Mosby's 2014 Nursing Drug Reference (366 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
(ser′tra-leen)
Zoloft
Func. class.:
Antidepressant
Chem. class.:
SSRI
Do not confuse:
Zoloft
/Zocor
Inhibits serotonin reuptake in CNS; increases action of serotonin; does not affect dopamine, norepinephrine
Major depressive disorder, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), panic disorder, social anxiety disorder, premenstrual dysphoric disorder (PMDD)
Unlabeled uses:
Premature ejaculation, pruritus with cholestatic liver disease, hot flashes during menopause, breast cancer patients taking tamoxifen; men with prostate cancer secondary to androgen-deprivation therapy
Hypersensitivity to this product or SSRIs
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, renal/hepatic disease, epilepsy, recent MI, latex sensitivity (dropper of oral conc)
Black Box Warning:
Children, suicidal ideation
Calculator
• Adult/geriatric patient/adolescent (unlabeled):
PO
25-50 mg/day; may increase to max of 200 mg/day; do not change dose at intervals of <1 wk; administer daily in
AM
or
PM
• Child 6-12 yr (unlabeled):
PO
25 mg/day, increase by 25-50 mg/wk
• Adult:
PO
50-150 mg nightly
• Adult:
PO
50 mg/day
• Adult:
PO
50-100 mg/day
• Adult:
PO
50 mg/day × 4 wk; men with prostate cancer (androgen deprivation), 50-100 mg/day
• Adult:
PO
Use lower dose or less frequent dosing intervals
Available forms:
Tabs 25, 50, 100 mg; oral sol 20 mg/ml
•
Increased fluids, bulk in diet for constipation, urinary retention
•
With food, milk for GI symptoms
•
Crushed if patient is unable to swallow medication whole
•
Sugarless gum, hard candy, frequent sips of water for dry mouth
•
Oral conc:
dilute before use with 4 oz (1/2 cup) of water, orange juice, ginger ale, or lemon/lime soda; do not mix with other liquids
•
Avoid use with other CNS depressants
CNS:
Insomnia, agitation, somnolence, dizziness, headache, tremor, fatigue
, paresthesia, twitching, confusion, ataxia, gait abnormality (geriatric patients),
seizures, neuroleptic malignant-syndrome–like reaction, serotonin syndrome, suicidal ideation
CV:
Palpitations, chest pain
EENT:
Vision abnormalities, yawning
ENDO:
SIADH (geriatric patients)
GI:
Diarrhea, nausea, constipation, anorexia, dry mouth
, dyspepsia,
vomiting, flatulence
, weight gain/loss
GU:
Male sexual dysfunction
, micturition disorder
INTEG:
Increased sweating, rash, hot flashes
MISC:
Hyponatremia
PO:
Peak 4.5-8.4 hr; steady state 1 wk; plasma protein binding 98%; elimination half-life 26 hr; extensively metabolized; metabolite excreted in urine, bile; weak inhibitor of CYP3A4, moderate inhibitor of CYP2D6
•
Altered lithium levels: lithium
•
Disulfiram reaction: disulfiram and oral conc due to alcohol content
Fatal reactions: MAOIs, pimozide
Increase:
sertraline levels—cimetidine, warfarin, other highly protein-bound products
Increase:
effects of antidepressants (tricyclics), diazepam, TOLBUTamide, warfarin, benzodiazepines, SUMAtriptan, phenytoin, cloZAPine
Increase:
bleeding risk—anticoagulants, NSAIDs, thrombolytic, platelet inhibitors, salicylates
Increase:
serotonin syndrome, neuroleptic malignant syndrome—SSRIs, SNRIs, serotonin-receptor agonists, tricyclics, sibutramine, traZODone, busPIRone, linezolid, traMADol
Increase:
of SSRI, serotonin syndrome—St. John’s wort, SAM-e, tryptophan; do not use together
Increase:
CNS effect—kava kava, valerian
Increase:
AST, ALT
False positive:
urine screen for benzodiazepines
Black Box Warning:
Mental status: mood, sensorium, affect, suicidal tendencies (child/young adult), increase in psychiatric symptoms, depression, panic attacks, OCD, PTSD, social anxiety disorder
S
erotonin syndrome
(hyperthermia, hypertension, rigidity, delirium, coma, myoclonus) or neuroleptic malignant-like syndrome (muscle cramps, fever, unstable B/P, agitation, tremors, mental changes)
Bleeding
(platelet serotonin depletion): GI bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage
•
LFTs at baseline and periodically
•
B/P (lying/standing), pulse q4hr; if systolic B/P drops 20 mm Hg, hold product, notify prescriber; VS q4hr in patients with CV disease
•
Weight q wk; appetite may decrease with product
•
Urinary retention, constipation, especially in geriatric patients
•
Alcohol consumption; hold dose until morning
•
Storage at room temp; do not freeze
•
Therapeutic response: significant improvement in depression, OCD
•
That therapeutic effect may take ≥1 wk
•
To use caution when driving, performing other activities requiring alertness because drowsiness, dizziness, blurred vision may occur
•
Not to discontinue medication quickly after long-term use; may cause nausea, headache, malaise
•
To avoid alcohol
•
May be taken without regard to food
•
Serotonin syndrome:
agitation, nausea, vomiting, diarrhea, twitching, sweating, shivering; report to prescriber immediately
•
To notify prescriber if pregnant or if planning to become pregnant, pregnancy (C) or breastfeed
Black Box Warning:
That suicidal thoughts/behaviors may occur in children/adolescents
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert