Information on Zoloft

Pronounced: ZOE-loft
Generic name: Sertraline

Why is Zoloft prescribed?

Zoloft is prescribed for major depressive disorder—a persistently low mood that interferes with everyday living. Symptoms may include loss of interest in your usual activities, disturbed sleep, change in appetite, constant fidgeting or lethargic movement, fatigue, feelings of worthlessness or guilt, difficulty thinking or concentrating, and recurrent thoughts of suicide.

Zoloft can also be used for the type of depression called premenstrual dysphoric disorder (PMDD). This recurring problem is marked by a depressed mood, anxiety or tension, emotional instability, and anger or irritability in the two weeks preceding menstruation. Other symptoms may include loss of interest in activities, difficulty concentrating, lack of energy, changes in appetite or sleep patterns, and feeling out of control.

In addition, Zoloft is used in the treatment of obsessive-compulsive disorder--symptoms of which include unwanted thoughts that won't go away and an irresistible urge to keep repeating certain actions, such as hand-washing or counting. It is also prescribed for the treatment of panic disorder (unexpected attacks of overwhelming anxiety, accompanied by fear of their return), and for posttraumatic stress disorder (re-experiencing a dangerous or life-threatening event through intrusive thoughts, flashbacks, and intense psychological distress).

Zoloft is a member of the family of drugs called "selective serotonin re-uptake inhibitors." Serotonin is one of the chemical messengers believed to govern moods. Ordinarily, it is quickly reabsorbed after its release at the junctures between nerves. Re-uptake inhibitors such as Zoloft slow this process, thereby boosting the levels of serotonin available in the brain.

Most important fact about Zoloft

Do not take Zoloft within 2 weeks of taking any drug classified as an MAO inhibitor. Drugs in this category include the antidepressants Marplan, Nardil, and Parnate. When serotonin boosters such as Zoloft are combined with MAO inhibitors, serious and sometimes fatal reactions can occur.

How should you take Zoloft?

Take Zoloft exactly as prescribed: once a day, in either the morning or the evening.

Zoloft is available in capsule and oral concentrate forms. To prepare Zoloft oral concentrate, use the dropper provided. Measure out the amount of concentrate prescribed by your doctor and mix it with 4 ounces of water, ginger ale, lemon/lime soda, lemonade, or orange juice. (Do not mix the concentrate with any other type of beverage.) Drink the mixture immediately; do not prepare it in advance for later use. At times, a slight haze may appear after mixing, but this is normal.

Improvement with Zoloft may not be seen for several days to a few weeks. You should expect to keep taking it for at least several months.

Zoloft may make your mouth dry. For temporary relief suck a hard candy, chew gum, or melt bits of ice in your mouth.

--If you miss a dose...

Take the forgotten dose as soon as you remember. If several hours have passed, skip the dose. Never try to "catch up" by doubling the dose.

--Storage instructions...

Store at room temperature.

What side effects may occur with Zoloft?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Zoloft.

More common side effects may include:

• abdominal pain
• agitation
• anxiety
• constipation
• decreased sex drive
• diarrhea or loose stools
• difficulty with ejaculation
• dizziness
• dry mouth
• fatigue
• gas
• headache
• decreased appetite
• increased sweating
• indigestion
• insomnia
• nausea
• nervousness
• pain
• rash
• sleepiness
• sore throat
• tingling or pins and needles
• tremor
• vision problems
• vomiting

Less common or rare side effects may include:

• acne
• allergic reaction
• altered taste
• back pain
• blindness
• breast development in males
• breast pain or enlargement
• breathing difficulties
• bruise-like marks on the skin
• cataracts
• changeable emotions
• chest pain
• cold
• clammy skin
• conjunctivitis (pinkeye)
• coughing
• difficulty breathing
• difficulty swallowing
• double vision
• dry eyes
• eye pain
• fainting
• feeling faint upon arising from a sitting or lying position
• feeling of illness
• female and male sexual problems
• fever
• fluid retention
• flushing
• frequent urination
• hair loss
• heart attack
• hemorrhoids
• hiccups
• high blood pressure
• high pressure within the eye (glaucoma)
• hearing problems
• hot flushes
• impotence
• inability to stay seated
• increased appetite
• increased salivation
• increased sex drive
• inflamed nasal passages
• inflammation of the penis
• intolerance to light
• irregular heartbeat
• itching
• joint pains
• kidney failure
• lack of coordination
• lack of sensation
• leg cramps
• menstrual problems
• low blood pressure
• migraine
• movement problems
• muscle cramps or weakness
• need to urinate during the night
• nosebleed
• pain upon urination
• prolonged erection
• purplish spots on the skin
• racing heartbeat
• rectal hemorrhage
• respiratory infection/lung problems
• ringing in the ears
• rolling eyes
• sensitivity to light
• sinus inflammation
• skin eruptions or inflammation
• sleepwalking
• sores on tongue
• speech problems
• stomach and intestinal inflammation
• swelling of the face and throat
• swollen wrists and ankles
• thirst
• throbbing heartbeat
• twitching
• vaginal inflammation, hemorrhage or discharge
• yawning

Zoloft may also cause mental or emotional symptoms such as:

• abnormal dreams or thoughts
• aggressiveness
• exaggerated feeling of well-being
• depersonalization ("unreal" feeling)
• hallucinations
• impaired concentration
• memory loss
• paranoia
• rapid mood shifts
• suicidal thoughts
• tooth-grinding
• worsened depression

Many people lose a pound or two of body weight while taking Zoloft. This usually poses no problem but may be a concern if your depression has already caused you to lose a great deal of weight.

In a few people, Zoloft may trigger the grandiose, inappropriate, out-of-control behavior called mania or the similar, but less dramatic, "hyper" state called hypomania.

Why should Zoloft not be prescribed?

Do not use this drug while taking an MAO inhibitor (see "Most important fact about Zoloft"). Avoid Zoloft if it causes an allergic-type reaction.

Special warnings about Zoloft

If you have a kidney or liver disorder, or are subject to seizures, take Zoloft cautiously and under close medical supervision. Your doctor may limit your dosage if you have one of these conditions.

Zoloft has not been found to impair the ability to drive or operate machinery. Nevertheless, the manufacturer recommends caution until you know how the drug affects you.

If you are sensitive to latex, use caution when handling the dropper provided with the oral concentrate.

Possible food and drug interactions when taking Zoloft

You should not drink alcoholic beverages while taking Zoloft. Use over-the-counter remedies with caution. Although none is known to interact with Zoloft, interactions remain a possibility.

If Zoloft is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Zoloft with the following:

• Cimetidine (Tagamet)
• Diazepam (Valium)
• Digitoxin (Crystodigin)
• Flecainide (Tambocor)
• Lithium (Eskalith, Lithobid)
• MAO inhibitor drugs such as the antidepressants Nardil and Parnate
• Other serotonin-boosting drugs such as Paxil and Prozac
• Other antidepressants such as Elavil and Serzone
• Over-the-counter drugs such as cold remedies
• Propafenone (Rythmol)
• Sumatriptan (Imitrex)
• Tolbutamide (Orinase)
• Warfarin (Coumadin)

If you are using the oral concentrate form of Zoloft, do not take disulfiram (Antabuse)

Special information if you are pregnant or breastfeeding

The effects of Zoloft during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, inform your doctor immediately. Zoloft should be taken during pregnancy only if it is clearly needed. It is not known whether Zoloft appears in breast milk. Caution is advised when using Zoloft during breastfeeding.

Recommended dosage

ADULTS
Depressive or Obsessive Compulsive Disorder

The usual starting dose is 50 milligrams once a day, taken either in the morning or in the evening.

Your doctor may increase your dose depending upon your response. The maximum dose is 200 milligrams in a day.

Premenstrual Dysphoric Disorder

Doses may be prescribed throughout the menstrual cycle or limited to the 2 weeks preceding menstruation. The starting dose is 50 milligrams a day. If this proves insufficient, the doctor will increase the dose in 50-milligram steps at the start of each new menstrual cycle up to a maximum of 100 milligrams per day in the 2-week regimen or 150 milligrams per day in the full-cycle regimen. (During the first 3 days of the 2-week regimen, doses are always limited to 50 milligrams.)

Panic Disorder and Posttraumatic Stress Disorder

During the first week, the usual dose is 25 milligrams once a day. After that, the dose increases to 50 milligrams once a day. Depending on your response, your doctor may continue to increase your dose up to a maximum of 200 milligrams a day.

CHILDREN
Obsessive-Compulsive Disorder

The starting dose for children aged 6 to 12 is 25 milligrams and for adolescents aged 13 to 17, 50 milligrams.

Your doctor will adjust the dose as necessary.

Safety and effectiveness have not been established for children under 6.

Overdosage

Any medication taken in excess can have serious consequences. An overdose of Zoloft can be fatal. If you suspect an overdose, seek medical attention immediately.

Common symptoms of Zoloft overdose include:

• agitation
• dizziness
• nausea
• rapid heartbeat
• sleepiness
• tremor
• vomiting

Other possible symptoms include:

• coma
• stupor
• fainting
• convulsions
• delirium
• hallucinations
• mania
• high or low blood pressure
• slow, rapid, or irregular heartbeat