Sertraline

ZOLOFT

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Pronunciation: SER-tra-leen (ZOE-loft)

Sertraline ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Sertraline ballicule

Sertraline ZOLOFT mascot mnemonic cartoon — Visual mnemonic: Sertraline mascot
**“So soft on the Shirt line”**
“Baby on Board” → preferred antidepressant during pregnancy
“So soft” → may cause diarrhea and erectile dysfunction

What it isSelective serotonin-reuptake inhibitor; depression, OCD, PTSD and anxiety disorders.

Why this oneIts broad anxiety-spectrum labeling and low interaction burden make it a default SSRI in medical comorbidity.

What limits itEarly diarrhea or nausea and later sexual dysfunction often limit treatment; taper rather than stop abruptly.

Sertraline molecular structure (skeletal formula) — Molecular structure: Sertraline

FDA-approved for

depression (1991)
OCD (1996)
panic disorder (1997)
PTSD (1999)
PMDD (2002)
social anxiety disorder (2003)

Off-label

premature ejaculation

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Suicidal thoughts and behaviors — increased risk in pediatric and young adult patients

FDA dosing	Population	Start	Target	Max
Major depressive disorder	Adults	150 mg QD	150-200 mg QD	200 mg QD
Obsessive-compulsive disorder	Adults & peds ≥6 yr	150 mg QD	150-200 mg QD	200 mg QD

Renal Undefined

Hepatic Not recommended

Do not initiate therapy with this product; only 150 mg and 200 mg strengths available

Instructions

Swallow capsules whole; do not open, crush, or chew
Do not initiate with this product; use another sertraline HCl product for initiation, titration, and doses <150 mg
May start after ≥1 week on 100-125 mg of another sertraline product
Taper gradually on discontinuation (requires another sertraline product)
Allow ≥14 days between stopping an MAOI and starting, and between stopping this drug and starting an MAOI
Screen for bipolar disorder before starting

Available strengths

tab 25, 50, 100 mg

Contraindications

MAOIs (concurrently or within 14 days) due to risk of serotonin syndrome
Concomitant pimozide

Cautions

Serotonin syndrome
Increased risk of bleeding
Activation of mania/hypomania
Discontinuation syndrome
Seizures
Angle-closure glaucoma
Hyponatremia/SIADH
QTc prolongation
Sexual dysfunction

Adverse reactions

Nausea
Diarrhea/loose stools
Tremor
Dyspepsia
Decreased appetite
Hyperhidrosis
Ejaculation failure
Decreased libido

Pregnancy Third-trimester exposure may cause PPHN and poor neonatal adaptation; possible postpartum hemorrhage risk

Lactation Low levels in human milk; no adverse reactions observed in breastfed infants

Cost

Sertraline (ZOLOFT)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	CostPlus
25 mg	tab	30 qd	$0.87	offered
50 mg	tab	30 qd	$1.04	offered
100 mg	tab	30 qd	$1.52	offered

Generic entry2006

⚠ BOXED WARNING

Suicidal thoughts and behaviors in patients under 25

Classes and tags

Clinical profile

Therapeutic safety burden1 / 4

Overdose danger1 / 4

Weight-gain liability1 / 4

Sedation liability1 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryC

Defining liabilityGI and sexual adverse effects, hyponatremia and additive bleeding risk.

Serotonin and MAOI

Provisional washout figures

SRI significance3 / 4

MAO-A inhibition0 / 4

Serotonin release0 / 4

Elevating mechanismSRI

Non-elevating actionNone recorded

Exposure dependenceTherapeutic exposure; severe toxicity requires meaningful MAO-A inhibition

Washout BEFORE an MAOI14 days

Evidence confidenceHigh

InterpretationClinically significant SRI. A second SRI generally represents therapeutic duplication/additive adverse effects, not the classic life-threatening interaction.

Active metabolites

Desmethylsertraline

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Memory aids: interaction avatars

CYP2D6 inhibitor (weak–moderate)

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