertraline or other SSRIs (BNF).
- Monitoring:
- Monitor for suicidal thoughts, especially during the initial weeks of treatment.
- Serum sodium levels in elderly patients (Lippincott).
- Pregnancy/Lactation:
- Use with caution; potential neonatal withdrawal or persistent pulmonary hypertension (PPHN) (Lange Basic & Clinical Pharmacology).
- MAO Inhibitors: Risk of serotonin syndrome; allow a 2-week washout period after stopping sertraline (BNF).
- QT-Prolonging Drugs (e.g., amiodarone, antipsychotics): Synergistic risk of arrhythmias.
- CYP2D6 Inhibitors (e.g., fluoxetine): Increase sertraline levels; monitor for toxicity.
- NSAIDs/Anticoagulants: Elevated bleeding risk due to SSRI-induced platelet dysfunction (Lippincott).
Sertraline is the generic name. It is marketed under the brand name Lustral® in some regions. Generic formulations are widely available as:
- Tablets: 25 mg, 50 mg, 100 mg.
- Oral Solution: 20 mg/mL (BNF).
