Sertraline belongs to a class of medications known as selective serotonin reuptake inhibitors (SSRIs). It is used to treat depression, panic disorder, and obsessive-compulsive disorder (OCD). Sertraline works by affecting the balance of chemicals in the brain. Specifically, it increases the level of a neurotransmitter called serotonin in the brain. Increased serotonin levels can help improve mood, reduce panic attacks, and treat OCD.

Although improvements may occur earlier, the full response to the medication may not appear until after 4 weeks of treatment or longer.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

For depression and obsessive-compulsive disorder, the recommended doses range from 50 mg to 200 mg once daily, taken with food.

For panic disorder, the recommended doses range from 25 mg to 200 mg once daily.

Your doctor may start you on a lower dose and gradually increase your dose to one that's appropriate for you.

Sertraline should be taken with food, preferably in the evening. But if you prefer to take it in the morning, take it with breakfast. Swallow the capsule whole. Do not crush, chew, or divide the capsules.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor.

If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from moisture, and keep it out of the reach of children.

Do not take sertraline if you:

• are allergic to sertraline or any ingredients of the medication
• are taking a MAO inhibitor (e.g., phenelzine, tranylcypromine, moclobemide) or have taken a MAO inhibitor within the last 14 days
• are taking pimozide

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• decreased sexual desire or ability
• diarrhea
• dizziness
• drowsiness
• dry mouth
• headache
• loss of appetite
• nausea
• nervousness
• sleep disturbance
• tremor (shakiness)

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• behaviour changes (e.g., anger, anxiety, violent thoughts)
• changes in vision, including blurred vision or eye pain
• fast talking and excited feelings or actions that are out of control
• inability to sit still
• liver problems (yellowing of the eyes or skin, abdominal pain, nausea, vomiting, dark urine)
• low blood sodium (e.g., tiredness, weakness, and confusion combined with achy, stiff, or uncoordinated muscles)
• symptoms of low blood sugar (weakness, hunger, sweating, anxiety, numbness/tingling in arms/legs)
• paranoia (suspicions of people, organizations, or situations, with no basis in reality)
• restlessness
• signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)
• symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)
• symptoms of mania (e.g., decreased need for sleep, elevated or irritable mood, racing thoughts)
• unusual or sudden body or facial movements or postures

Stop taking the medication and seek immediate medical attention if any of the following occur:

• seizure
• serotonin syndrome (diarrhea, fever, increased sweating, mood or behaviour changes, overactive reflexes, racing heartbeat, restlessness, shivering, or shaking)
• signs of an allergic reaction (hives; difficulty breathing; swelling of the face, tongue, or throat)
• signs of bleeding in the stomach (e.g., bloody, black, or tarry stools; spitting up of blood; vomiting blood or material that looks like coffee grounds)
• symptoms of irregular heartbeat (e.g., chest pain, dizziness, rapid, pounding heartbeat, shortness of breath)
• thoughts of suicide or self-harm

After you stop taking sertraline, your body may need time to adjust. The length of time this takes depends on the amount of medication you were using and how long you used it. During this period of time, check with your doctor if you notice any of the following side effects:

• abnormal dreams
• agitation
• anxiety
• difficulty concentrating
• dizziness
• headache
• increased sweating
• nausea
• trembling or shaking
• sensations similar to electric shocks

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Bleeding: This medication may increase the risk of bleeding, especially if you are also taking medications such as acetylsalicylic acid (ASA), nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, naproxen, ketoprofen), or warfarin. If you experience easy bruising, pinpoint-sized red spots on the skin, or unusual bleeding while taking this medication, contact your doctor immediately.

Bones: Sertraline may increase the risk of bone fracture, especially if you are a senior or have osteoporosis or other major risk factors for breaking a bone. Take extra care to avoid falls, especially if you get dizzy or have low blood pressure. Your doctor may monitor your bones while you are taking this medication.

Diabetes: Sertraline may cause a loss of blood sugar control (increased or decreased blood sugar) for some people who have diabetes and glucose tolerance may change. If you have diabetes, monitor your blood sugar closely and report any changes to your doctor.

If you have diabetes or are at risk for developing diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Drowsiness/reduced alertness: This medication may impair judgment, thinking, or motor skills. People using sertraline should avoid driving a car or operating hazardous machinery until they determine whether or not the medication affects them in this way.

Glaucoma: Sertraline may cause an increase in pressure in the eyes. It can cause symptoms of glaucoma to become worse. If you have glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Heart rhythm: Sertraline can cause changes to the normal rhythm of the heart, including an irregular heartbeat called QT prolongation. QT prolongation is a serious life-threatening condition that can cause fainting, seizures, and sudden death. If you are at risk for heart rhythm problems (e.g., people with heart failure, angina, low potassium or magnesium levels, family history of QT prolongation), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Mania: Sertraline may cause activation of mania. This means that people who are prone to mania may be more likely to have their mania start up again. If you have a history of mania or bipolar disorder, your doctor should closely monitor your condition while you are taking this medication.

Seizures: If you have a history of seizures, your doctor should closely monitor your condition while you are taking sertraline. If you develop seizures, stop taking the medication and contact your doctor.

Serotonin syndrome: This medication may cause a rare but potentially life-threatening condition called serotonin syndrome, especially when used with other medications that increase serotonin levels (e.g., sumatriptan, rizatriptan, tramadol, St. John's wort). If you experience symptoms such as agitation, confusion, hallucinations, fast heart rate, fever, lack of coordination, increased body temperature, overactive reflexes, nausea, vomiting, and diarrhea, get immediate medical attention.

Sodium levels: Sertraline can occasionally cause low levels of sodium in the blood (hyponatremia). This is more likely to happen to seniors or people who are also taking diuretics (water pills). If you experience confusion, weakness, headache, and memory problems, talk to your doctor as soon as possible. If too much sodium is lost from the body, it can cause hallucinations, confusion, seizures, coma, breathing, and even death.

Stopping the medication: Stopping this medication suddenly may lead to side effects. If you are thinking of stopping the medication, check with your doctor or pharmacist first. See also "What side effects are possible with this medication?"

Suicidal or agitated behaviour: People taking this medication may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after people start taking this medication. Your doctor will monitor you closely for emotional and behavioural changes. If you feel suicidal or agitated or notice any other changes in behaviour, talk to your doctor. Family members or caregivers of people who are taking this medication should contact the person's doctor immediately if they notice unusual behaviour changes.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately. There have been some reports that women taking SSRIs such as sertraline during the second half of pregnancy may be associated with lung disorders in newborns. Talk to your doctor if you have any concerns.

Breast-feeding: It is not known if sertraline passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children and adolescents: The safety and effectiveness of using this medication have not been established for people under the age of 18 years. The use of this medication by children below the age of 18 may cause behavioural and emotional changes, such as suicidal thoughts and behaviour.

Seniors: Seniors who take sertraline appear to be more likely to experience low sodium in their blood, which can cause problems with coordination, achy muscles, or confusion. If you experience anything unusual while taking sertraline, contact your doctor.

There may be an interaction between sertraline and any of the following:

• acetylsalicylic acid (ASA)
• alcohol
• amiodarone
• amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
• antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
• antipsychotic medications (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, pimozide, quetiapine, risperidone)
• apalutamide
• apixaban
• barbiturates (e.g., butalbital, pentobarbital, phenobarbital)
• benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
• beta-blockers (e.g. pindolol, propranolol, sotalol)
• bromocriptine
• bupropion
• buspirone
• celecoxib
• chloral hydrate
• chloroquine
• clopidogrel
• dabigatran
• degarelix
• desmopressin
• dexmethylphenidate
• dextromethorphan
• diabetes medications (e.g., chlorpropamide, glyburide, insulin, metformin, rosiglitazone)
• dipyridamole
• disopyramide
• disulfiram
• dofetilide
• domperidone
• dronedarone
• edoxaban
• efavirenz
• enzalutamide
• ergot alkaloids (e.g., ergotamine, dihydroergotamine)
• flecainide
• glucosamine
• grapefruit juice
• heparin
• linezolid
• lithium
• low molecular weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• methadone
• methylene blue
• methamphetamine
• metoclopramide
• mifepristone
• mirtazapine
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, rasagiline, selegiline, tranylcypromine)
• multivitamins
• muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine)
• narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone)
• non-steroidal anti-inflammatory medications (NSAIDs; e.g., diclofenac, ibuprofen, naproxen)
• obinutuzumab
• octreotide
• omega-3 fatty acids
• pentoxifylline
• prasugrel
• procainamide
• quinidine
• quinine
• quinolone antibiotics (e.g., ciprofloxacin, ofloxacin, sparfloxacin)
• rifabutin
• rifampin
• rivaroxaban
• St. John's wort
• scopolamine
• seizure medications (e.g., carbamazepine, clobazam, levetiracetam, phenobarbital, phenytoin, primidone, topiramate, valproic acid, zonisamide)
• serotonin antagonists (anti-emetic medications; e.g., granisetron, ondansetron)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine, venlafaxine)
• other selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
• sotalol
• tapentadol
• tetrabenazine
• thiazide diuretics (water pills; e.g., hydrochlorothiazide, indapamide, metolazone)
• thyroid replacements (e.g., desiccated thyroid, levothyroxine)
• ticagrelor
• ticlopidine
• tizanidine
• tramadol
• trazodone
• tricyclic antidepressants (e.g., amitriptyline, imipramine, nortriptyline)
• "triptan" migraine medications (e.g., eletriptan, sumatriptan)
• tryptophan
• tyrosine kinase inhibitors (e.g., dasatinib, lapatinib, nilotinib, pazopanib, sunitinib)
• vitamin E
• warfarin
• zolpidem
• zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.