sertraline, Zoloft
Adverse events in users of sertraline: results from an observational study in psychiatric practice in The Netherlands.

Meijer WE, Heerdink ER, van Eijk JT, Leufkens HG.

Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), PO Box 80.082, 3508 TB Utrecht, The Netherlands.

PURPOSE: To evaluate the safety profile of sertraline versus other Selective Serotonin Reuptake Inhibitors (SSRIs) directly following the introduction of sertraline to the Dutch market. METHODS: In a prospective follow-up study, 109 psychiatrists included patients with a new episode of treatment with sertraline and an equal number of patients starting treatment with other SSRIs. All Adverse Events (AEs) during follow-up were recorded by the psychiatrists for the duration of SSRI treatment until discontinuation or until at least 12 months. RESULTS: A total of 1251 patients were included in the study of which 659 used sertraline and 592 used other SSRIs (paroxetine, fluoxetine or fluvoxamine). The most frequently reported events in sertraline users and users of other SSRIs were nausea (160 (24.3%) sertraline patients versus 160 (27.0%) patients using other SSRIs), headache (127 (19.3%) sertraline patients versus 101 (17.1%) patients using other SSRIs), diarrhoea (94 (14.0%) sertraline patients versus 40 patients using other SSRIs (6.8%, p < 0.05)), sweating (88 (13.4%) sertraline patients versus 69 (11.7%) patients using other SSRIs) and dizziness (75 (11.4%) sertraline patients versus 70 (11.8%) patients using other SSRIs). A total of 121 patients reported 134 different unlabelled AEs of which 10 were reported by more than 1% of the population. CONCLUSIONS: In this study we found that almost three out of four patients reported an adverse event. When comparing with other SSRIs and the literature, we found a similar distribution of the most frequently reported adverse events in patients using sertraline. However, in this observational study we found over 100 different unlabelled adverse events.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12512241&dopt=Abstract sertraline Zoloft



sertraline, Zoloft
Sertraline overdose.

Lau GT, Horowitz BZ.

Division of Emergency Medicine and Clinical Toxicology, University of California, Davis, Medical Center, Sacramento 95817, USA.

OBJECTIVE: To determine the clinical presenting signs and symptoms in presumed overdoses of sertraline, a recently approved antidepressant. METHODS: A prospective study involving five western regional poison control centers was performed to evaluate the clinical manifestations of presumed sertraline ingestions (overdoses). Information about calls pertaining to sertraline ingestions was recorded on a standard data collection form. Data including subject age, sex, amount ingested, coingestants, time interval to evaluation, vital signs, presenting signs and symptoms, ECG abnormalities, treatment given, disposition, and length of stay in the ED were collected over a nine-month period. RESULTS: Of 42 ingestions reported, two were adverse reactions to normal doses and 40 were overdoses. Stated amounts of sertraline ingested ranged from 50 to 8,000 mg (mean 1,579 mg). Mean patient age was 35.3 years (range 1 to 69 years). Mean interval to presentation was 3.0 hours. Seventeen of the 40 patients ingested sertraline alone. Of this subgroup, ten had no sign or symptom. The most common abnormalties reported in isolated sertraline overdose were tremor, lethargy, and nausea. Less common findings included agitation, confusion, and vomiting. There was no significant morbidity in this subgroup of presumed isolated sertraline ingestion. Of the 23 patients who ingested other medications along with sertraline, four were asymptomatic. Benzodiazepines and alcohol were the most frequently coingested substances. Lethargy, nausea, dry mouth, and mydriasis were the most common features reported in this group. Treatment included lavage, activated charcoal, and observation. Twelve patients were admitted for 24-hour observation, none had an adverse outcome. Of the patients released from the ED, the mean length of stay was 3.9 hours. CONCLUSION: Sertraline is commonly taken in overdose with other medications or alcohol. The signs and symptoms that develop in association with an overdose of sertraline appear to be minor and of short duration.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8808373&dopt=Abstract sertraline Zoloft



sertraline, Zoloft
Concomitant use of anxiolytics and hypnotics with selective serotonin reuptake inhibitors.

Gregor KJ, Riley JA, Downing DK.

PCS Health Systems, Inc., Scottsdale, Arizona.

A retrospective drug utilization analysis was conducted to compare concomitant use of anxiolytics and hypnotics among patients who received selective serotonin reuptake inhibitors (SSRIs). Data were extracted from an administrative prescription claims database. Patients must have been 18 to 64 years of age, without antidepressant, anxiolytic, or hypnotic use before SSRI therapy initiation, and without the use of antidepressants, other than the original SSRI, after SSRI therapy initiation. The study sample included 117,319 patients. Concomitant anxiolytic use for the total sample was 9.8%. Concomitant anxiolytic use rates for the comparison groups were: fluoxetine, 9.5%; paroxetine, 11.4%; and sertraline, 9.5%. Concomitant hypnotic use for the total sample was 2.8%. Concomitant hypnotic use rates for the comparison groups were: fluoxetine, 2.5%; paroxetine, 3.5%; and sertraline, 2.8%. The majority of concomitant anxiolytic and hypnotic use was initiated on the same day as SSRI therapy initiation. The anxiolytic and hypnotic concomitant use rates for fluoxetine and sertraline patients were significantly lower than the concomitant use rates for paroxetine patients. An understanding of the clinical, quality-of-life, and economic implications of the concomitant use differences will require further study.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8829028&dopt=Abstract sertraline Zoloft



sertraline, Zoloft
Differential potentiation of L-tryptophan-induced head-twitch response in mice by cocaine and sertraline.

Darmani NA.

Department of Pharmacology Kirksville College of Osteopathic Medicine, MO 63501, USA.

Using selective monoamine uptake blockers and appropriate selective monoamine receptor antagonists, we have previously shown that cocaine enhances the frequency of 5-HT2A receptor-mediated 5-hydroxytryptophan (5-HTP)-induced head-twitch response (HTR) in mice via inhibition of serotonin uptake. Concomitantly, cocaine prevented the maximal producible HTR frequency via simultaneous indirect stimulation of the inhibitory presynaptic 5-HT1A and postsynaptic alpha 2 receptors. In the present study, we have investigated the effects of cocaine and the selective 5-HT (sertraline), norepinephrine (nisoxetine) and dopamine (GBR 12935) uptake inhibitors on the L-tryptophan-induced HTR in the presence of a nonselective monoamine oxidase inhibitor, tranylcypromine. We utilized two experimental protocols where cocaine or sertraline were administered either after (protocol 1) or prior to (protocol 2) L-tryptophan injection. Cocaine potentiated the ability of L-tryptophan to induce HTR to a greater extent in protocol 1, whereas sertraline induced a greater effect in protocol 2. However, in our earlier study cocaine (and also sertraline) up to 10 mg/kg produced a similar degree of potentiation in both experimental protocols on the 5-HTP-induced HTR. Furthermore, as in the latter study on the 5-HTP-induced HTR, in the present investigation nisoxetine potently attenuated whereas GBR 12935 did not modulate the induced HTR. The results show that the respective serotonergic and noradrenergic effects of cocaine also operate on the L-tryptophan-induced HTR. The differential effects of cocaine and sertraline in experimental protocols 1 and 2 on the L-tryptophan- versus 5-HTP-induced HTRs suggest that cocaine has additional effects on the conversion of L-tryptophan to 5-HT.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8831798&dopt=Abstract sertraline Zoloft



sertraline, Zoloft
Influence of liver cirrhosis on sertraline pharmacokinetics.

Demolis JL, Angebaud P, Grange JD, Coates P, Funck-Brentano C, Jaillon P.

Clinical Pharmacology Unit, Saint-Antoine University Hospital, Paris, France.

Sertraline is a serotonin reuptake inhibitor. The enhancement of serotoninergic transmission is associated with antidepressant activity. In order to determine the pharmacokinetics of sertraline in patients with chronic stable hepatic insufficiency, 10 patients were matched (age, weight, sex) with 10 healthy subjects in an open study. Each participant received a single capsule containing the equivalent of 100 mg sertraline base. Blood samples were taken during 264 h after administration for measurement of plasma concentrations of sertraline. The results confirm that the oral clearance of sertraline is reduced with a 1.7-fold increase in Cmax and a significant prolongation in elimination half-life in hepatically impaired patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8877033&dopt=Abstract sertraline Zoloft



sertraline, Zoloft
An open trial of adjunctive sertraline in the treatment of chronic schizophrenia.

Thakore JH, Berti C, Dinan TG.

Department of Psychological Medicine, St Bartholomew's Hospital, London, UK.

While the positive symptoms of schizophrenia are amenable to treatment with standard neuroleptics, negative symptoms are often difficult to treat. Co-prescribing antidepressants, such as sertraline, for patients on stable neuroleptic depot preparations is one pharmacological method of overcoming this problem. A total of 20 patients with chronic schizophrenia were enrolled in an open trial over a 12-week period during which sertraline was added to their usual antipsychotic medication. Prior to this, baseline scores for positive and negative symptoms, and extrapyramidal side-effects, were measured. The addition of sertraline resulted in global improvement, with a significant reduction in positive and negative symptom scores and no increase in undesirable neuroleptic side-effects. Sertraline may act by indirectly reducing dopaminergic activity.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8891087&dopt=Abstract sertraline Zoloft



sertraline, Zoloft
Regulation of glutamic acid decarboxylase mRNA expression in rat brain after sertraline treatment.

Giardino L, Zanni M, Bettelli C, Savina MA, Calza L.

Inst. of Otolaryngol. II, Milano University, Italy. cefisnmo mbox.vol.it

We now investigated the effect of chronic treatment with sertraline on glutamic acid decarboxylase mRNA expression in different rat brain areas by means of in situ hybridization. We found a reduced glutamic acid decarboxylase mRNA expression in the prefrontal cortex, accumbens nucleus, olfactory tubercle and reticular nucleus of the thalamus. The involvement of presynaptic modulation of gamma-amino-butyric acid transmission in the anxiolytic effect of sertraline is discussed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8894594&dopt=Abstract sertraline Zoloft