sertraline

CLINICAL USE

SSRI:Antidepressant Post-traumatic stress disorder Obsessive compulsive disorder

DOSE IN NORMAL RENAL FUNCTION

25–200 mg daily depending on indication

PHARMACOKINETICS

Molecular weight :342.7 (as hydrochloride)

%Protein binding :>98

%Excreted unchanged in urine : 0

Volume of distribution (L/kg) :25

half-life – normal/ESRD (hrs) :26/Probably unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unlikely to be dialysed. Dose as in normal renal function

HD :Not dialysed. Dose as in normal renal function

HDF/high flux :Unknown dialysability. Dose as in normal renal function

CAV/VVHD :Unknown dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Analgesics: increased risk of bleeding with aspirin and NSAIDs; risk of CNS toxicity increased with tramadol

Anticoagulants: effect of coumarins possibly enhanced

Antidepressants: increased risk of toxic CNS effects of MAOIs and moclobemide; sertraline and MAOIs should not be prescribed within a 2 week period of each other; avoid concomitant use with St John’s wort; possibly enhanced serotonergic effects with duloxetine; can increase tricyclics antidepressant concentration; increased agitation and nausea with tryptophan

Anti-epileptics: antagonism (lowered convulsive threshold)

Antimalarials: avoid concomitant use with artemether/lumefantrine

Antipsychotics: concentration of clozapine and pimozide increased – avoid concomitant use with pimozide

Antivirals: concentration reduced by efavirenz and darunavir; possibly increased concentration with ritonavir

Ciclosporin: may increase serotonin syndrome

Dopaminergics: increased risk of hypertension and CNS excitation with selegiline – avoid concomitant use; increased risk of CNS toxicity with rasagiline – avoid concomitant use

Dopaminergics: hypertension and CNS excitation5HT 1 agonist: increased risk of CNS toxicity with sumatriptan – avoid concomitant use; possibly increased risk of serotonergic effects with frovatriptanLinezolid: use with caution

Lithium: increased risk of CNS effects; lithium toxicity reported

Sibutramine: increased risk of CNS toxicity – avoid concomitant use

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Sertraline is extensively metabolised by the liver. It can be used in renal failure at normal doses with caution.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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