ZOLOFT(sertraline)

Presented by
Varghese S
Mathew
OBJECTIVES
• By the end of this session, all the staff Nurses will be
able to
Define Anti-depressants
List down the types of antidepressants
Enumerate indications and contra-indications of Zoloft.
Explain the mode of action
Discern the dosage of Zoloft.
Review the nursing management of client taking Zoloft.
• Apply this knowledge in clinical setting as per the
guidelines of KCMH and MOH Kuwait.
Antidepressants
• Antidepressants are drugs used for the treatment
of major depressive disorder and other
conditions, including dysthymia, anxiety
disorders, obsessive compulsive disorder, eating
disorders, chronic pain, in some cases,
dysmenorrhea, snoring, migraine, attention-
deficit hyperactivity disorder (ADHD), addiction,
dependence, and sleep disorders.
Types
•Selective serotonin reuptake inhibitors
•Serotonin-norepinephrine reuptake inhibitors
•Tricyclic antidepressants
•Tetracyclic antidepressants
•Monoamine oxidase inhibitors
Zoloft
Generic Name: sertraline (SER-tra-leen)
Brand Name: Zoloft
Indications
•Treating depression
•OCD
•Panic disorder
•Posttraumatic stress disorder (PTSD)
•Premenstrual dysphoric disorder(a severe form
of premenstrual syndrome)
•Social anxiety disorder(fear of social situations)
Mode of action

• Zoloft is a selective serotonin reuptake inhibitor

(SSRI). It works by restoring the balance of
serotonin, a natural substance in the brain,
which helps to improve certain mood problems.
Contraindications

• Pregnancy or breast-feeding
• Hypersensitivity
• Use of ZOLOFT within 14 days of stopping an
MAOI(serotonin syndrome) ie agitation;
confusion; hallucinations; coma; fever; fast or
irregular heartbeat; tremor; excessive sweating;
and nausea, vomiting, or diarrhea.
• Use of alcohol(dizziness, drowsiness, and
difficulty concentrating)
• Hyponatremia(SSRI can cause hyponatremia)
• Liver Disease(plasma concentrations of
metabolites increased)
• Mania and Seizure Disorders(trigger)
Drug Interaction
• Fentanyl, linezolid
• MAOIs (eg, phenelzine, selegiline, rasagiline)
• SNRIs (eg, duloxetine, venlafaxine)
• SSRIs (eg, citalopram, fluoxetine)
Fever, rigid muscles, blood pressure changes,
mental changes, confusion, irritability, agitation,
delirium, and coma.
• Anticoagulants (eg, warfarin), aspirin
nonsteroidal anti-inflammatory drugs (NSAIDs)
(eg, ibuprofen, ketorolac) risk of bleeding,
including stomach bleeding, may be increased
• Diuretics (eg, furosemide, hydrochlorothiazide)
because the risk of hyponatremia
• Tramadol, because the risk of seizures may be
increased
• Antipsychotics like chlorpromazine &
thioridazine- heart problems, including irregular
heartbeat.
• Propranolol - beta-blockers

• Clozapine - atypical antipsychotic

• Diazepam – benzodiazipines

• Lithium – mood stabilizer

• Amitriptyline - tricyclic antidepressants

• Valproic acid – anticonvulsant

Risk of their side effects may be increased by Zoloft

Sertraline dosage

Usual Adult Dose of Sertraline for Depression:

• Initial dose: 50 mg orally once a day
• Maintenance Dose: 50 to 200 mg orally once a
day

Dose adjustments may be made at intervals of at

least one week.
Usual Adult Dose of Sertraline for Obsessive
Compulsive Disorder:
• Initial dose: 50 mg orally once a day
• Maintenance Dose: 50 to 200 mg orally once a
day

Dose adjustments may be made at intervals of at

least one week.
Usual Adult Dose of Sertraline for Post Traumatic
Stress Disorder:
• Initial dose: 25 mg orally once a day, increased
after one week to 50 mg orally once a day
• Maintenance dose: 50 to 200 mg orally once a
day

Dose adjustments may be made at intervals of at

least one week.
Usual Adult Dose for Social Anxiety Disorder:

• Initial dose: 25 mg orally once a day, increased

after one week to 50 mg orally once a day
• Maintenance dose: 50 to 200 mg orally once a
day

Dose adjustments may be made at intervals of at

least one week.
• Usual Adult Dose of Sertraline for Premenstrual Dysphoric
Disorder:
• Continuous regimen:
• Initial dose: 50 mg orally once a day during the menstrual
cycle
• Maintenance dose: 50 to 150 mg orally once a day during
the menstrual cycle
• Cyclic regimen:
• Initial dose: 50 mg orally once a day starting 14 days prior
to the anticipated start of menstruation through to the first
full day of menses, and repeated with each new cycle
• Maintenance dose: 50 to 100 mg orally once a day
Usual Pediatric Dose for Obsessive Compulsive Disorder:
• 6 to 12 years:
• Initial dose: 25 mg orally once a day
• Maintenance dose: 25 to 200 mg orally once a day
• 13 to 17 years:
• Initial dose: 50 mg orally once a day
• Maintenance dose: 50 to 200 mg orally once a day
The dose may be increased at intervals of at least one
week.
How to use Zoloft:
• Orally with or without food
• Do not miss any doses.
• Do not suddenly stop taking Zoloft without
consulting doctor. Side effects may occur, like
mental or mood changes, numbness or tingling
of the skin, dizziness, confusion, headache,
trouble sleeping, or unusual tiredness
Side effects :
• Constipation; diarrhea; dizziness; drowsiness;
dry mouth; increased sweating; loss of appetite;
nausea; tiredness; trouble sleeping; weight loss.
Nursing Responsibilities

Before Administration
• History: Hypersensitivity to sertraline; impaired hepatic
or renal function; lactation, pregnancy
• Check for drug or herbal interactions
• Check for allergies
• Assess baseline mental status
• Assess for suicidal tendencies
After Administration

• Physical examination: Weight; T; skin rash, lesions;

reflexes, affect; bowel sounds, urinary output, LFTs,
renal function tests
• Monitor for effectiveness as exhibited by a decrease
in symptoms
• Monitor for side effects and serotonin syndrome
• These drugs can cause dizziness in the first few
weeks of taking so take safety precautions.
Teaching

• Insure the patient takes the medication as prescribed.

The medication should not be withdrawn abruptly
but tapered. If withdrawn abruptly can cause:
Dizziness, headache, nausea, tremor, anxiety and
mood changes
Symptoms can occur within a day of stopping or up
until weeks of ending and the symptoms can persist
for weeks.
• Teach the importance of follow up visits with
HCP
• These drugs may take 3-4 weeks or longer to be
effective.
• Inform of drugs and herbs that can interact
• SSRIs work best for moderate to severe
depression when accompanied by some type of
psychotherapy.