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Zoloft

Zoloft (sertraline hydrochloride) is an oral antidepressant prescription medication used to treat a variety of mental health conditions. Zoloft affects certain chemicals in the brain that may become unbalanced, causing symptoms of depression, anxiety, panic, and obsessive compulsive behavior.

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Zoloft is a member of the selective serotonin reuptake inhibitors (SSRIs), one of several different classes of antidepressant drugs. These drugs work to increase the levels of serotonin, a neurotransmitter that is generally associated with mood and overall well-being in the brain, and helps to maintain mental balance. 1

Other SSRIs include:

  • Prozac (fluoxetine, Eli Lilly)
  • Celexa (citalopram, Forest Laboratories)
  • Paxil (paroxetine, GlaxoSmithKline)
  • Lexapro (escitalopram, Forest Laboratories)
  • Luvox (fluvoxamine, Abbott Laboratories)

Pfizer and Sertraline

Zoloft is the name of sertraline hydrochloride in the U.S. However, the drug was first developed by Pfizer for marketing in the United Kingdom, where it is known as Lustral.

In June 2006, Pfizer’s patent on sertraline hydrochloride expired, and the company could no longer lay exclusive claim to the drug. Currently, there are more than a dozen companies that have FDA approval to market the drug under the generic name sertraline.

Zoloft Label Indications

Zoloft is indicated in the treatment of depression. It is also used in the treatment of several other conditions such as Major Depressive Disorder (MDD), Obsessive-Compulsive Disorder (OCD), Panic Disorder, Posttraumatic Stress Disorder (PTSD), Premenstrual Dysphoric Disorder (PMDD), and Social Anxiety Disorder.

The label for Zoloft also includes a number of warnings:

  • People who are allergic to sertraline hydrochloride or any of its ingredients should not take Zoloft or similar drugs.
  • Patients who take the antipsychotic medicine pimozide (Orap) should not take Zoloft due to the potential development of heart problems.
  • Patients taking Antabuse (disulfiram), a drug used for problem drinkers, should avoid the liquid form of Zoloft due to the alcohol content.
  • Avoid Zoloft if you are currently taking other antidepressants known as monoamine oxidase inhibitors (MAOIs)
  • Avoid taking Zoloft for about two weeks before changing treatments or switching medications, as this may cause serious or life-threatening side effects.

Symptoms

Get medical attention immediately if you experience any symptoms such as:

  • High fever
  • Uncontrolled muscle spasms
  • Stiff muscles
  • Rapid changes in heart rate or blood pressure
  • Confusion
  • Loss of consciousness (pass out)

Antidepressant Interactions with Other Drugs

In some cases, it may become necessary to take more than one medication at a time. This may increase the risk of certain side effects.

Consult your physician before taking multiple medications. If an interaction between drugs may occur, your physician may need to adjust the dosage(s) or change the course of your therapy to decrease these risks. Provide your physician with a complete list of any medications, both prescription and over-the-counter (including nutritional supplements), before taking Zoloft.

Medicines that Can Cause Problems When Taken with Zoloft

  • Triptans
  • Tricyclic antidepressants
  • Fentanyl
  • Lithium
  • Valium (diazepam)
  • Other SSRIs like Prozac (fluoxetine) or Paxil
  • Serotonin–norepinephrine reuptake inhibitors (SNRIs)
  • Antipsychotic drugs
  • Valproate
  • Phenytoin
  • Tramadol
  • Warfarin (medication)
  • Propafenone
  • Flecainide
  • Digitoxin
  • Tolbutamide
  • Cimetidine
  • Aspirin or other NSAIDs
  • Tryptophan
  • St. John’s Wort

Age and Zoloft Dosage

The initial dose of Zoloft depends on the age and condition of the patient and may vary between 25 mg and 50 mg daily.

For younger people, treatment should begin with 25 mg in children (ages 6-12) and 50 mg in adolescents (ages 13-17), with body weight taken into consideration for any future adjustments.

For certain conditions, continuation and maintenance of the patient on Zoloft may require changes to achieve the maximum benefit, depending on how the patient responds to the medication.  These changes may range up to a final dose between 20-200 mg per day. Talk to your doctor regularly to determine the need for continued, maintenance or long-term treatment.

Women should talk with their doctors about whether to take Zoloft or other SSRIs during pregnancy or if attempting to become pregnant. Taking Zoloft or other SSRIs while pregnant can cause a condition in newborns known as Neonatal Persistent Pulmonary Hypertension, which has been found to cause potentially long-term and life-threatening heart defects, according to the FDA.

Side Effects of Zoloft

Data from clinical trials along with postmarket surveillance are reviewed for any adverse events or side effects to determine the overall safety of a drug. These events can happen when the drug is first administered, during therapy and when use of the drug has stopped. They may also depend on the type of patient (age, weight, sex, ethnicity, etc.) and can vary in the length of time a patient experiences these effects and range in severity from very minor or common side-effects to more severe or major events that can be life-threatening and require immediate medical attention. Tell your doctor of the severity of these side effects and if they do not go away.

Women should talk with their doctors about whether to take Zoloft or other SSRIs during pregnancy or if attempting to become pregnant. Taking Zoloft or other SSRIs while pregnant can cause a condition in newborns known as Neonatal Persistent Pulmonary Hypertension, which has been found to cause potentially long-term and life-threatening heart defects, according to the FDA. The agency indicates that Zoloft and other SSRIs may also be responsible for additional effects on newborns that are not yet adequately documented. The FDA warns that taking SSRIs including Zoloft together with norepinephrine reuptake inhibitors and monoamine oxidase inhibitors can trigger serotonin syndrome, a condition known to cause seizure, coma or even death. 2

Important Symptom Warning

Call your doctor immediately if you or your family member experience any of the following symptoms, especially if they are new, worse, or worry you: 3

  • Thoughts about suicide or dying
  • Attempts to commit suicide
  • New or worse depression
  • New or worse anxiety
  • Feeling very agitated or restless
  • Panic attacks
  • Trouble sleeping (insomnia)
  • New or worse irritability
  • Acting aggressive, being angry, or violent
  • Acting on dangerous impulses
  • An extreme increase in activity and talking (mania)
  • Other unusual changes in behavior or mood

Common Side Effects

  • Digestive conditions such as appetite loss, nausea, indigestion, or diarrhea
  • Sleepiness, insomnia, or other changes in your sleep routine
  • Excessive sweating
  • Decreased sex drive, erectile dysfunction, or ejaculation problems
  • Tremors and shaking
  • Feeling tired or fatigued
  • Agitation or restlessness

Other Side Effects in Children and Adolescents

  • Abnormal increase in muscle movement
  • Nose bleeds
  • Frequent urination
  • Urinary incontinence
  • Aggressive reactions
  • Heavy menstrual periods
  • Possible slowed growth rate
  • Weight changes
  1. Young, Simon N. “How to increase serotonin in the human brain without drugs.” (Nov. 2007) Journal of Psychiatry & Neuroscience. 32(6): 394–399. Accessed Oct. 22, 2014. 

  2. U.S. Food & Drug & Drug Administration. “Serotonin-3 (5-HT3) Receptor Antagonists.” (Updated Oct. 16. 2014) http://www.fda.gov/safety/medwatch/safetyinformation/ucm418818.htm. Accessed Jan. 15, 2015;  MedlinePlus. “Serotonin syndrome.” (Updated July 8, 2012) http://www.nlm.nih.gov/medlineplus/ency/article/007272.htm. Accessed  Jan. 15, 2015. 

  3. U.S. Food & Drug Administration. “Drug Safety, Zoloft Medication Guide.” (Dec. 2012) FDA.gov. Accessed July 29, 2013.