Premature Ejaculation Treatment Plan

Sertraline

Be sure to take your time and read everything below. It is essential for you to understand the potential risks and benefits of treatment. Please do not hesitate to reach out to our medical support team if you have any questions.


Getting started

Premature ejaculation (PE) is one of the most common male sexual health conditions. While it may be a source of distress for both partners in a sexual relationship, it is often ignored by the men with the condition and by the doctors who treat them. It takes confidence and courage to address what so many ignore. We are here to help you find the solution that is right for you.

Many men are under the mistaken impression that there is no treatment available for PE. Some men believe that it is “just the way they are built.” Other men are too embarrassed to seek help. While no single treatment can be guaranteed to work for everyone, most men can be treated successfully. Working with your physician throughout your treatment is the best way to find the best treatment for you.

There are multiple medications that can be tried, a large number of different topical anesthetics, and several effective techniques that can be used alone or in personalized combinations. If one solution doesn’t work for you, or if you experience an adverse side effect, don’t give up. Contact your physician and work through the solutions.

Your physician has reviewed your medical information and has prescribed sertraline as part of your initial treatment plan. The goal is for you to experience improvement immediately. Sometimes, the treatment plan can change based on the effectiveness of the initial intervention. Your feedback will be important; your treatment plan can be refined and improved if needed.

We want you to read and learn about the treatment plan that your provider has prescribed—and become familiar with the other possible treatments that can be used or added to your regimen, if warranted. We need you to engage in the process of finding the best treatment outcome. Please read the list of contraindications and side effects carefully and use medications only as directed.


Take control

Telemedicine has the advantage of convenience, but it relies on your honesty and on your involvement in the process. That includes reading everything below carefully (including the package insert now online and when it arrives in print with your medication) and communicating with your doctor. If your health should change, should you have a side effect, should the medicine not work or stop working over time, should you be prescribed ANY new medication or change your medication regimen, should you visit another doctor, please contact us. Keep EVERY healthcare provider informed.

Your physician has prescribed medication as part of your treatment plan. Being fully informed is the only way for you to know if it suits your needs, and if you want to accept it as presented. You may reject it or you may want to request a modification to the plan. Please, do not hesitate to make your voice heard. Being informed and in control of this process will increase the chances of success. Contact us with any questions.  

Let’s begin. Read everything below and don’t forget to read the package inserts when they arrive with your medicine. Keep all the literature handy in case your medical status changes and you need to refer back to it.


The plan

Your doctor has reviewed your medical information and has created a plan to help resolve your PE. It includes the use of prescription medication, sertraline (the same medication found in Zoloft). Sertraline is recommended as a first line treatment by the American Urological Association to treat PE as an off-label treatment to delay ejaculation in men with PE.

Although sertraline can be taken on demand, 4 to 8 hours prior to sex, studies have shown that daily dosing at a convenient time (such as in the morning when you brush your teeth) is much more effective and easier for most men. That’s why we recommend daily dosing. Taking a pill at the same time every day becomes part of a routine and removes the requirement to prepare differently on days that you have sexual activity. 

One important point for any patient is that you must review any change in your medical regimen with your doctor. Changes should never be made without a discussion with your doctors. There are always risks to using medication. There are risks in starting them, restarting them, and even in abruptly stopping them. That is why you must include your doctor in any changes you want to make.     

Medications that treat PE may have significant advantages over other interventions, such as topical anesthetics or desensitizing agents, which could blunt the sensations felt during sex more than desired. And using distraction techniques, or barriers, can disassociate the man from the very act that is supposed to bring him closer to his partner. Too few men know just how possible it is to find a solution to PE. Being open to all possible treatments is the best way to get the results you want.

You will read below about the different steps that have proven effective for many men. In addition to medication, behavior modification techniques can help train men to control the timing of their orgasm. For many men, this is a very effective way to increase the duration of sexual activity without using medications or topical anesthetics. They are able to extend the duration of sex, feel what they find most appealing, and be present in the process throughout.

Other men are so sensitive to sexual stimulation that a topical agent that lessens the overly intense sensations that bedevil them is a welcomed solution. They might use a topical anesthetic and experience (with practice) just the right balance of sexual pleasure and the duration of intimacy they want.

Benzocaine wipes are the only topical agent that has shown positive results (American Urological Association Annual Meeting 2017) from an independent, double-blind, randomized, Phase 4 controlled clinical study that included a placebo group. Data showed that benzocaine wipes statistically and significantly improved both objective and subjective symptoms of premature ejaculation (PE) when compared to placebo wipes.
 
In fact, 80% of the study participants were no longer considered to have PE by the conclusion of the 2-month study. The time to orgasm with vaginal intercourse was just 75 seconds at the start of the study but was nearly 3 minutes after 1 month and 5.5 minutes at the 2 month mark. This is a 340% increase in the time to ejaculation.

Medications alone may reliably allow all the sensations to be felt that others experience without the fear of premature ejaculation. Both the man and his partner can be fully involved in the physical and psychological pleasures of sex and not the concerns that can blunt the enjoyment of sex. Of course, there are downsides to using medications. There may be side effects and no medication is 100% effective. All the potential side effects and drug interactions of sertraline are listed in the Prescriber’s Digital Reference (PDR). Being familiar with them can help you recognize if they occur and if you should try a different medication.

The point is that there is great variability in how men might like to approach resolving their PE. The medications have great advantages when they work as planned. However, if men practice behavior modification techniques (which can take a few months to perfect) and learn over time (2 to 3 months) how to use just right the amount of topical anesthetic (i.e., the amount that increases both the timing of their sexual encounters and their enjoyment of the experience), they may reach the point where they need far less medicine or none at all. That would be great for the patient and a true success for all the healthcare providers at Roman.     

What follows are the details of your plan and information about PE and sertraline. Take the time to read about PE before diving into the details of treatment with sertraline. Knowing all you can about the condition will prepare you to evaluate not just your own condition but how well the medication is working. You have options and we are here to help you find the best solution. Read everything carefully and do not hesitate to contact us with any questions.

The goal is a complete sense of control over the timing of ejaculation but it may take time to find the ideal solution. This is a process. Some men respond quickly to treatment. Others require more time and adjustments in the treatment plan. We have to be frank about that. Just remember, success is what happens in the long run. We are on this journey together.

“If you want to travel fast, go alone. If you want to travel far, go with a friend.”  


Learning about PE

What is Premature Ejaculation (PE)?

One of the problems with the diagnosis and treatment of PE is that until recently there has not been agreement on what constitutes premature ejaculation. Many men believe they orgasm more quickly than they should only to discover that their time to orgasm is well within the average range. Other men might orgasm in 2 minutes but find it is neither a cause for concern for them nor for their partner.

The lack of consistency in understanding who should be treated and how they should be treated led to confusion both among doctors and their patients. In 2009 and again in 2013, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop “an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE).” Their goal was “to develop clearly worded, practical, evidence-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts.” To a large extent, they succeeded and a summary of their understanding of PE is stated below.

According to the International Society of Sexual Medicine (ISSM) premature ejaculation is a male sexual dysfunction characterized by the following:

  • Ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience—Lifelong Premature Ejaculation (LPE),

OR a clinically significant reduction in latency time (time it takes to reach orgasm after engaging in sex), often to about 3 minutes or less–Acquired Premature Ejaculation (APE);

  • The inability to delay ejaculation on all or nearly all vaginal penetrations; and
  • Negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy

Men with PE generally fall into two groups: those who have it from their first sexual experience and those who develop it later. Men with lifelong PE tend to orgasm more quickly than men who acquire it later in life. Also, men with acquired PE tend to have psychological issues that are at the source of the problem, though medical issues must always be considered.

The good thing is that many of the interventions work for both groups. One stark difference is that men with lifelong PE should be cared for with the understanding that any psychological difficulties they experience more likely resulted from their PE and were not the cause. In most cases, advice is focused on helping men restore their confidence and develop a comfort with sexual interactions. This, along with effective medical treatment, allows men to experience sexual pleasure without the constant dread of disappointing their partners or of having a less than satisfactory personal experience.

Men with the acquired form of PE generally are able to last a little longer (up to 3 minutes) but still reach orgasm far more rapidly than they were previously accustomed. It may be sudden and unexpected but it can be disturbing. Concern may even feed into a “negative feedback loop,” where each sexual event that is marked by premature ejaculation only adds to the concern and anxiety the man feels, which can make the PE worse.

What causes PE?

For men with LPE, a genetic predisposition may be the cause. In one family study, 88% of first degree relatives of men with lifelong PE (of less than 1 minute) also had PE of less than 1 minute. Genetic studies have been scant and conflicting, but it is possible that people with certain genetics are more prone to be affected by PE.

Medical conditions can sometimes cause PE. Some factors that have been associated with PE include ED, anxiety, depression, hypersensitivity of the glans penis, prostatitis, chronic pelvic pain syndrome, or thyroid disorders. Men with acquired PE often have other conditions that contribute to the issue (e.g., erectile dysfunction (ED), chronic prostatitis, and high levels of performance anxiety).

Whatever the cause, the impact on the quality of life of men and their partners may be considerable.

What are some consequences of PE?

Premature ejaculation, like ED, is a non‐life‐threatening, but often psychologically devastating, medical condition that may have adverse consequences on intimate relationships. It can result in isolation, resentment, arguments, and silent suffering. There is even evidence that PE may lead to sexual dysfunction in the partners of men with ED.  

Some couples present for care when they are unable to conceive because the man has an orgasm before he can place the penis in the vagina. This is called anteportal PE. It has been estimated “that between 5% and 20% of men with LPE suffer from anteportal PE.”

How common is PE?

The estimates vary greatly. Much of the variance is due to the different definitions of PE that have been applied over the years. They can be as flexible as that of the American Urological Association (2004), which stated that PE was “Ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners,” or as tightly defined as the more recent definition supplied above by the ISSM.

According to some studies, “20–30% of the male population are affected by PE at any one time, and some experts believe that up to three out of four men experience PE sometime during their lives, although many or most may never raise the subject with their physician, suggesting that PE is undoubtedly more common than current statistics would suggest.”

In studies, it has been noted that despite the high number of men who have PE and the emotional weight it places on them and their partners, “only 12% of the men surveyed with self‐reported PE had consulted a physician.”

What are some risk factors for PE?

Data gathered by the National Health and Social Life Survey (NHSLS) indicate that there are health-related and psychosocial predictors of sexual difficulties. In particular, “the risk of PE is substantially higher in men who have poor to fair health, have emotional problems, or are under stress. Men who experience a >20% drop in household income are also at increased risk.”

Stress, whether from financial misfortune or from poor health can lead to acquired PE. Erectile dysfunction and PE often occur together and ED, in particular, can be a sign of an underlying illness.

Time to ejaculate after vaginal penetration

There have been several studies over the past 15 years concerning the time it takes for men to ejaculate during sex. A study titled, A five-nation survey to assess the distribution of the intravaginal ejaculatory latency time among the general male population, provides some insight.

Using a hidden timer, the researchers measured how long it took for men (from The Netherlands, United Kingdom, Spain, Turkey, and the United States) to orgasm and ejaculate after their penis was inserted into the vagina, called the Intravaginal Ejaculatory Latency Time, or IELT. Foreplay was not timed and no same-sex couples were included. They took note of condom use and circumcision.
The average was about 6 minutes, with men from Turkey having the shortest time (4.4 minutes) and the men in Great Britain having the longest time (the longest IELT) (10 minutes).

Condom use and circumcision did not account for differences in results and the men who felt that they didn’t last long enough lasted on average 5.2 minutes.

These results show that the usual times of vaginal penetration may not be much longer than for men who suffer from premature ejaculation, which has been defined as lasting as many as 3 minutes.

Time to orgasm with masturbation:

In one study, men who experienced premature ejaculation (PE) were asked to measure the time it took for them to masturbate both in a medical office and at home. The time it took for them to reach orgasm was compared to men who did not experience PE. The reported times for men with PE was 3.42 minutes and for men without PE 8.84 minutes.

Knowing what is typical can help define what is not typical (i.e., what might be considered PE).

What are some ways to treat PE other than using Sertraline?

Sildenafil: Sildenafil is primarily thought of as an erectile dysfunction (ED) medication, but it can be extremely effective for PE, as well. What is most interesting is that ED often is an underlying cause of PE. Sometimes, the same stress that causes either one can cause both. However, ED itself can begin a cascade of changes that results in PE.

Men with ED often attempt to keep themselves erect with increasing levels of stimulation either with a partner or when masturbating. This intense stimulation can inadvertently result in ejaculation before they would like and can occur even when the penis is not fully erect. When a full erection is supported by a PDE5i like sildenafil, the need to maintain an erection with overly energetic stimulation is no longer necessary and a more well-timed orgasm can follow.

However, men who take sildenafil for ED and who do not have PE report that they will find it takes longer to orgasm than they might have anticipated so a biological effect of sildenafil may be at work also.  
Sildenafil works especially well when there is some degree of ED as well as PE.
 
Tadalafil: Tadalafil is the same medicine that’s in Cialis and is in the same class of drugs as sildenafil. It is a PDE5 inhibitor, which means it has been used primarily to treat erectile dysfunction. Two of the great advantages of tadalafil are that it can be taken in a low dose every day (convenient), or on an “as-needed” basis (and lasts for 36 hours when used that way), and works for both ED and PE (1 medicine, 2 solutions). One downside is that tadalafil might be more expensive than sildenafil.

Tadalafil is available in doses of 2.5 mg, 5 mg, 10 mg, and 20 mg tablets. The FDA approved tadalafil for erectile dysfunction (ED) as a medication that can be taken as needed or as a daily medication. It can be used off label to treat PE in a similar manner. When used on an as-needed basis, the typical starting dose taken at least 2 hours before sex is 10 mg, which can then be raised or lowered based on how well it works and on how well it is tolerated. When tadalafil is taken every day, the starting dose is 2.5 mg (typical) or 5 mg.  

Though more expensive, a daily regimen may be the most convenient way for some men to manage their PE. Taking a pill at the same time every day becomes part of a routine and removes the requirement to prepare differently on the days you anticipate sexual activity.

Some men with mild PE say they only need a little help. If intermittent use works (even if less well than daily use), it may be enough of an improvement. Also, men who have sex once or twice a month may prefer taking a pill only when they know they will be sexually active. There are also cost considerations. Taking 10 mg, or even 20 mg, once every two weeks may be less costly than low dose, daily use of 2.5 mg or 5 mg.

Circumstances change, so the preferred usage of the medication may change, as well. No one knows their life better than the patient, so the choice is theirs.
 
Topical Anesthetics: Topical anesthetics are a potential treatment for PE and are applied to the penis just before sexual activity. They are generally available without a prescription and may come in the form of creams, lotions, sprays, or wipes. One advantage of topical applications is that the side effect rate is low and they are effective to some degree in almost everyone. Some men like the creams, lotions, sprays, and wipes because they feel they give them the sensations they want without becoming too desensitized. Other men find that they feel so little that their enjoyment of sex is too negatively affected. It is a very individual response and it can take practice to learn which agent, if any, works best.

Some men prefer the creams, lotions, and sprays while others swear by the wipes that are available over-the-counter. The creams and lotions can be difficult to control in terms of the area covered and the amount used. They can also spread to the partner. The sprays are much more controllable than the creams or lotions in terms of the area covered and the amount used. Still, the sprays are a bit imprecise—even promescent, which is the best of the sprays. Once it is sprayed, the anesthetic must be rubbed into the area that the patient wishes to desensitize. The benefit of a spray is somewhat diminished by the need to rub it into the areas one wishes to desensitize. Using a wipe is far more convenient in this regard. One of the main benefits of the benzocaine wipes is that they do not so desensitize the penis that it is completely numbed to sexual pleasure. Read here for the details on how to choose and use your topical anesthetic.

The science behind the use of these agents is well established in the U.S. and international literature. That’s what makes a topical anesthetic an attractive agent. When added to any other medical or behavioral treatment the effects are additive and the anesthetics have few side effects (mostly allergy related).  

Men can learn through trial and error when to apply the agent and how much. Through experience, they discover how long it will work and if it fits their lifestyle. The benzocaine wipe should decrease (but not eliminate) sensation, thereby prolonging the time before ejaculation without interfering with being able to appreciate the sexual sensations of intercourse. Stronger agents that contain lidocaine or that have very high concentrations of anesthetics can completely eliminate sexual sensations. This is sometimes needed for people who cannot benefit from the Endurance (Benzocaine 4%) wipes, combination therapy, or other interventions.   
 
Condoms: Condoms can help with PE by decreasing penile sensitivity and have the added benefit of reducing the likelihood of transmission of sexually transmitted infection or unwanted pregnancy. Since they are always recommended to prevent transmission of sexually transmitted infections, they are usually the first thing men have tried for PE. When condoms are used with a topical anesthetic, the potential spread of the anesthetic to a partner is eliminated.
 
Behavioral modification: The squeeze and start-stop techniques are two different behavioral strategies that can be practiced during masturbation or sexual activity and, over time, may improve control over the timing of ejaculation. As an ongoing method of prolonging sex, these strategies have some significant drawbacks. Interrupting sex or focusing on when to squeeze so as to avoid an orgasm is not a practical way to stay “in the moment” during sex. However, as a training method during masturbation or as a playful exercise with a partner, they may lead to an improved control over orgasming. Read about these techniques here.   
 
Psychotherapy: Counseling, whether in person, by telephone or video, or by text messaging, may increase the likelihood of success for some patients. Many men who have had lifelong issues often suffer silently with a burden that weighs on them every time they consider developing a physical and emotional attachment to another person. They face disappointing the very person they hope to please the most. For many men, it terminates relationships before they begin and can lead to isolation and a loss of companionship. Men with PE face increased risks of divorce and relationship stress often more as a result of the emotional consequences of having PE than from the PE itself.

Men who develop PE later in life may have developed it as a result of an underlying condition but often it is related to some relationship or personal stress. Uncovering the reasons the PE developed are as important as breaking the cycle with medical interventions.

Also, psychotherapy can be enormously helpful in restoring a man’s sense of value and worth beyond the ability to delay an orgasm, which often restores their capacity to experience sex as they had before PE developed.   
 
Combination Therapy: Any of the above treatments can be combined with any one or more of the other treatments. Although it’s often best to keep things simple, the good news is that combination therapy can help treat men who don’t respond satisfactorily to single mode therapies.  


Sertraline (please read the PDR for a full discussion)

Read everything below. It is a summary of some of the information in the PDR and other sources. It is by no means complete. You must read the full package insert when it arrives with your medicine. You can access the PDR directly, as well. Keep all the literature handy in case your medical status changes and you need to refer back to it.

What are some important things my doctor should know?

  • History of problems getting or maintaining erections 
  • Thoughts of doing harm to yourself at any point in the past
  • Shortness of breath 
  • History of mental illness in you or your family (e.g., depression, psychosis, bipolar disorder, manic depression)
  • Diabetes requiring medication
  • Glaucoma
  • Recent Heart Attack, congestive heart failure, unstable heart disease
  • Irregular heartbeats (arrhythmia)
  • Slow heart rate
  • High blood pressure
  • All medications taken now and within the past two weeks
  • History of illicit drug use 
  • History of drug addiction
  • History of serotonin syndrome
  • A list of all your current medical problems, including, but not limited to, liver disease, kidney disease, heart disease, and bleeding disorders
  • Allergy or negative reaction to sertraline or other selective serotonin reuptake inhibitors (SSRI) under different names or any components (e.g. Lexapro, Celexa, Paxil, Prozac, Viibryd, Zoloft, paroxetine, fluoxetine, citalopram, escitalopram)

If you have any of the aforementioned conditions—or any others that are not listed—make sure to share this information with your Ro physician, as well as all of your other healthcare providers.


Some warnings

SSRIs like sertraline are generally safe for most people, but all medicines have the potential for causing side effects. Rarely, these can be serious, and you need to know about them.

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 your Ro doctor and all 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. 

Serotonin syndrome is a potentially life-threatening condition that almost always occurs when people take 2 or more drugs that increase the activity of serotonin in the central nervous system (CNS). Drugs, like sertraline, can increase the activity of serotonin in the central nervous system. Serotonin Syndrome is characterized by elevated body temperature and sweating, muscle rigidity, diarrhea, confusion, and agitation. In severe cases, it can lead to multiorgan failure and death. Sertraline also has the ability to precipitate a manic episode in people suffering from bipolar disorder. 

You should always tell every doctor all medications you are taking to avoid dangerous drug interactions. See below for contraindications and drug interactions.


How does Sertraline work?

Sertraline is in a category of medication called SSRIs and is indicated for anxiety and/or depression. It was quickly realized that depressed men on SSRIs like sertraline had a side effect that many of them considered bothersome: it took more time and stimulation to reach ejaculation. The side effect that was so bothersome to depressed men became a much needed treatment for men who had premature ejaculation. Men who do not have anxiety or depression and use SSRIs to treat PE are not using the medications as they were originally intended.

Nevertheless, for many men with PE it works and this “off-label” use is recommended by the American Urological Association (AUA) for the treatment of PE. Although there are potential side effects with any medication, men without a diagnosis of anxiety or depression don’t typically experience any changes in mood when they take sertraline. For men with excellent erectile function and PE, sertraline is a perfect choice because it delays ejaculation and does not depend on improving erectile function to do so.

The simplest effective treatment is usually the best choice, so your provider tries to prescribe the medication that is most likely to work well for you. Based on your feedback, however, your management may change over time by switching to another medication choice or using a combination of agents. Some men use an oral medication, apply a topical anesthetic that they then cover with a condom. They get the sensations they want, experience the prolonged pleasure of an extended sexual experience, and orgasm at a time both they and a partner find satisfying. For other men, such a combination is overkill. 

That is why your personal experience is so important.


Common side effects

Sertraline also is well tolerated by most patients. Side effects can include decreased sex drive, ED, sedation (which is usual minimal), activation (experienced as a “jittery” feeling), headache and stomach upset. Upset stomach does not last for more than a week usually. The vast majority of patients do not have weight changes that are attributable to sertraline, but a small minority gain weight.

Most people should be advised to take daily pill in morning, partially because it’s easier to make it a habit and remember. For men who felt drowsy, they can switch to taking it at bedtime.


Contraindications (who should never take Sertraline for PE)

  1. History of suicidal thoughts or attempts
  2. History of self-injurious behavior
  3. History of bipolar disorder
  4. History of manic or depressive episodes
  5. History of serotonin syndrome
  6. Patients taking an SSRI for another indication like depression or anxiety. (e.g. Lexapro, Celaxo, Paxil, Prozac, Viibryd, Zoloft, paroxetine, fluoxetine, citalopram, escitalopram)
  7. People taking MAOIs or who have taken MAOIs in the previous 2 weeks.
  8. People with a history of long QT syndrome or who are taking drugs that lengthen the QT interval.
  9. People with moderate-severe liver disease. People with mild liver disease may require reduced doses of sertraline
  10. People who are pregnant or nursing.
  11. Children under the age of 18.
  12. People with bleeding disorders, or who are taking medications that increase their risks of bleeding, should discuss this with their doctor before taking sertraline. In most cases, an alternative treatment strategy will be used.

Although SSRIs were originally designed to reduce stress and anxiety, they can exacerbate psychiatric conditions in men with a history of clinical depression and increase the risk of suicidal thoughts or behaviors. They can also cause patients with undiagnosed bipolar disorder to become manic, which is a self-destructive condition. Patients with bipolar disorder are much more likely to have depressive episodes before mania. Sertraline should therefore not be taken for PE by patients with a history of depression. 

Kids under 18 years should never take sertraline or any other SSRI unless directed to do so by their psychiatrist. A study showed an increase in suicidal thoughts and behavior (but not actually suicide), and therefore the Food and Drug Administration (FDA) has issued a black box warning against children taking this medication.

Sertraline cannot be used with medications called Monoamine Oxidase Inhibitors (MAOIs)—examples include, rasagiline (Azilect), selegiline (Eldepryl, Zelapar), isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate).

In fact, sertraline cannot be used in anyone who used an MAOI two weeks before starting sertraline or who even may need it two weeks after stopping sertraline. 

Sertraline also cannot be used in anyone who is on linezolid (Zyvox), which is an antibiotic, or intravenous methylene blue (used to treat a rare disorder called methemoglobinemia).

This is all very unlikely, but we need to stress that it does not matter if something is rare if it happens to you. That’s why we want you to read all the warnings and to keep everyone informed as you go through this process.


Drug interactions

Why is it so important that all your healthcare providers, including your pharmacists, are fully informed and coordinated about every aspect of your care?

There are hundreds of medications that can interact with sertraline. Most are not severe but some can be life-threatening. Even simple over-the-counter medications should be checked for interactions. All your providers should be kept informed of any medication that is added, dropped, or changed in your regimen.

The Physicians Desk Reference (PDR) lists the medications that can interact with sertraline, along with the contraindications to its use. The PDR is referenced because it is comprehensive and must be read in its entirety. Contraindications can be absolute, act as relative warnings about drug interactions, and inform patients and healthcare providers how certain conditions can affect the metabolism of drugs, either increasing or decreasing the amount in the blood. Certain conditions can also make side effects more likely to occur. For example: Some medications might make it more likely for sertraline to cause a seizure. 

A few relevant sections are summarized below concerning contraindications to using the medication and drug interactions that can alter how the drugs work or alter their side effect profile, but it is not a complete overview. Please, read the entire package insert, as well.

First, a few general pieces of information. Sertraline can be taken with food if it causes an upset stomach. Sertraline should not be taken at bedtime if it causes insomnia. 

Do not break the medication. Keep your medication between 68 and 77 degrees F. Keep it stored in a cool, dry, dark place with the lid tightly sealed and away from children. Throw it out if it is beyond the expiration date.

Children, Suicidal ideation (thoughts)

Sertraline should never be used by children unless prescribed by a psychiatrist. Even up to the age of 24 patients can have an increased likelihood of having suicidal thoughts, especially when they start the medication. 

MAOI therapy

Sertraline cannot be used with medications called Monoamine Oxidase Inhibitors (MAOIs)—examples include, rasagiline (Azilect), selegiline (Eldepryl, Zelapar), isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate).

In fact, sertraline cannot be used in anyone who used an MAOI two weeks before starting sertraline or who may need it two weeks after stopping. 

Sertraline cannot be used in anyone who is on linezolid (Zyvox), which is an antibiotic or intravenous methylene blue (used to treat a rare disorder called methemoglobinemia).

Side effects

See the PDR for the very comprehensive list of possible side effects. 

According to the PDR the common reactions to sertraline include nausea, diarrhea, insomnia, dry mouth, dizziness, fatigue, drowsiness, tremor, dyspepsia, agitation, hyperhidrosis (excessive sweating), decreased libido, vomiting, delayed ejaculation, constipation, palpitations, erectile dysfunction, and visual disturbances. 
 

Drug Interactions

See the PDR