Medscript

Sertraline: uses, dosage and side effects

Sertraline is an SSRI antidepressant. It is prescription-only in Ireland and is used for depression, obsessive compulsive disorder, panic disorder, post-traumatic stress disorder and social anxiety disorder. This page explains what the medicine is used for, how it is taken, the side effects to watch for and how an existing course of treatment is renewed. It is information, not a recommendation to take any medicine, and it does not replace the assessment of your own doctor.

What sertraline is used for

Sertraline is used to treat depression and several anxiety-related conditions, including obsessive compulsive disorder, panic disorder, post-traumatic stress disorder and social anxiety disorder. It belongs to the group of selective serotonin reuptake inhibitors, usually shortened to SSRIs, which act on the way the brain handles serotonin. The licensed indications differ slightly between the products authorised here, so the leaflet in your own pack is the reference that applies to you. A prescriber decides whether sertraline is suitable after considering your symptoms, your medical history, any other medicines you take and whether talking therapy is available to you. Medication is one part of treatment for these conditions and is often combined with psychological therapy; the HSE and your GP can point you towards what is available locally. Sertraline is not a sleeping tablet, not a sedative taken as needed, and not something to start or stop on your own judgement.

Side effects of sertraline

The side effects reported most often with sertraline are nausea, loose stools or diarrhoea, dry mouth, difficulty sleeping, drowsiness, headache, sweating, tremor and changes in sexual function such as reduced desire or delayed orgasm. Many of these are strongest in the first weeks and settle as the body adjusts, which is why a prescriber usually asks you to persevere for a short period before judging the medicine. There is one warning that matters more than the rest. In the early weeks of treatment with an antidepressant, and after any change of dose, anxiety, agitation and thoughts of self-harm or suicide can become worse rather than better, and this is seen most clearly in people under 25 years of age. If that happens to you, or someone close to you notices it, contact your GP or, out of hours, an emergency service on 112 or 999. Seek urgent help too for signs of a serious reaction such as a rash with blistering, unusual bruising or bleeding, confusion, high fever with muscle stiffness, or a seizure.

Dosage and how to take sertraline

Sertraline tablets are taken by mouth once a day, in the morning or the evening, with or without food, and the prescriber sets both the starting dose and any later change. Treatment is usually started low and adjusted at review, because the aim is the smallest dose that controls the symptoms. Do not increase the dose yourself if the effect seems slow: the medicine typically needs several weeks before the full benefit is clear, and some people notice sleep or appetite improving before mood does. Take it at roughly the same time each day. If you miss a dose, take the next one at the usual time rather than doubling up. Do not stop sertraline abruptly, even when you feel well: stopping suddenly can cause dizziness, electric-shock sensations, sleep disturbance and irritability, so a planned reduction agreed with a doctor is the safe route. If you are unwell and cannot keep tablets down for more than a day or two, contact your GP rather than skipping doses indefinitely.

Is sertraline available without a prescription in Ireland?

No. Sertraline is a prescription-only medicine in Ireland and no pharmacy can supply it without a valid prescription. Any website offering to send it to you without one is operating outside the law and outside the safety checks that exist for a reason with this class of medicine. Sertraline is not a controlled drug, so it is not in the group of substances excluded from cross-border prescriptions under Article 11(6) of Directive 2011/24/EU. A prescription written in another EU or EEA country can be presented in an Irish pharmacy. The Pharmaceutical Society of Ireland has published separate guidance for pharmacists on dispensing prescriptions issued by prescribers elsewhere in the EU and EEA. The pharmacist still exercises professional judgement on each prescription and may decline where anything is unclear, which is why the document has to carry the full set of fields required by the Annex to Implementing Directive 2012/52/EU and name the active substance.

Why we do not assess sertraline online

We do not assess antidepressants online at the moment, not even as a continuation of treatment a prescriber has already established. There is nothing to buy on this page and no fee to pay. The reason is the nature of the service: you answer a written questionnaire and a doctor reviews it separately, with no video consultation, no telephone appointment and no live chat. With a medicine whose dose is adjusted against mood, sleep and side effects, that adjustment belongs with a prescriber who knows you and can speak to you. If you are already taking sertraline and your supply is running low, contact your GP or the service following you in good time, and do not stop on your own, because stopping abruptly can cause withdrawal symptoms. If you are newly unwell, if your symptoms have changed, or if you are having thoughts of harming yourself, contact your GP, an out-of-hours GP service, or an emergency service on 112 or 999.

Cost and reimbursement in Ireland

What you pay at the counter for sertraline itself depends on the pack, the manufacturer and the pharmacy, and it is set by the pharmacy rather than by us. Generic sertraline is widely dispensed here and is normally the less expensive option. We do not sell medicines and we do not quote a price for them; the pharmacist will tell you the cost before dispensing if you ask. On the state side, the HSE runs the medical card scheme and the Drugs Payment Scheme, which caps what a household pays for approved prescribed medicines in a calendar month. Whether a particular prescription is covered, and how a prescription written by a prescriber in another EU country is treated under those schemes, is decided by the HSE and applied by the pharmacy, so check it with them before you rely on it. Our own charge is the consultation fee described above and is separate from anything the pharmacy charges.

Interactions and alcohol

Sertraline interacts with a number of medicines, and the important ones are those that also raise serotonin. Monoamine oxidase inhibitors must not be combined with it, and a gap is required when switching between them. Other antidepressants, triptans for migraine, tramadol, lithium and the herbal remedy St John's wort can all add to the serotonin effect; together they can cause a serious reaction with agitation, fever, sweating, tremor and a fast heartbeat that needs urgent medical assessment. Sertraline can also increase the risk of bleeding when taken with anti-inflammatory painkillers such as ibuprofen or naproxen, with aspirin, or with anticoagulants, so tell the prescriber about them. Alcohol is not recommended while taking sertraline: it does not stop the tablet working, but it adds to drowsiness and poor concentration and it tends to worsen low mood and disturbed sleep, which is what you are trying to treat. Always give a full list of your medicines, including anything bought over the counter.

Who should not take sertraline

Sertraline is not suitable for anyone who has had an allergic reaction to it, or for anyone taking a monoamine oxidase inhibitor or pimozide, and it needs particular care in several other situations. Tell the prescriber if you have epilepsy or have ever had a seizure, if you have liver or kidney problems, if you have a history of mania or bipolar disorder, if you have glaucoma, a bleeding disorder or low blood sodium, or if you are due to have surgery. Age matters too: use in children and adolescents is restricted to specific indications and specialist care. If you drive or operate machinery, be careful until you know how the medicine affects you, because drowsiness and reduced concentration are common early on. None of this is a complete list. The contraindications and warnings for your exact product are set out in its leaflet and in the summary of product characteristics published by the HPRA, and your own doctor is the person who applies them to your history.

Generic and brand names

Sertraline is the international non-proprietary name of the active substance, and it is dispensed in Ireland both as generic sertraline carrying the manufacturer's name and under brand names. The active substance and the strength are what determine the effect, so a generic pack authorised by the HPRA works the same way as a branded one. This is worth knowing at the counter, because the box you collect this month may carry a different name from the one you collected last month if the pharmacy has changed supplier. Check the active substance and the strength on the box rather than the brand, and ask the pharmacist if the tablets look different. A cross-border prescription names the active substance rather than a brand, precisely so that a pharmacist in another country can dispense the equivalent product available there. If you have a reason to stay with one particular product, for example because of an intolerance to a specific formulation, say so to both the prescriber and the pharmacist.

Sertraline in pregnancy and breastfeeding

Sertraline is not automatically ruled out in pregnancy or while breastfeeding, but it is a decision to be made with a doctor rather than alone, because it weighs the risk of untreated depression or anxiety against the risk of the medicine. Tell your doctor as soon as you are pregnant or planning to become pregnant, and do not stop the tablets on your own: an abrupt stop in pregnancy carries its own risk. Points a doctor will raise include effects reported in newborns when an SSRI is taken late in pregnancy, and the fact that small amounts pass into breast milk. Maternity services and your GP can review this with you and, where appropriate, arrange extra monitoring. Because this needs an individual assessment and often shared care with a maternity team, our questionnaire is not the right route for it. Speak to your GP or your maternity service.

Where to find the patient information leaflet

Every medicine authorised in Ireland has a patient information leaflet, and the leaflet inside your own pack is the version that applies to you. The Health Products Regulatory Authority (HPRA) keeps a public database of medicines authorised here, where you can look up the leaflet and the summary of product characteristics for the exact strength and manufacturer you have been given. For centrally authorised medicines the European Medicines Agency publishes the same documents. Read the leaflet before the first dose and again if the pack you collect looks different from the last one, because generic versions can differ in their inactive ingredients even when the active substance and the strength are identical. If anything in the leaflet does not match what you were told, ask your pharmacist before taking the medicine. A leaflet is written for the whole patient population, so it lists effects that are uncommon; it is not a prediction of what will happen to you.

Is sertraline prescription-only in Ireland?

Yes. Sertraline is a prescription-only medicine and no pharmacy in Ireland can supply it without a valid prescription. It is not a controlled drug, so it is not excluded from cross-border prescriptions under Article 11(6) of Directive 2011/24/EU.

How long does sertraline take to work?

It usually takes several weeks before the full benefit is clear, although sleep, appetite or energy sometimes improve earlier than mood. Side effects tend to appear before the benefit does, which is why a prescriber normally asks you to come back for review rather than stop at the first difficult week.

What are the common side effects of sertraline?

Nausea, loose stools, dry mouth, poor sleep, drowsiness, headache, sweating, tremor and changes in sexual function are reported most often. Contact a doctor if anxiety, agitation or thoughts of self-harm get worse in the first weeks or after a dose change, particularly under the age of 25.

Can I drink alcohol while taking sertraline?

It is not recommended. Alcohol adds to drowsiness and poor concentration and tends to worsen low mood and disturbed sleep, which works against the treatment. If you drink, discuss it honestly with your doctor rather than leaving it out of the questionnaire.

How do I get a repeat prescription for sertraline?

If treatment has already been started by a doctor, fill in our medical questionnaire. A doctor reviews it and, where continuation is appropriate, issues a cross-border prescription as a PDF by e-mail; you bring it and photo identification to any pharmacy. It is not a route for starting an antidepressant for the first time.