![]() ![]() In addition, patients with medical conditions affecting their liver may need decreased doses for better tolerability.Ĭlinicians require vigilance regarding the toxic effects of serotonergic medications and ensure not to prescribe multiple medications that can cause serotonin syndrome, which is possible by preventing polypharmacy and minimizing unnecessary use of these drugs this is one of the areas where the pharmacist can provide valuable input to the team as they monitor and verify the patient's medication regimen as well as monitor dosing of sertraline and other drugs. For example, elderly patients may need dosing adjustments, as they may tolerate lower doses better. Patient safety can also be improved when dosing adjustments are considered by health care professionals who are a part of a patient's care team. Patient education regarding medication use and compliance will improve outcomes and ensure patient safety. It is also essential to educate all patients who are prescribed sertraline on the possible adverse effects and the prevention and recognition of toxicity due to sertraline (in combination with other serotonergic drugs). All providers should know the medication's contraindications, adverse effects, and interactions with other drugs. All healthcare team members must follow the patient regularly to monitor the reduction of symptoms or any adverse effects. Healthcare providers who often prescribe sertraline include primary care physicians, psychiatrists, nurse practitioners, and others, functioning as an interprofessional team. When treating pregnant women with sertraline during the third trimester, the physician should consider tapering sertraline in the third trimester by risk-benefit analysis. Although not mandatory, therapeutic drug monitoring may be a consideration to ensure the safety of pregnant patients and infants who may have exposure to the medication. Sertraline is also considered safe in pregnancy and with breastfeeding. However, due to the minor effect of QT prolongation, it may benefit the provider to monitor the QT interval with electrocardiograms. Sertraline is considered safe in patients with a history of myocardial infarction, heart failure, and other cardiac conditions. įor geriatric patients, monitor for changes in mental status, and check their sodium concentration regularly due to the risk of SIADH or hyponatremia. The abnormal bleeding may primarily occur if used concurrently with aspirin, NSAIDs, warfarin, or other anticoagulants, as sertraline may impair platelet aggregation and cause bruising, epistaxis, or hemorrhage. Monitor for abnormal bleeding, adverse effects of medication use, or withdrawal symptoms from abrupt discontinuation in patients taking sertraline. ![]() Monitor for symptoms of mania in patients who are started on sertraline, especially if they have a family history of mania or bipolar disorder. Sertraline may also precipitate mania in patients at risk for bipolar disorder. Regularly evaluate for depression and suicidality, especially when changing the dose of sertraline. It is essential to monitor patients for unusual changes in behavior, anxiety, suicidality, or any other clinical signs of worsening illness. Neonates exposed to sertraline late in the third trimester have been reported with complications requiring prolonged hospitalization, tube feeding, and respiratory support. Sertraline use in the first trimester of pregnancy increases the risk of cardiovascular-related malformations such as atrial and/or ventricular septal defects in infants. It is identified in the Beers Criteria as a high-risk medication in geriatric patients, as it may induce a syndrome of inappropriate antidiuretic hormone or hyponatremia. Sertraline use requires caution in patients 65 years and older. Sertraline, like other antidepressants, may increase the risk of suicidal ideation and behavior in children, adolescents, and young adults with major depression. These symptoms include myoclonus, muscle rigidity, diaphoresis, tremor, hyperreflexia, agitated delirium, and hyperthermia. Sertraline may rarely produce symptoms of serotonin syndrome, though this generally happens when combining it with another serotonergic medication. Furthermore, this risk is higher in citalopram rather than sertraline or other SSRIs. Sertraline can prolong the QT interval however, the prolongation is dose-dependent and is very modest. There is a bleeding risk associated with sertraline, as it may inhibit platelet aggregation. The primary side effects of sertraline include syncope, lightheadedness, diarrhea, nausea, sweating, dizziness, xerostomia, confusion, hallucinations, tremor, somnolence, impotence, a disorder of ejaculation, fatigue, rhinitis, and female sexual disorder. SSRIs, considered a newer class of antidepressants, are better tolerated than tricyclic antidepressants or monoamine oxidase inhibitors. ![]()
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