Section 19 · Monograph
Sertraline
Reviewed Nov 2026FDA label
ZoloftSSRI
- Forms
- Tab: 25, 50, 100mg | Soln: 20mg/mL
- Dose
- Depression or anxiety: start 25-50mg daily, usual 50-200mg/day
- MOA
- Selective serotonin reuptake inhibition
Black Box Warning
- Increased risk of suicidal thoughts and behavior in children, adolescents and young adults (under 25) — monitor closely, especially at initiation and dose changes
Indications
- Major depressive disorder, OCD, panic disorder, PTSD, social anxiety disorder, PMDDFDA-labeled
Mechanism of Action
- Selective serotonin reuptake inhibitor increasing synaptic serotonin
Full Dosing
Adult / usual
- Depression or anxiety: start 25-50mg daily (25mg in older or anxious patients); usual 50-200mg/day
- Titrate at intervals of at least 1 week; taper gradually to avoid discontinuation syndrome
Contraindications
- MAO inhibitors within 14 days (and linezolid or IV methylene blue)
- Pimozide; disulfiram with sertraline oral concentrate (contains alcohol)
- Hypersensitivity
Drug Interactions
- Serotonergic drugs (triptans, linezolid, tramadol, MAOIs): serotonin syndrome
- NSAIDs, anticoagulants, antiplatelets: increased bleeding risk
- CYP2D6 substrates (metoprolol, TCAs): modest increase; with pimozide contraindicated
Adverse Effects
- Nausea, diarrhea, insomnia or somnolence
- Sexual dysfunction
- Hyponatremia/SIADH, especially older adults
- Bleeding, QT prolongation (rare)
- Serotonin syndrome
Monitoring Parameters
- Suicidality and mood
- Serum sodium in older adults
- Bleeding signs with anticoagulants
Pregnancy & Lactation
- Possible neonatal adaptation syndrome and PPHN risk with late-pregnancy use; weigh benefit and risk
- Low transfer into milk; generally compatible