DE
FR
IT
ES
Buy Zoloft Online
Active Ingredient: Sertraline
Zoloft is a brand name of the active ingredient Sertraline that has been developed by the pharmaceutical company Pfizer. The use of the antidepressant Zoloft stimulates the increased synthesis of serotonin, and it prevents a destruction of the neurons of the brain, improves memory, lowers the level of the aggression, forms mood and energetic activity of the brain.
Before Ordering Zoloft
Before ordering Zoloft or Sertraline, you should definitely consult a doctor and read the instructions for the tablet. Zoloft - It's an antidepressant. The active component of the drug is sertraline. Zoloft is available in the form of tablets (50 mg, 100 mg). Zoloft is a selective serotonin reuptake inhibitor (5-HT). The drug does not have a sedative, anticholinergic, stimulating, cardiotoxic effect.
Its active component selectively blocks the process of reuptake in nerve cells of the neurotransmitter serotonin. Zoloft is prescribed for panic and anxiety disorders, obsessive-compulsive disorder, depressive episodes of any severity, post-traumatic stress disorder, social phobia. Sertraline is indicated for the treatment and prevention of depression of various origins, accompanied by a feeling of increased anxiety. The drug is used in the treatment of post-traumatic stress disorders, obsessive-compulsive disorders and panic disorders with or without agoraphobia.
Contraindications
Hypersensitivity to Sertraline, combined use with MAO inhibitors, tryptophan or fenfluramine, children under 6 years of age and unstable epilepsy.
Caution is recommended when prescribing the drug to patients with neurological disorders, mental retardation, manic state, hepatic dysfunction, epilepsy, renal failure and severe weight loss.
You can not use Zoloft:
- If you are allergic to the components of the drug;
- With simultaneous administration of MAO inhibitors, pimozide;
- During breastfeeding;
- During pregnancy;
- Under the age of six.
It is used with caution for epilepsy, significant weight loss, organic brain diseases, mental retardation, liver/kidney failure.
- Known hypersensitivity to Sertraline;
- Simultaneous use of MAO inhibitors and pimozide;
- Pregnancy;
- The period of breastfeeding;
- Children under 6 years;
- Organic diseases of the brain (including delay in mental development);
- Epilepsy;
- Hepatic and / or renal insufficiency;
- Pronounced weight loss.
On the part of the digestive system: flatulence, nausea, vomiting, diarrhea, constipation, abdominal pain, pancreatitis, dry mouth.
Cardiovascular: palpitations, tachycardia, hypertension.
From the musculoskeletal system: arthralgia, muscle cramps.
From the side nervous system: dyskinesias, akathisia, gnashing of teeth, gait disturbance, involuntary muscular contractions, paresthesia, fainting, drowsiness, headache, migraine, dizziness, tremor, insomnia, anxiety, agitation, hypomania, mania , Hallucinations, euphoria, nightmares, psychosis, decreased libido, suicide, coma.
On the part of the respiratory system: bronchospasm, yawning.
From the urinary system: enuresis, urinary incontinence or retention.
On the part of the reproductive system and breast: a violation of sexual function (delay ejaculation, decreased potency), galactorrhea, gynecomastia, menstrual irregularity, priapism.
On the part of the organs of vision: visual impairment, mydriasis.
On the part of the endocrine system: Hyperprolactinaemia, hypothyroidism, the syndrome of inadequate secretion of ADH.
From the hepatic system: hepatitis, jaundice, liver failure.
Allergic reactions: urticaria, pruritus, anaphylactoid reaction.
Other: weakness, redness of the skin or flushing of the face, ringing in the ears, alopecia, angiooedema, facial edema, periorbital edema, photosensitivity reaction, purpura, increased sweating, decreased appetite (rarely increased), down to anorexia, decrease or increase Body weight, bleeding (including nasal, gastrointestinal or hematuria), peripheral edema, occasionally Stevens-Johnson syndrome and epidermal necrolysis. Possible development of leukopenia and thrombocytopenia, as well as increased serum cholesterol levels.
Use during pregnancy and lactation
Pregnant women are prescribed Zoloft only if the expected health benefits of the mother exceed the risks to the fetus.
Women of childbearing age should use effective contraceptives during treatment.
Sertraline is able to penetrate into breast milk, so treatment during breastfeeding is contraindicated (or feeding is stopped).
Method of administration and dosage
It is used orally (inside) 1 time / day (morning or evening), regardless of food intake.
The initial dose for depression, OCD – 50 mg / day, for panic disorders, PTSD, social phobia-25 mg/day, which is increased after a week to 50 mg / day. The dose should be increased at intervals of a week.
The drug is taken by adults and children over 12 years of age orally at an initial dosage of 25 to 50 mg once a day. With an insufficiently pronounced effect, a gradual increase in the dose of the drug is carried out, but not more than 200 mg per day.
Children from 6 to 12 years of age receive the drug at 25 mg per day, with a subsequent increase in the dosage to 50 mg per day. Children from 12 to 17 years of age receive the drug at the beginning of treatment at 50 mg 1 time a day, if necessary, it is possible to increase the dose to 200 mg.
Overdose
Symptoms of overdose: vomiting, drowsiness, rapid heartbeat, agitation( agitation), dizziness, loose stools, increased sweating, myoclonus, hyperreflexia, impaired consciousness.
Treatment of overdose: requires intensive maintenance therapy, constant monitoring of vital functions, support of airway patency.
It is not recommended to induce vomiting. Enterosorbents are prescribed.
Side effects
Digestive disorders: nausea, flatulence, diarrhea/constipation, pancreatitis, abdominal pain, hepatitis, dry mouth, jaundice, liver failure.
Cardiovascular disorders: rapid heartbeat, increased blood pressure.
Musculoskeletal disorders: joint pain, muscle cramps.
Nervous disorders: extrapyramidal disorders, manifested by gnashing teeth, dyskinesia, akathisia (the need to move, change posture), gait disorders, as well as involuntary muscle contractions, paresthesia, fainting, drowsiness, migraine, tremor (trembling), dizziness, insomnia, hypomania/mania, anxiety, agitation, hallucinations, nightmares, psychosis, euphoria, decreased libido, coma, suicide.
Respiratory disorders: bronchial spasm, yawning.
Urinary disorders: urinary incontinence / retention, enuresis.
Sexual disorders: delayed ejaculation, menstrual disorders, decreased potency, gynecomastia, galactorrhea, priapism (involuntary erection).
Impaired perception: visual disturbances, dilated pupils.
Endocrine disorders: hyperprolactinemia, hypothyroidism, syndrome of inadequate ADH secretion.
Other:
- Weakness,
- Allergic reactions,
- Flushes of blood to the face,
- Redness of the skin,
- Alopecia,
- Periorbital edema,
- Photosensitization,
- Purpura,
- Decreased appetite,
- Increased sweating,
- Weight loss/increase,
- Tinnitus,
- Bleeding (nasal, gastrointestinal, hematuria),
- Edema,
- Development of leukopenia,
- Thrombocytopenia,
- Increased cholesterol levels in the blood,
- Withdrawal syndrome.
On the part of the digestive system: flatulence, nausea, vomiting, diarrhea, constipation, abdominal pain, pancreatitis, dry mouth.
Cardiovascular: palpitations, tachycardia, hypertension.
From the musculoskeletal system: arthralgia, muscle cramps.
From the side nervous system: dyskinesias, akathisia, gnashing of teeth, gait disturbance, involuntary muscular contractions, paresthesia, fainting, drowsiness, headache, migraine, dizziness, tremor, insomnia, anxiety, agitation, hypomania, mania , Hallucinations, euphoria, nightmares, psychosis, decreased libido, suicide, coma.
On the part of the respiratory system: bronchospasm, yawning.
From the urinary system: enuresis, urinary incontinence or retention.
On the part of the reproductive system and breast: a violation of sexual function (delay ejaculation, decreased potency), galactorrhea, gynecomastia, menstrual irregularity, priapism.
On the part of the organs of vision: visual impairment, mydriasis.
On the part of the endocrine system: Hyperprolactinaemia, hypothyroidism, the syndrome of inadequate secretion of ADH.
From the hepatic system: hepatitis, jaundice, liver failure.
Allergic reactions: urticaria, pruritus, anaphylactoid reaction.
ZOLOFT is indicated for the treatment of patients with coronary pathology
According to the results of recent studies, the serotonin reuptake inhibitor Zoloft (sertraline) manufactured by Pfizer is an effective and safe treatment for depression in patients with recent myocardial infarction and unstable angina.
It has long been known that antidepressants due to cardiotoxicity are contraindicated for use in patients of this profile. The exception is the latest serotonin reuptake inhibitors: it has been proven that they do not have a cardiotoxic effect when used in patients without diseases of the circulatory system. But little has been known about the effectiveness and safety of their use in patients with coronary pathology, which is a strict contraindication for the patient's participation in clinical trials of antidepressants, until today.
The results of the Pfizer-sponsored Sertraline Antidepressant Heart Attack Randomized Trial (SADHART) open up a vast new market for sertraline. More than 1 million US residents suffer from acute coronary syndromes every year, and about 20% of them develop deep depressive disorders. Depressive disorders are also an independent risk factor for morbidity and mortality in patients with a cardiological profile, increasing this risk almost threefold.
According to representatives of the Pfizer company, the processing of the final results of the study has not yet been completed and it is premature to raise the question of introducing new indications into the brand annotation of the drug Zoloft. To do this, you will need supporting data from several randomized clinical trials.
The SADHART study involved 369 patients with deep depressive disorders that developed immediately after hospitalization for acute coronary circulatory disorders. During a 24-week blind randomized trial, they received placebo and sertraline at a dose of 50-200 mg per day. The use of sertraline did not significantly affect the left ventricular ejection fraction (the primary criterion), the duration of the Q-T interval and other electrocardiographic parameters. In patients treated with sertraline, the number of cardiovascular events decreased by 20%.
It was more difficult to evaluate the therapeutic efficacy of sertraline in patients with depressive disorders in this study: it included patients with less pronounced and less prolonged psychiatric symptoms than those who participated in previous trials of antidepressants. In the group of patients receiving placebo, in about 50% of cases, depressive symptoms were spontaneously reduced, and among the remaining half of patients, they either acquired a prolonged course or resumed within a year.
Experts Dr. Quintan Washington (Cleveland Clinic) and Allan Jaffe (Mayo Clinic, Rochester), who participated in the summing up of the SADHART study, admit that it has a number of limitations: the number of patients was relatively small, patients with severe disorders did not participate in it, in addition, interaction with other drugs and the occurrence of side effects were not taken into account. Therefore, the results obtained cannot be extrapolated to the entire contingent of post-infarction patients, as well as to all drugs of the serotonin reuptake inhibitor group (due to their differences in interaction with other drugs).
But despite the limitations, experts highly appreciate the importance of the SADHART clinical trial and believe that it should be continued. The comments on the results of the study, published in one of the August issues of the Journal of the American Medical Association (JAMA), emphasize that for patients with acute coronary pathology, concomitant depressive disorders often have fatal consequences. The results of the SADHART study open up new prospects for their pharmacotherapy.
Sertraline in the treatment of depressive states
The prevalence of depressive disorders, the variability of their structure, the combination with other neurotic or psychotic disorders, the connection with personal attitudes, somatic and social factors give rise to a large number of clinical forms of depression and, therefore, require the use of a variety of therapeutic means.
Affective disorders occur throughout the life of every fifth person. The risk of developing depression reaches the level of 20%, 1% of cases are initially diagnosed annually, 55% of people have a relapse of depression, and 12-15% become chronic. More than 60% of patients with depression do not come to the attention of psychiatrists, since the structure of the incidence is dominated by atypical clinical forms.
Only 10-15% of patients with depression receive treatment, and only 0.1% of patients are admitted to psychiatric hospitals. According to WHO estimates, major depression currently ranks 4th among the main causes of reduced life expectancy-taking into account the decline in working capacity.
30-40% of patients with depression remain resistant to adequate thymoanaleptic therapy. At the same time, the resistance to the first drug reaches 40-60%.
Modern requirements for an antidepressant, along with a sufficiently effective thymoanaleptic effect, include good tolerability and a favorable side-effect profile, as well as the absence of "behavioral toxicity".
In this regard, we are constantly searching for drugs that would optimally combine both high thymoanaleptic efficacy and a sufficient degree of safety.
The most widely used in the world psychiatric and general medical practice are antidepressants from the group of selective serotonin reuptake inhibitors (SSRIs). Their therapeutic effect is associated with the inhibition of serotonin reuptake in both the central nervous system and the peripheral nervous system. At the next stage, the blocking function of serotonin IA-receptors located in the somatodendritic part of neurons in the midbrain suture region is disrupted. At the same time, the side effects of the drug that occur at the 1st stage are mitigated, and signs of therapeutic antidepressant effects appear. Serotonin neurons are disinhibited (disinhibited), and serotonin begins to be rapidly released from axons leading to different brain structures. SSRI drugs do not have pronounced "behavioral toxicity", anticholinergic side effects, adverse hepatotrophic, cardiotropic effects, and teratogenicity. They are convenient to use, as they have a prolonged effect up to a day, can be used without titration of doses, do not cause dependence and withdrawal syndrome.
This group of drugs includes sertraline (zoloft, seralin). However, it has its own specific features that determine its relevance in clinical practice.
First, it is a balanced type of drug that does not cause exacerbation of anxiety and emotional tension, which allows you to expand the scope of its use.
Secondly, it can be attributed to the second-generation SSRI, since its structure has changed the structure of the antidepressant at the molecular level, as a result of which it was possible to achieve a more "accurate" interaction with the receptor. Thus, when comparing the S-and R-enantiomers, it turned out that the S-enantiomer of the active substance is a 30-fold stronger serotonin reuptake inhibitor than its optical antipode.
Third, sertraline is one of the few antidepressants approved for use in children's practice, which, apparently, may indicate the level of its safety.
Fourth, this drug has proven itself well in the treatment of depression with comorbid mental disorders, which expands the range of its use both in psychiatry and in general medical practice: chronic pain syndrome, bulemia, obesity, alcoholism, obsessive-compulsive disorders, attention deficit hyperactivity disorder, panic disorders, etc.
Side effects of the drug are associated with hyperstimulation of the serotonin system: gastrointestinal disorders, decreased appetite, dizziness, nausea, diarrhea, hyperreflexia.
Sertraline hydrochloride is a drug of bicyclic structure, a derivative of naphthylamine. It is a powerful selective serotonin reaptake inhibitor, does not cause blockage of muscarinic, serotonin, adrenergic and GABAergic receptors. The drug has practically no cholinolytic, cardiotoxic and sedative properties. The basis of its action profile is a distinct timoleptic effect with a weak stimulating component. By relieving depressive symptoms, the drug also successfully affects the indicators of the immune, neurotransmitter and hormonal systems.
A number of works of modern authors are devoted to the clinical evaluation of the use of sertraline for the relief of depression in patients.
Our study aimed to confirm the antidepressant activity of seralin*; to determine the effectiveness of the drug depending on the complexity and depth of the structure of depressive disorders; to clarify the spectrum of psychotropic activity of the drug, to identify the existing side effects.
The study involved 40 patients (14 men, 26 women), whose clinical picture revealed depressive states within a single or recurrent depressive episode (F-33.1; F-33.2), bipolar affective disorder (F-31.3; F-31.4), cyclothymia with comorbid anxiety-phobic disorders of personality disorder (F-60.1; F-60.3).
The selection criteria were: leading mental disorder-depressive syndrome; relative monomorphism of the disorder.
Exclusion criteria: childhood and old age; severe somatoneurological pathology; severity of schizophrenic defect; substance abuse.
The age of the patients is from 20 to 61 years. The duration of the disease is from 1 week to 18 years. The mental state of the patients at the time of initiation of therapy was determined by depressive symptoms of various depths and structures.
Patients were diagnosed with the following syndromes:
- Typical classical depression;
- Anxiety depression; apathetic depression;
- Obsessive-phobic syndrome;
- Depressive-delusional syndrome.
Comorbid anxiety-phobic disorders were represented by panic attacks in 21 patients, manifestations of generalized anxiety-in 14, obsessive-compulsive disorders — in 5 patients. The duration of treatment was 6 weeks. The initial daily dose was determined individually (50 or 100 mg / day). The maximum dose is up to 150 mg/day. The drug was administered orally in the morning, along with meals; combinations with other antidepressants were avoided if possible. However, the peculiarities of the mental state of the patients dictated the need to prescribe sedative or hypnotic drugs. Therefore, we used clonazepam, phenazepam and small doses of neuroleptics: sonapax, chlorprotexene. During the follow-up, 5 patients dropped out of the study for various reasons: 2 of them were discharged from the hospital for family reasons against the background of some improvement in their condition; in 2 clinical cases, a transition to another phase (inversion of affect) was noted.
A feeling of nausea, mild diarrhea, increased heartburn, decreased appetite was noted by 1 patient.
The therapeutic effect of seralin was determined by the degree of reduction of the total Hamilton scale score (HDRS) to assess depressive symptoms at different treatment periods. The total score was recorded during five visits: H0 - when included in the study; H1 - 1 week after the start of taking the drug; H2 - 2 weeks; H3 - 4 weeks; H6-after 6 weeks after the start of taking seralin.
The criterion for the effectiveness of therapy was a 50% reduction of symptoms according to HDRS. An additional assessment of the effectiveness of therapeutic measures was carried out on the basis of the general clinical impression scale CGI. All patients were examined daily by a doctor. The dynamics of the condition was reflected in the extended diaries on the evaluation scales and the results of paraclinical studies.
When analyzing the results of the study, attention is drawn to the dynamism and relative harmony of the reduction of depressive symptoms, the absence of a period of hyperstimulation, increased anxiety, agitation, and activation of suicidal tendencies. This is especially important for patients with depression with obsessive-phobic disorders in the form of panic attacks, since their initial level of anxiety at the beginning of therapy significantly exceeded the level of anxiety in other patients. At the 1st stage of treatment, the actualization of anxiety concerns decreases, a calmer attitude to phobias is formed, hypochondriacal manifestations fade, by the end of the 2nd week, the manifestation of anxiety and somatization decreases in patients, the level of anxiety decreases harmoniously and the mood improves.
Obsessive-phobic symptoms cease to dominate consciousness, the manifestations of avoidant behavior soften, obsessions and phobias cease to be painfully painful, and their significance decreases. At the 4th week of therapy, patients have plans for the future, interest in cognitive and work activities wakes up, they move more easily, communicate and gradually return to their usual lifestyle. Patients develop a positive attitude to the drug and an understanding of the need for long-term maintenance therapy.
The dynamics in the form of a dissociated version of the reduction of symptoms was observed in those clinical cases when the predominant affect in the structure of the depressive syndrome was melancholy or apathy, and comorbid symptoms were represented by a generalized anxiety state or "depressive alienation" of mental functions (apathy, anhedonia, abscess in the form of surges of painful reasoning, without a pronounced somatovegetative component, adynamia, etc.). At the 1st stage of the study, anxiety and the relevance of painful experiences decreased, and at the 2nd stage, mood improved and vital activity appeared.
At the time of completion of the study, the results of therapy showed that 22 patients had " marked improvement "(on the CGI scale), 11 — "moderate improvement", 4 patients — "slight improvement", 2 — "indefinite antidepressant effect" (short — term improvement, without stabilization of the condition) and 1-no changes.
The pronounced thymoleptic activity of the drug was confirmed by the dynamics of the HDRS depression scale indicators: a pronounced therapeutic effect (a decrease in indicators by more than 50% ) was registered at the transition from the 3rd to the 4th week of the study. By the time of completion of therapy, the average HDRS score decreased by 34% from the initial one.
In all patients, the stimulating effect was manifested at the 4th week of therapy.
In the course of the study, 5 patients were found to have side effects. In 1 patient on the 3rd day, there was anxiety, an excited state, which, apparently, is associated with the insufficiently formed anxiolytic effect of the drug. In three clinical cases, transient symptoms of nausea were observed. In 1 patient, there was a short-term delay in urination, which was resolved without discontinuing the drug and reducing the doses. The side effects described in the literature (L. Ziplinski et al., 1989; H. Gommans, 1990) were not registered in our study.
Analyzing the clinical observations, we can draw the following conclusions.
- The drug seralin (sertraline) has a pronounced thymoleptic effect.
- The profile of the therapeutic activity of the antidepressant seralin consists of a harmonious, consistently formed anxiolytic, thymoleptic and stimulating effects.
- Seralin can serve as the drug of choice in the treatment of depression with a predominance of anxiety affect, especially with comorbid obsessive-phobic disorders.
- The peculiarity of the therapeutic profile of the drug makes it possible to avoid an increase in suicidal risk in the early stages of treatment of depression.
- The drug seralin has good tolerability, side effects are insignificant, quickly stopped and do not interfere with the therapy.
- The antidepressant seralin (sertraline) is characterized by a balanced therapeutic effect with consistently advancing anxiolytic, thymoleptic and weak stimulating effects.
Pros and cons
Positive:
It is an effective SSRI antidepressant. Causes less drowsiness than other antidepressants. Easy to swallow. One of the best antidepressants for pregnant women.
Cons:
Most patients report cases of diarrhea after taking the drug compared to other antidepressants.
It interacts with medications and may increase the risk of bleeding when combined with other medications.
