The following is information on contraindications to the use of sertraline in general, pregnancy & amp; Breastfeeding and children. Please note that the contraindications may vary depending on the dosage form of a drug (eg tablet, syringe, ointment).
When should not Sertraline be used?
Sertraline must not be used at:
- Hypersensitivity to the active substance
- concomitant treatment with MAO inhibitors such as selegiline or moclobemide; There must be a gap of at least 14 days between the use of sertraline and the active substances mentioned
- pimozide treatment
- Severe hepatic dysfunction because it interferes with the breakdown of sertraline in the body.
The concomitant use of sertraline and other agents that also affect sertonin metabolism should be handled with caution by the physician and avoided as much as possible. This substance group includes the hypnotic tryptophan, the now in Germany banned appetite suppressant fenfluramine, the herbal antidepressant St. John’s Wort and all serotonin-like drugs such as the psychotropic drug clozapine, ondansetron (for nausea and vomiting), the Parkinson’s drug pergolide and ergotamine and Sumatriptan (for migraine).
Only after careful consideration of the benefit and risk by the physician and under his control may sertraline be used in
- Patients with epilepsy because it can increase their suffering
- other than depressive mental illness, because the tendency to suicide may increase
- History of bleeding and ingestion of bleeding agents because sertraline favors bleeding
- older patients and those with low blood volume, because there is an increased risk of a low sodium content of the blood. Signs include headache, difficulty concentrating, limited memory, confusion, weakness, and balance disorder, which can lead to falls.
- liver disease because sertraline is excreted mainly through the liver; if necessary, the doctor will prescribe a reduction in dosage or an extension of the time between receipts
- Diabetics, because the blood sugar adjustment can change and therefore the oral antidiabetics and also insulin must be dosed differently
- Green cataract in prehistory or existing narrow-angle glaucoma, because the sertraline-induced dilation of the pupil narrows the drainage channel of the eye water
Note: There are no clinical trials comparing sertraline and electroconvulsive therapy. The joint application has to be done with the utmost medical care.
What should you watch out for during pregnancy and lactation?
During pregnancy and lactation, the active ingredient may only be taken if absolutely necessary and in agreement with the attending physician.
Newborns whose mothers have used sertraline until later in pregnancy, especially to the last third, should be monitored by a doctor. The children may experience the following symptoms: shortness of breath, blue discoloration of the skin, respiratory arrest, convulsions, fluctuation of body temperature, difficulty in feeding, vomiting, hypoglycaemia, increased / decreased muscle tension, exaggerated reflexes, trembling, irritability, indifference, prolonged weeping, drowsiness and sleep disorders. In most cases, these signs start immediately or within 24 hours of birth.
In studies on animals, sertraline reduced the quality of the semen. In theory, this could affect fertility, but so far no impact on human fertility has been observed.
What should be considered in children?
Sertraline should not be used to treat children and adolescents under 18 years of age, except those with obsessive-compulsive disorder, aged 6 to 17 years. Children under the age of six are prohibited from using the active substance.
Hostility (predominantly aggression, oppositional behavior and anger) is a common side effect in this age group. In addition, children and adolescents are particularly at risk of suicide. If sertraline treatment is considered necessary by the doctor, patients should also be carefully monitored by their relatives for the occurrence of suicidal tendencies.
In addition, there is a lack of long-term safety studies in children and adolescents regarding growth, maturation, and the development of thinking and behavior.
Warnings and Precautions
- Children and adolescents treated with this drug in clinical trials were more likely to experience feelings of weakness, suicide-inducing behaviors (suicidal ideation and suicide attempts) than children treated with a dummy treatment. The hostile behavior expressed in anger, aggressiveness or resistance.
- Because of the increased risk of suicide at the beginning of treatment, the doctor will prescribe only the smallest possible number of tablets and recommend careful monitoring of the patient.
- If seizures occur in patients, the drug should be discontinued.
- The drug can lead to changes in blood pressure, cardiac arrhythmia and circulatory disturbances of the heart muscle to heart attack. Patients with pre-existing heart disease need careful pre-examination.
- As with other serotonin reuptake inhibitors, when treatment is stopped, the medication should not be stopped suddenly, but gradually over a period of weeks or months. Sudden termination of treatment can lead to withdrawal symptoms such as dizziness, tremor, anxiety, palpitations, and nausea.
- Severe Depressed and young adults under the age of 30 are at particular risk for suicide and need to be monitored carefully.
- The medicine may increase the risk of bone fractures.
- The drug is not for the treatment of children under six years.
- Reactivity may be impaired by the drug to the extent that driving a car or driving machinery are dangerous. This is especially true in conjunction with alcohol.
- The drug may falsify urine tests for benzodiazepines.
Sometimes medications release allergic reactions.
If you notice any signs of allergic reaction, tell your doctor or pharmacist immediately.