Journal Club Compound Database

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Sertraline Nursing Considerations & Implications | Bioavailable

Compound database
Selective serotonin reuptake inhibitors (SSRIs)
Sertraline

SertralineNursing considerations

Known brand names include Zoloft.

An SSRI antidepressant taken once a day for depression, OCD, panic disorder, PTSD, social anxiety, and PMDD. Full benefit builds over weeks.

Nursing implications

Hold parameters

Stop sertraline and other serotonergic drugs if serotonin syndrome develops
Stop in symptomatic hyponatremia
Do not start within 14 days of an MAOI
Screen for bipolar disorder before starting
Taper rather than stopping abruptly

Sources: [1][2][3][4][5]

Administration

Oral, once daily
Increase in 25 to 50 mg steps no more than once a week
Oral solution: dilute right before the dose in 4 ounces of one approved liquid only (orange juice, lemonade, lemon-lime soda, ginger ale, or water); a slight haze is normal

The oral solution dropper contains natural rubber (latex)

Sources: [1][2][3]

Assess and report

Side effects by what to assess

GI

Nausea, diarrhea, indigestion, decreased appetite

Neuro and mental status

Tremor and sweating
Suicidal thoughts or behavior, mainly in young patients and early in treatment or after dose changes (serious)
Serotonin syndrome (serious)
Mania or hypomania in bipolar disorder (serious)
Seizures, angle-closure glaucoma, QTc prolongation (serious)
Discontinuation syndrome after abrupt stop (serious)

General

Sexual dysfunction: ejaculation failure, lower libido

Bleeding

Bleeding, especially with aspirin, NSAIDs, or anticoagulants (serious)

Labs

Hyponatremia from SIADH, especially in older adults (serious)

Sources: [1][2][3][4][5][6][7]

Labs and vitals

Sodium

Why: Hyponatremia from SIADH
When: When symptoms appear, and with higher risk (older adults, diuretics, volume depletion)
Act on: Stop sertraline in symptomatic hyponatremia
Normal: 135 to 145 mEq/L.

Sources: [1][2]

Safety

High-alert status

SSRIs are not on the ISMP acute care high-alert list.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1]

Boxed warning

Suicidal thoughts and behaviors. Antidepressants raised the risk of suicidal thinking and behavior in children and young adults in short-term trials. Watch all patients closely for worsening or new suicidality.

Sources: [1]

Antidote or reversal

No specific antidote. Overdose can cause delayed seizures, altered mental status, QRS or QTc prolongation, and serotonin syndrome. Consider activated charcoal if the patient presents early, and provide supportive care.

Sources: [1]

Patient teaching

Watch for new or worse depression, suicidal thoughts, or unusual behavior, especially early and after dose changes, and report them right away
Seek care for agitation, fever, sweating, fast heartbeat, muscle stiffness, or twitching, which can signal serotonin syndrome
Check before using aspirin, NSAIDs, or blood thinners because of bleeding risk
Do not stop suddenly; withdrawal symptoms can occur
Avoid disulfiram with the oral solution

Sources: [1][2]

Sound-alike and look-alike names

sertraline and cetirizine
sertraline and Soriatane

Sources: [1]

Dosing

Doses come from the FDA label. Study tool, not for clinical decisions.

Adult dose

Major depressive disorder, OCD: Start 50 mg daily; range 50 to 200 mg daily.
Panic disorder, PTSD, social anxiety: Start 25 mg daily; maximum 200 mg daily.
PMDD: Continuous: 50 mg daily, up to 150 mg. Luteal phase only: 50 mg daily, up to 100 mg, starting 14 days before expected menses.

Sources: [1][2]

Renal adjustment

None for mild to severe renal impairment, including hemodialysis.

Sources: [1]

Hepatic adjustment

Mild impairment (Child-Pugh 5 to 6): use half the usual starting dose and range. Moderate or severe impairment: not recommended.

Sources: [1]

How it works

Mechanism

Blocks reuptake of serotonin into neurons, boosting serotonin signaling in the brain. Its half-life is about 24 hours, so dose changes are spaced a week apart.

Sources: [1][2]