Premature ejaculation / Sertraline

Sertraline

Zoloft

Sertraline is the generic form of the brand Zoloft®. Both medications work similarly in the body.

Sertraline is a type of medication known as an SSRI that is used to treat major depression, social anxiety disorder, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), panic disorder, and premenstrual dysphoric disorder (PMDD). Sertraline can also be used off-label to treat premature ejaculation (PE) and is one of the recommended treatments for PE by the American Urological Association (AUA).

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Disclaimer: The information provided on this page is not a substitute for professional medical advice, diagnosis, or treatment. If you have any questions or concerns about your health, please talk to a doctor.

While doses for sertraline typically range from 50-200mg daily to treat psychiatric disorders, doses for premature ejaculation are lower, from 25-50mg daily.

Sertraline can have some serious side effects. These include suicidal thoughts or actions, manic episodes, seizures, eye pain, changes in your vision, and bleeding. In addition, sertraline can cause serotonin syndrome, the symptoms include changes in mental status, muscle twitching or rigidity, racing heartbeat, nausea, vomiting, and sweating. Sertraline has also been shown to reduce blood sodium levels, causing headaches, weakness, and confusion in some people. If you experience any of these side effects, seek immediate medical attention. Do not stop taking sertraline without first talking to your doctor.

Sertraline has a “boxed warning.” In the US, The Food and Drug Administration (FDA) mandates that a boxed warning is used when an approved medication carries a significant risk of serious or even life-threatening adverse effects. It’s called a boxed warning because this text appears in a box on the packaging. The boxed warning for sertraline states: “There is a causal relationship between the use of antidepressants, such as sertraline, and the risk of suicidal ideation and behavior in children, adolescents, and young adults (ages 18 to 24 years).”

What is Sertraline?

Sertraline is part of a family of drugs called Selective Serotonin Reuptake Inhibitors, or SSRIs. Serotonin is a signaling molecule, called a neurotransmitter, that allows neurons (nerve cells) in the brain to communicate with each other. Certain neurons release serotonin into a small space between it and an adjacent neuron called the synaptic space or synaptic cleft. From there the serotonin can travel to the next neuron to deliver its message. Serotonin gets reabsorbed by the neuron that released it in a process called reuptake. SSRIs prevent this reuptake of serotonin, which increases the amount of serotonin in the synaptic space. Over time, the increased serotonin causes other chemical changes that may be responsible for some of the effects of SSRIs. Serotonin plays a role in mood, social behavior, appetite, digestion, sleep, memory, and sexual desire and function. Serotonin also plays an important role in inhibiting ejaculation, and SSRIs have been studied as a treatment for premature ejaculation. SSRIs are FDA-approved to treat anxiety and depression, but they are also used off-label to treat several other conditions, including premature ejaculation (PE). The American Urological Association (AUA) recommends certain SSRIs, including sertraline, as a primary treatment for PE.

Is Sertraline an MAOI?

Monoamine oxidase inhibitors (MAOIs) are an older class of antidepressants that are rarely used anymore due to many interactions with other drugs and certain foods. SSRIs are the most commonly used drugs in the modern treatments of depression due to being safer and having better side effect profiles than older drugs, including MAOIs. Sertraline is not an MAOI.

What is Zoloft®?

Sertraline is the chemical name of the active ingredient in Zoloft®. Zoloft® was originally patented and sold by Pfizer. It is FDA-approved to treat major depression, social anxiety disorder, obsessive compulsive disorder (OCD), posttraumatic stress disorder (PTSD), panic disorder, and premenstrual dysphoric disorder (PMDD). After the patent expired, the FDA gave permission to other drug companies to manufacture a generic version of Zoloft®. The FDA requires generic drugs to be bioequivalent to the brand name version. This means that they act the same way in the body and are expected to produce the same effects as the original brand name drug. Generic drugs are generally much cheaper than the original brand name drug, and most drugs prescribed in the US are generic.

What is Sertraline Used to Treat (on-label and off-label)?

Sertraline is FDA-approved to treat major depression, social anxiety disorder, obsessive compulsive disorder (OCD), posttraumatic stress disorder (PTSD), panic disorder, and premenstrual dysphoric disorder (PMDD). It is sometimes used off-label to treat premature ejaculation (PE) and several other conditions. The American Urological Association (AUA) recommends certain SSRIs, including sertraline, as a primary treatment for PE. Physicians on the Roman platform have the discretion to prescribe sertraline for PE if they believe that it is an appropriate course of treatment for a particular patient. It is up to the medical judgment of the doctor to decide if off-label treatment is appropriate for a patient based on his unique medical history, symptoms, and preferences. The Roman Pharmacy Network is able to fill prescriptions for sertraline that are issued by a physician on the Roman platform.

What are the Dosages of Sertraline?

Sertraline comes in 25 mg, 50 mg, and 100 mg tablets. It can be used in dosages of anywhere between 25 mg and 200 mg. It is often successfully used at lower doses (25 mg–50 mg) for the treatment of PE. Doses for psychiatric diseases are often higher (50 mg–200 mg).

Sertraline Half-life / How Long Does it Last in Your Body?

The average elimination half-life of sertraline is approximately 26 hours. This means after 52 hours, around 25% of sertraline is still in your body. It takes 104 hours before more than 90% of sertraline is eliminated from the body. N-desmethylsertraline, a less active metabolite of sertraline, has an elimination half-life of 62 to 104 hours.

Sertraline Side Effects

The most common side effects in adults who take sertraline include:

  • Nausea
  • Loss of appetite,
  • Diarrhea
  • Indigestion
  • Increased sweating (hyperhidrosis)
  • Tremor or shaking
  • Agitation
  • Change in sleep habits including increased sleepiness or insomnia
  • Sexual problems including decreased libido and ejaculation dysfunction
  • Feeling tired or fatigued
  • Anxiety

Sertraline Withdrawal (aka Antidepressant Discontinuation Syndrome)

Do not stop sertraline without first talking to your healthcare provider.

People who abruptly stop taking SSRIs may suffer a constellation of symptoms collectively referred to as Antidepressant Discontinuation Syndrome (ADS). Symptoms include:

  • Dizziness
  • Fatigue 
  • Headache
  • Nausea
  • Agitation
  • Anxiety
  • Chills
  • Diaphoresis (excessive sweating) 
  • Dysphoria 
  • Insomnia
  • Irritability
  • Myalgias
  • Paresthesias
  • Rhinorrhea (runny nose)
  • Tremor

Does Sertraline Cause Weight Gain?

Although some SSRIs are known to cause weight gain, sertraline typically does not cause weight gain. Weight loss due to decreased appetite is listed as a potential side effect in the Prescriber’s Digital Reference (PDR).

Is Sertraline a Controlled Substance?

Sertraline has not been designated as a controlled substance by the Drug Enforcement Administration (DEA). It is not considered to have any serious risk of abuse or addiction.

Does Sertraline have any Special Warnings?

Sertraline has a “boxed warning,” which states, “There is a causal relationship between the use of antidepressants, such as sertraline, and the risk of suicidal ideation and behavior in children, adolescents, and young adults (ages 18 to 24 years).” The potential for risk of suicidal thoughts and behaviors is also increased in people who abruptly stop the medication. That is why you should discuss any changes in your therapy with all of your healthcare providers. Sertraline is used primarily as an antidepressant and people with depression are at higher risk of suicidal thoughts and behaviors. It’s possible that sertraline taken for other reasons, like PE, might also have this increased risk.

Sertraline Safety Information

Call your healthcare provider right away if you have any of the following symptoms, or call 911 if there is an emergency.

Suicidal thoughts or actions:

  • Sertraline and other antidepressant medicines may increase suicidal thoughts or actions in some people 24 years of age and younger, especially within the first few months of treatment or when the dose is changed.
  • Depression or other serious mental illnesses are the most important causes of suicidal thoughts or actions.
  • Watch for these changes and call your healthcare provider right away if you notice new or sudden changes in mood, behavior, actions, thoughts, or feelings, especially if severe.
    • Pay particular attention to such changes when sertraline is started or when the dose is changed.
    • Keep all follow-up visits with your healthcare provider and call between visits if you are worried about symptoms.

Call your healthcare provider right away if you have any of the following
symptoms, or call 911 if an emergency, especially if they are new, worse, or
worry you:

  • Attempts to commit suicide
  • Acting aggressive or violent
  • New or worse depression
  • Feeling agitated, restless, angry or irritable
  • An increase in activity or talking more than what is normal for you
  • Acting on dangerous impulses
  • Thoughts about suicide or dying
  • New or worse anxiety or panic attacks
  • Trouble sleeping
  • Other unusual changes in behavior or mood

Serotonin Syndrome. This condition can be life-threatening and symptoms may include:

  • Agitation, hallucinations, coma, or other changes in mental status
  • Coordination problems or muscle twitching (overactive reflexes)
  • Racing heartbeat, high or low blood pressure
  • Nausea, vomiting, or diarrhea
  • Sweating or fever
  • Muscle rigidity

Increased chance of bleeding: Sertraline and other antidepressant medicines may increase your risk of bleeding or bruising, especially if you take the blood thinner warfarin (Coumadin®, Jantoven®), a non-steroidal anti-inflammatory drug (NSAIDs, like ibuprofen or naproxen), or aspirin.

Manic episodes. Symptoms may include:

  • Greatly increased energy
  • Racing thoughts
  • Unusually grand ideas
  • Severe trouble sleeping
  • Reckless behavior
  • Excessive happiness or irritability
  • Talking more or faster than usual

Seizures or convulsions.

Glaucoma (angle-closure glaucoma). Many antidepressant medicines including sertraline may cause a certain type of eye problem called angle-closure glaucoma. Call your healthcare provider if you have eye pain, changes in your vision, or swelling or redness in or around the eye. Only some people are at risk for these problems. You may want to undergo an eye examination to see if you are at risk and receive preventative treatment if you are.

Low salt (sodium) levels in the blood. Elderly people may be at greater risk for this. Symptoms may include:

  • Headache
  • Weakness or feeling unsteady
  • Confusion, problems concentrating or thinking, or memory problems

This is not a comprehensive list of sertraline side effects. To see a full list of potential side effects, please see the full Prescribing Information, including the Medication Guide, or the Prescriber’s Digital Reference (PDR).

Sertraline interacts with many drugs so it’s important to tell all of your doctors about all medications you are taking, including sertraline

Is it Safe to Drink Alcohol While Taking Sertraline?

The PDR states that it is not recommended to drink alcohol while taking sertraline although there is no known interaction between sertraline and alcohol.