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Patient Profiles

Robin

(she/her)

Actor portrayal.

Age: 43
Marital Status: Married
Profession: Office manager
Diagnosis: Major depressive disorder (MDD) @ 35 years old
MDD Treatment: Sertraline 200 mg (in the form of two 100 mg tablets)

Robin's challenge:

Robin has been struggling with depression for several years. For much of that time, she sought help from a therapist, and her primary care physician began treatment with sertraline 50 mg per day. Because Robin continued to have significant MDD symptoms, the doctor increased the dosage to 100 mg per day. After a period of time, her dosage was increased to 200 mg per day (in the form of two 100 mg tablets), which improved her MDD symptoms.

In recent office visits:

Robin shared that, about 6 months ago, her mother was diagnosed with Alzheimer disease. This has devastated Robin, as they enjoyed a long, incredibly close relationship, and now her mom doesn't always recognize her.

Robin is struggling to manage being the main caregiver to her mom while performing the duties of her job. As a result, self-care has taken a back seat—she has already stopped seeing her therapist, and it's becoming more and more difficult to keep up with her medication.

Making a switch:

Robin's doctor suggests switching to a single-capsule dosing option instead of multiple pills, saying it may help her stay on track with her medication. Robin feels like this would be one less thing to worry about and may help her fit her depression treatment into her busy life. Her doctor prescribes Sertraline HCl 200 mg Capsules. In a telehealth check-in 60 days later, Robin reports that the single capsule is much easier to fit into her day.

Important Safety Information

INDICATION FOR USE

Sertraline HCl Capsules is indicated for the treatment of major depressive disorder in adults and obsessive-compulsive disorder in adults and pediatric patients 6 years and older.

CONTRAINDICATIONS

Sertraline HCl Capsules is contraindicated in patients:

Taking, or within 14 days of stopping, monoamine oxidase inhibitors (MAOIs) because of an increased risk of serotonin syndrome
Taking pimozide
With known hypersensitivity to sertraline or the excipients in Sertraline HCl Capsules (eg, anaphylaxis, angioedema)

WARNINGS AND PRECAUTIONS

Serotonin Syndrome

Sertraline HCl Capsules can precipitate serotonin syndrome, a potentially life-threatening condition. The risk is increased with concomitant use of other serotonergic drugs and with drugs that impair metabolism of serotonin.

Increased Risk of Bleeding

Sertraline HCl Capsules increases the risk of bleeding events. Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), other antiplatelet drugs, warfarin, and other anticoagulants may add to this risk. There is an association between drugs that interfere with serotonin reuptake and the occurrence of gastrointestinal bleeding. Exposure to SSRIs, particularly in the month before delivery, has been associated with a less than 2-fold increase in the risk of postpartum hemorrhage.

Activation of Mania or Hypomania

In patients with bipolar disorder, treating a depressive episode with Sertraline HCl Capsules may precipitate a mixed/manic episode. Prior to treatment, screen patients for any personal or family history of bipolar disorder, mania, or hypomania.

Discontinuation Syndrome

Adverse reactions after discontinuation of serotonergic antidepressants, particularly after abrupt discontinuation, include: nausea, sweating, dysphoric mood, irritability, agitation, dizziness, sensory disturbances, tremor, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. A gradual reduction in dosage rather than abrupt cessation is recommended.

Seizures

Sertraline HCl Capsules has not been systematically evaluated in patients with seizure disorder and should be prescribed with caution in these patients.

Angle-Closure Glaucoma

Sertraline HCl Capsules may trigger an angle closure attack in a patient with anatomically narrow angles who does not have a patent iridectomy. Avoid use in patients with untreated anatomically narrow angles.

Hyponatremia

Hyponatremia may occur with Sertraline HCl Capsules. In patients with symptomatic hyponatremia, discontinue Sertraline HCl Capsules and institute appropriate medical intervention. Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia.

False-Positive Effects on Screening Tests for Benzodiazepines

False-positive urine immunoassay screening tests for benzodiazepines have been reported in patients taking another Sertraline HCl product and may be expected for several days following discontinuation of sertraline.

QTc Prolongation

During post-marketing use of sertraline, cases of QTc prolongation and Torsade de Pointes (TdP) have been reported. Sertraline should be used with caution in patients with risk factors for QTc prolongation.

Reactions to FD&C Yellow No. 5 (Tartrazine)

Sertraline HCl Capsules contain FD&C Yellow No. 5 (tartrazine), which may cause allergic-type reactions in certain individuals, seen frequently in patients who also have aspirin hypersensitivity.

Sexual Dysfunction

Sertraline HCl Capsules may cause symptoms of sexual dysfunction. In male patients, use may result in ejaculatory delay or failure, decreased libido, and erectile dysfunction. In female patients, use may result in decreased libido and delayed or absent orgasm.

ADVERSE REACTIONS

Most frequent adverse reactions in pooled placebo-controlled clinical trials were nausea, diarrhea / loose stool, tremor, dyspepsia, decreased appetite, hyperhidrosis, ejaculation failure, and decreased libido. In trials for major depressive disorder, somnolence was also seen. In trials for obsessive-compulsive disorder, insomnia and agitation were also seen.

DRUG INTERACTIONS

Monitor for adverse reactions, and reduce dosage of Sertraline HCl Capsules or other protein-bound drugs (eg, warfarin) as warranted.
Decrease the dosage of drugs metabolized by CYP2D6 if needed. Conversely, an increase in dosage of a CYP2D6 substrate may be needed if Sertraline HCl Capsules are discontinued.
Sertraline HCl Capsules may increase phenytoin concentrations. Monitor phenytoin levels, and reduce dosage if needed.

USE IN SPECIFIC POPULATIONS

Pregnancy

Use of Sertraline HCl Capsules in the month before delivery may be associated with an increased risk of postpartum hemorrhage. Third trimester use may increase risk for neonatal complications requiring prolonged hospitalization, respiratory support, and tube feeding—and/or persistent pulmonary hypertension and withdrawal in the neonate.

Hepatic Impairment

Sertraline HCl Capsules are not recommended in patients with mild, moderate, or severe hepatic impairment.

For additional safety information about Sertraline HCl Capsules, see the Full Prescribing Information, including BOXED WARNING, and Medication Guide.

You are encouraged to report negative side effects of prescription drugs to Almatica at 1-877-447-7979 or the FDA at www.fda.gov/medwatch, or call 1-800-FDA-1088.