2522/2523
30.07.14[7]
PATIENT INFORMATION LEAFLET
(sertraline hydrochloride)
Read all of this leaflet carefully before you start taking this medicine.
- Keep this leaflet. You may need to read it again.
- If you have any further questions, ask your doctor or pharmacist.
- This medicine has been prescribed for you. Do not pass it on to others.
It may harm them, even if their symptoms are the same as yours.
- If any of the side effects gets serious, or if you notice any side effectsnot listed in this leaflet, please tell your doctor or pharmacist.
This medicine is available using any of the above names but will be referred to as Lustral throughout this leaflet.
In this leaflet:
1. What Lustral is and what it is used for.
2. Before you take Lustral.
3. How to take Lustral.
4. Possible side effects.
5. How to store Lustral.
6. Further information.
1. What Lustral is and what it is used for
Lustral contains the active ingredient sertraline. Sertraline is one of a group of medicines called Selective Serotonin Re-uptake Inhibitors(SSRIs); these medicines are used to treat depression and/or anxietydisorders.
Lustral can be used to treat:
- Depression and prevention of recurrence of depression (in adults).
- Social anxiety disorder (in adults).
- Post traumatic stress disorder (PTSD) (in adults).
- Panic disorder (in adults).
- Obsessive compulsive disorder (OCD) (in adults and children andadolescents aged 6-17 years old).
Depression is a clinical illness with symptoms like feeling sad, unable to sleep properly or to enjoy life as you used to.
OCD and Panic disorders are illnesses linked to anxiety with symptoms like being constantly troubled by persistent ideas (obsessions) that makeyou carry out repetitive rituals (compulsions).
PTSD is a condition that can occur after a very emotionally traumatic experience, and has some symptoms that are similar to depression andanxiety. Social anxiety disorder (social phobia) is an illness linked toanxiety. It is characterised by feelings of intense anxiety or distress insocial situations (for example: talking to strangers, speaking in front ofgroups of people, eating or drinking in front of others or worrying that youmight behave in an embarrassing manner).
Your doctor has decided that this medicine is suitable for treating your illness.
You should ask your doctor if you are unsure why you have been given Lustral.
2. Before you take LustralDo not take Lustral:
- If you are allergic (hypersensitive) to sertraline or any of the otheringredients of Lustral (see 6. Further Information for a list ofingredients).
- If you are taking or have taken medicines called monoamine oxidaseinhibitors (MAOIs such as selegiline, moclobemide) or MAOI like drugs(such as linezolid). If you stop treatment with sertraline, you must waituntil at least one week before you start treatment with a MAOI.
After stopping treatment with a MAOI, you must wait at least 2 weeks before you can start treatment with sertraline.
- If you are taking another medicine called Pimozide (a medicine formental disorders such as psychosis).
Take special care with Lustral:
Medicines are not always suitable for everyone. Tell your doctor before you take Lustral, if you suffer from or have suffered in the past from anyof the following conditions:
- Epilepsy or a history of seizures. If you have a fit (seizure), contact yourdoctor immediately.
- If you have suffered from manic depressive illness (bipolar disorder) orschizophrenia. If you have a manic episode, contact your doctorimmediately.
- If you have or have previously had thoughts of harming or killingyourself (see below-Thoughts of suicide and worsening of yourdepression or anxiety disorder).
- Serotonin Syndrome. In rare cases this syndrome may occur when youare taking certain medicines at the same time as sertraline. (Forsymptoms, see section 4. Possible Side Effects). Your doctor will havetold you whether you have suffered from this in the past.
- If you have low sodium level in your blood, since this can occur as aresult of treatment with Lustral. You should also tell your doctor if youare taking certain medicines for hypertension, since these medicinesmay also alter the sodium level in your blood.
- Take special care if you are elderly as you may be more at risk ofhaving low sodium level in your blood (see above).
- Liver disease; your doctor may decide that you should have a lowerdose of Lustral.
- Diabetes; your blood glucose levels may be altered due to Lustral andyour diabetes medicines may need to be adjusted.
- If you have suffered from bleeding disorders or have been takingmedicines which thin the blood (e.g. acetylsalicyclic acid (aspirin), orwarfarin) or may increase the risk of bleeding.
- If you are a child or adolescent under 18 years old. Lustral should onlybe used to treat children and adolescents aged 6-17 years old, sufferingfrom obsessive compulsive disorder (OCD). If you are being treated forthis disorder, your doctor will want to monitor you closely (see below -Use in children and adolescents).
- If you are having electro-convulsive therapy (ECT).
- If you have eye problems, such as certain kinds of glaucoma (increasedpressure in the eye).
Restlessness/Akathisia:
The use of sertraline has been linked to a distressing restlessness and need to move, often being unable to sit or stand still (akathisia). This ismost likely to occur during the first few weeks of treatment. Increasing thedose may be harmful so if you develop such symptoms you should talk toyour doctor.
Withdrawal reactions:
Side effects relating to stopping treatment (withdrawal reactions) are common, particularly if the treatment is stopped suddenly (see section 3 Ifyou stop taking Lustral and section 4 Possible side effects). The risk ofwithdrawal symptoms depends on the length of treatment, dosage, andthe rate at which the dose is reduced. Generally, such symptoms are mildto moderate. However, they can be serious in some patients. Theynormally occur within the first few days after stopping treatment. Ingeneral, such symptoms disappear on their own and wear off within 2weeks. In some patients they may last longer (2-3 months or more).
When stopping treatment with sertraline it is recommended to reduce the dose gradually over a period of several weeks or months, and you shouldalways discuss the best way of stopping treatment with your doctor.
Thoughts of suicide and worsening of your depression or anxiety disorder:
If you are depressed and/or have anxiety disorders you can sometimes have thoughts of harming or killing yourself. These may be increasedwhen first starting antidepressants, since these medicines all take time towork, usually about two weeks but sometimes longer.
You may be more likely to think like this:
- If you have previously had thoughts about killing or harming yourself.
- If you are a young adult. Information from clinical trials has shown anincreased risk of suicidal behaviour in adults aged less than 25 yearswith psychiatric conditions who were treated with an antidepressant.
If you have thoughts of harming or killing yourself at any time, contact your doctor or go to a hospital straight away.
You may find it helpful to tell a relative or close friend that you are depressed or have an anxiety disorder, and ask them to read this leaflet.You might ask them to tell you if they think your depression or anxiety isgetting worse, or if they are worried about changes in your behaviour.
Use in children and adolescents:
Sertraline should not usually be used in children and adolescents less than 18 years old, except for patients with Obsessive CompulsiveDisorder (OCD). Patients under 18 have an increased risk of undesirableeffects, such as suicide attempt, thoughts of harming or killing themselves(suicidal thoughts) and hostility (mainly aggressiveness, oppositionalbehaviour and anger) when they are treated with this class of medicines.Nevertheless, it is possible that your doctor decides to prescribe Lustral toa patient under 18 if it is in the patient's interest. If your doctor hasprescribed Lustral to you and you are less than 18 years old and youwant to discuss this, please contact him/her. Furthermore, if any of thesymptoms listed above appear or worsen while you are taking Lustral,you should inform your doctor. Also, the long-term safety of Lustral inregard to growth, maturation and learning (cognitive) and behaviouraldevelopment in this age group has not yet been demonstrated.
Taking other medicines:
Please tell your doctor if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.
Some medicines can affect the way Lustral works, or Lustral itself can reduce the effectiveness of other medicines taken at the same time.
Taking Lustral together with the following medicines may cause serious side effects:
- Medicines called monoamine oxidase inhibitors (MAOIs), likemoclobemide (to treat depression) and selegiline (to treat Parkinson'sdisease), the antibiotic linezolid and methylene blue (to treat high levelsof methaemoglobin in the blood). Do not use Lustral together with thesemedicines.
- Medicines to treat mental disorders such as psychosis (pimozide).
Do not use Lustral together with pimozide.
Talk to your doctor if you are taking the following medicine:
- Herbal medicine containing St. John's Wort (Hypericum perforatum).The effects of St. John's Wort may last for 1-2 weeks.
- Products containing the amino acid tryptophan.
- Medicines to treat severe pain (e.g. tramadol).
- Medicines used in anaesthesia or to treat chronic pain (fentanyl).
- Medicines to treat migraines (e.g. sumatriptan).
- Blood thinning medicine (warfarin).
- Medicines to treat pain/arthritis (Non steroidal anti-inflammatory drug(NSAID) such as ibuprofen, acetylsalicylic acid (aspirin).
- Sedatives (diazepam).
- Diuretics (also called ‘water' tablets).
- Medicines to treat epilepsy (phenytoin, phenobarbital, carbamazepine).
- Medicines to treat diabetes (tolbutamide).
- Medicines to treat excessive stomach acid, ulcers and heartburn(cimetidine, omeprazole, lanzoprazole, pantoprazole, rabeprazole).
- Medicines to treat mania and depression (lithium).
- Other medicines to treat depression (such as amitriptyline, nortriptyline,nefazodone, fluoxetine, fluvoxamine).
- Medicines to treat schizophrenia and other mental disorders (such asperphenazine, levomepromazine and olanzapine).
- Medicines used to treat high blood pressure, chest pain or regulate therate and rhythm of the heart (such as verapamil, diltiazem, flecainide,propafenone).
- Medicines used to treat bacterial infections (such as rifampicin,clarithromycin, telithromycin, erythromycin).
- Medicines used to treat fungal infections (such as ketoconazole,itraconazole, posaconazole, voriconazole, fluconazole).
- Medicines used to treat HIV/AIDS and Hepatitis C (protease inhibitorssuch as ritonavir, telaprevir).
- Medicines used to prevent nausea and vomiting after an operation orchemotherapy (aprepitant).
Taking Lustral with food and drink:
Lustral tablets can be taken with or without food.
Alcohol should be avoided whilst taking Lustral.
Sertraline should not be taken in combination with grapefruit juice, as this may increase the level of sertraline in your body.
Pregnancy, breast-feeding and fertility:
Ask your doctor or pharmacist for advice before taking any medicine.
The safety of sertraline has not fully been established in pregnant women. Sertraline will only be given to you when pregnant if yourdoctor considers that the benefit for you is greater than anypossible risk to the developing baby. If you are a woman capable ofhaving children you should use a reliable method of contraception(such as the contraceptive pill), when taking sertraline.
Make sure your midwife and/or doctor know you are on Lustral. When taken during pregnancy, particularly in the last 3 months ofpregnancy, medicines like Lustral may increase the risk of a seriouscondition in babies, called persistent pulmonary hypertension of thenewborn (PPHN), making the baby breathe faster and appear bluish.These symptoms usually begin during the first 24 hours after thebaby is born. If this happens to your baby you should contact yourmidwife and/or doctor immediately.
Your newborn baby might also have other conditions, which usually begin during the first 24 hours after birth. Symptoms include:
- trouble with breathing,
- a blueish skin or being too hot or cold,
- blue lips,
- vomiting or not feeding properly,
- being very tired, not able to sleep or crying a lot,
- stiff or floppy muscles,
- tremors, jitters or fits,
- increased reflex reactions,
- irritability,
- low blood sugar.
If your baby has any of these symptoms when it is born, or you are concerned about your baby’s health, contact your doctor or midwifewho will be able to advise you.
There is evidence that sertraline passes into human breast milk. Sertraline should only be used in women during breast-feeding, ifyour doctor considers that the benefit exceeds any possible risk tothe baby.
Some medicines like sertraline may reduce the quality of sperm in animal studies. Theoretically, this could affect fertility, but impact onhuman fertility has not been observed as yet.
Driving and using machines:
Psychotropic drugs such as sertraline may influence your ability to drive or use machines. You should therefore not drive or operate machinery, untilyou know how this medication affects your ability to perform these activities.
3. How to take Lustral
Always take Lustral exactly as your doctor has told you.
Lustral tablets may be taken with or without food.
Take your medication once daily either in the morning or evening.
You should check with your doctor or pharmacist if you are not sure.
The usual dose is:
Adults:
Depression and Obsessive Compulsive Disorder
For depression and OCD, the usual effective dose is 50 mg/day. The daily dose may be increased in 50 mg increments and at intervals of atleast one week over a period of weeks. The maximum recommendeddose is 200 mg/day.
Panic disorder, Social anxiety disorder and Post Traumatic Stress Disorder:
For panic disorder, social anxiety disorder and post traumatic stress disorder, treatment should be started at 25 mg/day, and increased to 50mg/day after one week.
The daily dose then may be increased in 50 mg increments over a period of weeks. The maximum recommended dose is 200 mg/day.
Children and adolescents:
Lustral must only be used to treat children and adolescents suffering from OCD aged 6-17 years old.
Obsessive Compulsive Disorder:
Children aged 6 to 12: the recommended starting dose is 25 mg daily. After one week, your doctor may increase this to 50 mg daily. Themaximum dose is 200 mg daily.
Adolescents aged 13 to 17: the recommended starting dose is 50 mg daily.
The maximum dose is 200 mg daily.
If you have liver or kidney problems, please tell your doctor and follow the doctor's instructions.
Your doctor will advise you on how long to take this medication for. This will depend on the nature of your illness and how well you are respondingto the treatment. It may take several weeks before your symptoms beginto improve. Treatment of depression should usually continue for 6 monthsafter improvement.
If you take more Lustral than you should:
If you accidentally take too much Lustral contact your doctor at once or go to the nearest hospital casualty department. Always take the labelledmedicine package with you, whether there is any medication left or not.
Symptoms of overdose may include drowsiness, nausea and vomiting, rapid heart rate, shaking, agitation, dizziness and in rare casesunconsciousness.
If you forget to take Lustral:
If you forget to take a dose, do not take the missed dose. Just take the next dose at the right time.
Do not take a double dose to make up for a forgotten dose.
If you stop taking Lustral:
Do not stop taking Lustral unless your doctor tells you to.
Your doctor will want to gradually reduce your dose of Lustral over several weeks, before you finally stop taking this medicine. If yousuddenly stop taking this medicine you may experience side effects suchas dizziness, numbness, sleep disturbances, agitation or anxiety,headaches, feeling sick, being sick and shaking. If you experience any ofthese side effects, or any other side effects whilst stopping taking Lustral,please speak to your doctor.
If you have any further questions on the use of this product, ask your doctor or pharmacist.
Lustral® 50 mg film-coated tablets PLPI 20636/2522 Lustral® 100 mg film-coated tablets PLPI 20636/2523
POM
4. Possible side effects
Like all medicines, Lustral can cause side effects, although not everybody gets them.
If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.
Nausea is the most common side effect. The side effects depend on the dose and often disappear or lessen with continued treatment.
Tell your doctor immediately:
If you experience any of the following symptoms after taking this medicine, these symptoms can be serious.
- If you develop a severe skin rash that causes blistering (erythemamultiforme), (this can affect the mouth and tongue). These may besigns of a condition known as Stevens Johnson Syndrome, or ToxicEpidermal Necrolysis (TEN). Your doctor will stop your treatment inthese cases.
- Allergic reaction or allergy, which may include symptoms such as an itchyskin rash, breathing problems, wheezing, swollen eyelids, face or lips.
- If you experience agitation, confusion, diarrhoea, high temperature andblood pressure, excessive sweating and rapid heartbeat. These aresymptoms of Serotonin Syndrome. In rare cases this syndrome mayoccur when you are taking certain medicines at the same time assertraline. Your doctor may wish to stop your treatment.
- If you develop yellow skin and eyes which may mean liver damage.
- If you experience depressive symptoms with ideas of harming or killingyourself (suicidal thoughts).
- If you start to get feelings of restlessness and are not able to sit orstand still after you start to take Lustral. You should tell your doctor ifyou start to feel restless.
- If you have a fit (seizure).
- If you have a manic episode (see section 2 “Take special care withLustral”).
The following side effects were seen in clinical trials in adults.
Very common side effects (occurs in more than 1 out of 10 patients):
Insomnia, dizziness, sleepiness, headache, diarrhoea, feeling sick, dry mouth, ejacul*tion failure, fatigue.
Common side effects (occurs in between 1 and 10 out of 100 patients):
- Sore throat, anorexia, increased appetite,
- depression, feeling strange, nightmare, anxiety, agitation, nervousness,decreased sexual interest, teeth grinding,
- numbness and tingling, shaking, muscle tense, abnormal taste, lack ofattention,
- visual disturbance, ringing in ears,
- palpitations, hot flush, yawning,
- abdominal pain, vomiting, constipation, upset stomach, gas,
- rash, increased sweating, muscle pain, erectile dysfunction, chest pain.
- joint pain,
- Malaise.
Uncommon side effects (occurs in between 1 and 10 out of 1.000 patients):
- Chest cold, runny nose,
- hypersensitivity,
- low thyroid hormones,
- hallucination, feeling too happy, lack of caring, thinking abnormal,aggression,
- convulsion, involuntary muscle contractions, abnormal coordination,moving a lot, amnesia, decreased feeling, speech disorder, dizzinesswhile standing up, passing out, migraine,
- enlarged pupils,
- ear pain, fast heartbeat, high blood pressure, flushing,
- breathing difficulty, possible wheezing, shortness of breath, nose bleed,
- inflammation of the oesophagus, difficulty swallowing, haemorrhoids,increased saliva, tongue disorder, burping,
- eye swelling, purple spots on skin, face oedema, hair loss, cold sweat,dry skin, hives, itching,
- osteoarthritis, muscular weakness, back pain, muscle twitching,
- nighttime urination, unable to urinate, increase in urination, increase infrequency of urination, problem urinating, urinary incontinence,
- vagin*l haemorrhage, sexual dysfunction, female sexual dysfunction,menstrual irregularities, swelling in legs, chills, fever, weakness, thirst,increase in liver enzyme levels, weight decreased, weight increased.
Rare side effects (occurs in between 1 and 10 out of 10.000 patients):
- Intestine problem, ear infection, cancer, swollen glands, highcholesterol, low blood sugar,
- physical symptoms due to stress or emotions, drug dependence,psychotic disorder, paranoia, suicidal thoughts, sleep walking,premature ejacul*tion,
- severe allergic reaction,
- coma, abnormal movements, difficulty moving, increased sensation,sensory disturbance,
- glaucoma, tear problem, spots in front of eyes, double vision, light hurtseye, blood in the eye,
- problems controlling blood sugar levels (diabetes),
- heart attack, slow heart beat, heart problem, poor circulation of armsand legs, closing up of throat, breathing fast, breathing slow, difficultytalking, hiccups,
- blood in stool, sore mouth, tongue ulceration, tooth disorder, tongueproblem, mouth ulceration, problems with liver function,
- skin problem with blisters, hair rash, hair texture abnormal, skin odourabnormal, bone disorder,
- decreased urination, urinary hesitation, blood in urine,
- excessive vagin*l bleeding, dry vagin*l area, red painful penis andforeskin, genital discharge, prolonged erection, breast discharge,
- hernia, drug tolerance decreased, difficulty walking, sem*n abnormal,increase in blood cholesterol levels, injury, relaxation of blood vesselsprocedure.
- Cases of suicidal ideation and suicidal behaviours have beenreported during sertraline therapy or early after treatmentdiscontinuation (see section 2.).
After marketing sertraline, the following side effects have been reported:
- Decrease in white blood cells, decrease in clotting cells, endocrineproblem, low blood salt, increase in blood sugar levels,
- terrifying abnormal dreams, suicidal behaviour,
- muscular movement problems (such as moving a lot, tense muscles,difficulty walking and stiffness, spasms and involuntary movements ofthe muscles), sudden severe headache (which may be a sign of aserious condition known as Reversible Cerebral VasoconstrictionSyndrome (RCVS)),
- vision abnormal, unequal sized pupils, bleeding problems (such asstomach bleeding), progressive scarring of lung tissue (Interstitial LungDisease), pancreatitis, serious liver function problems, yellow skin andeyes (jaundice),
- skin oedema, skin reaction to sun, muscle cramps, breast enlargement,problems with clotting, bedwetting.
Side effects in children and adolescents
In clinical trials with children and adolescents, the side effects were generally similar to adults (see above). The most common side effects inchildren and adolescents were headache, insomnia, diarrhoea and feelingsick.
Symptoms that can occur when treatment is discontinued
If you suddenly stop taking this medicine you may experience side effects such as dizziness, numbness, sleep disturbances, agitation or anxiety,headaches, feeling sick, being sick and shaking (see section 3. “If youstop taking Lustral”).
An increased risk of bone fractures has been observed in patients taking this type of medicines.
Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can alsoreport side effects directly via the Yellow Card Scheme at:www.mhra.gov.uk/yellowcard. By reporting side effects, you can helpprovide more information on the safety of this medicine.
5. How to store Lustral
Keep out of the sight and reach of children.
Do not store above 25oC.
Do not use Lustral after the expiry date which is stated on the pack. The expiry date refers to the last day of that month.
If the medicines become discoloured or show any other signs of deterioration, consult your pharmacist who will tell you what to do.Medicines should not be disposed of via wastewater or household waste.Ask your pharmacist how to dispose of medicines no longer required.These measures will help to protect the environment.
6. Further informationWhat Lustral contains
Lustral 50 mg - Each film-coated tablet contains 50 mg sertraline (as hydrochloride).
Lustral 100 mg - Each film-coated tablet contains 100 mg sertraline (as hydrochloride).
Other ingredients: Calcium hydrogen phosphate, hydroxypropylcellulose, hypromellose, magnesium stearate, microcrystalline cellulose, macrogol,polysorbate, sodium starch glycollate and titanium dioxide (E171).
What Lustral looks like and contents of the pack
Lustral 50 mg - White, capsular shaped, film-coated scored tablets marked 'ZLT 50' on one side and 'PFIZER' on the other.
Lustral 100 mg - White, capsular shaped, film-coated tablets marked 'ZLT 100' on one side and 'PFIZER' on the other.
Each pack contains 30 or 60 film-coated tablets.
Manufacturer and Product Licence Holder
Manufactured by Pfizer Italia S.R.L., Borgo San Michele S.S. Km 50, Latina, Italy. Procured from within the EU by Product Licence holder:Star Pharmaceuticals Ltd., 5 Sandridge Close, Harrow, Middlesex HA11XD. Repackaged by Servipharm Ltd.
Leaflet issue and revision date (Ref.) 30.07.14[7] Lustral® is a trademark of Pfizer Products lnc.
2522/2523
30.07.14[7]
PATIENT INFORMATION LEAFLET
(sertraline hydrochloride)
Read all of this leaflet carefully before you start taking this medicine.
- Keep this leaflet. You may need to read it again.
- If you have any further questions, ask your doctor or pharmacist.
- This medicine has been prescribed for you. Do not pass it on to others.
It may harm them, even if their symptoms are the same as yours.
- If any of the side effects gets serious, or if you notice any side effectsnot listed in this leaflet, please tell your doctor or pharmacist.
This medicine is available using any of the above names but will be referred to as Sertraline throughout this leaflet.
In this leaflet:
1. What Sertraline is and what it is used for.
2. Before you take Sertraline.
3. How to take Sertraline.
4. Possible side effects.
5. How to store Sertraline.
6. Further information.
1. What Sertraline is and what it is used for
Sertraline contains the active ingredient sertraline. Sertraline is one of a group of medicines called Selective Serotonin Re-uptake Inhibitors(SSRIs); these medicines are used to treat depression and/or anxietydisorders.
Sertraline can be used to treat:
- Depression and prevention of recurrence of depression (in adults).
- Social anxiety disorder (in adults).
- Post traumatic stress disorder (PTSD) (in adults).
- Panic disorder (in adults).
- Obsessive compulsive disorder (OCD) (in adults and children andadolescents aged 6-17 years old).
Depression is a clinical illness with symptoms like feeling sad, unable to sleep properly or to enjoy life as you used to.
OCD and Panic disorders are illnesses linked to anxiety with symptoms like being constantly troubled by persistent ideas (obsessions) that makeyou carry out repetitive rituals (compulsions).
PTSD is a condition that can occur after a very emotionally traumatic experience, and has some symptoms that are similar to depression andanxiety. Social anxiety disorder (social phobia) is an illness linked toanxiety. It is characterised by feelings of intense anxiety or distress insocial situations (for example: talking to strangers, speaking in front ofgroups of people, eating or drinking in front of others or worrying that youmight behave in an embarrassing manner).
Your doctor has decided that this medicine is suitable for treating your illness.
You should ask your doctor if you are unsure why you have been given Sertraline.
2. Before you take SertralineDo not take Sertraline:
- If you are allergic (hypersensitive) to sertraline or any of the otheringredients of Sertraline (see 6. Further Information for a list ofingredients).
- If you are taking or have taken medicines called monoamine oxidaseinhibitors (MAOIs such as selegiline, moclobemide) or MAOI like drugs(such as linezolid). If you stop treatment with sertraline, you must waituntil at least one week before you start treatment with a MAOI.
After stopping treatment with a MAOI, you must wait at least 2 weeks before you can start treatment with sertraline.
- If you are taking another medicine called Pimozide (a medicine formental disorders such as psychosis).
Take special care with Sertraline:
Medicines are not always suitable for everyone. Tell your doctor before you take Sertraline, if you suffer from or have suffered in the past fromany of the following conditions:
- Epilepsy or a history of seizures. If you have a fit (seizure), contact yourdoctor immediately.
- If you have suffered from manic depressive illness (bipolar disorder) orschizophrenia. If you have a manic episode, contact your doctorimmediately.
- If you have or have previously had thoughts of harming or killingyourself (see below-Thoughts of suicide and worsening of yourdepression or anxiety disorder).
- Serotonin Syndrome. In rare cases this syndrome may occur when youare taking certain medicines at the same time as sertraline. (Forsymptoms, see section 4. Possible Side Effects). Your doctor will havetold you whether you have suffered from this in the past.
- If you have low sodium level in your blood, since this can occur as aresult of treatment with Sertraline. You should also tell your doctor ifyou are taking certain medicines for hypertension, since thesemedicines may also alter the sodium level in your blood.
- Take special care if you are elderly as you may be more at risk ofhaving low sodium level in your blood (see above).
- Liver disease; your doctor may decide that you should have a lowerdose of Sertraline.
- Diabetes; your blood glucose levels may be altered due to Sertralineand your diabetes medicines may need to be adjusted.
- If you have suffered from bleeding disorders or have been takingmedicines which thin the blood (e.g. acetylsalicyclic acid (aspirin), orwarfarin) or may increase the risk of bleeding.
- If you are a child or adolescent under 18 years old. Sertraline shouldonly be used to treat children and adolescents aged 6-17 years old,suffering from obsessive compulsive disorder (OCD). If you are beingtreated for this disorder, your doctor will want to monitor you closely(see below - Use in children and adolescents).
- If you are having electro-convulsive therapy (ECT).
- If you have eye problems, such as certain kinds of glaucoma (increasedpressure in the eye).
Restlessness/Akathisia:
The use of sertraline has been linked to a distressing restlessness and need to move, often being unable to sit or stand still (akathisia). This ismost likely to occur during the first few weeks of treatment. Increasing thedose may be harmful so if you develop such symptoms you should talk toyour doctor.
Withdrawal reactions:
Side effects relating to stopping treatment (withdrawal reactions) are common, particularly if the treatment is stopped suddenly (see section 3 Ifyou stop taking Sertraline and section 4 Possible side effects). The risk ofwithdrawal symptoms depends on the length of treatment, dosage, andthe rate at which the dose is reduced. Generally, such symptoms are mildto moderate. However, they can be serious in some patients. Theynormally occur within the first few days after stopping treatment. Ingeneral, such symptoms disappear on their own and wear off within 2weeks. In some patients they may last longer (2-3 months or more).
When stopping treatment with sertraline it is recommended to reduce the dose gradually over a period of several weeks or months, and you shouldalways discuss the best way of stopping treatment with your doctor.
Thoughts of suicide and worsening of your depression or anxiety disorder:
If you are depressed and/or have anxiety disorders you can sometimes have thoughts of harming or killing yourself. These may be increasedwhen first starting antidepressants, since these medicines all take time towork, usually about two weeks but sometimes longer.
You may be more likely to think like this:
- If you have previously had thoughts about killing or harming yourself.
- If you are a young adult. Information from clinical trials has shown anincreased risk of suicidal behaviour in adults aged less than 25 yearswith psychiatric conditions who were treated with an antidepressant.
If you have thoughts of harming or killing yourself at any time, contact your doctor or go to a hospital straight away.
You may find it helpful to tell a relative or close friend that you are depressed or have an anxiety disorder, and ask them to read this leaflet.You might ask them to tell you if they think your depression or anxiety isgetting worse, or if they are worried about changes in your behaviour.
Use in children and adolescents:
Sertraline should not usually be used in children and adolescents less than 18 years old, except for patients with Obsessive CompulsiveDisorder (OCD). Patients under 18 have an increased risk of undesirableeffects, such as suicide attempt, thoughts of harming or killing themselves(suicidal thoughts) and hostility (mainly aggressiveness, oppositionalbehaviour and anger) when they are treated with this class of medicines.Nevertheless, it is possible that your doctor decides to prescribeSertraline to a patient under 18 if it is in the patient's interest. If yourdoctor has prescribed Sertraline to you and you are less than 18 yearsold and you want to discuss this, please contact him/her. Furthermore, ifany of the symptoms listed above appear or worsen while you are takingSertraline, you should inform your doctor. Also, the long-term safety ofSertraline in regard to growth, maturation and learning (cognitive) andbehavioural development in this age group has not yet beendemonstrated.
Taking other medicines:
Please tell your doctor if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.
Some medicines can affect the way Sertraline works, or Sertraline itself can reduce the effectiveness of other medicines taken at the same time.
Taking Sertraline together with the following medicines may cause serious side effects:
- Medicines called monoamine oxidase inhibitors (MAOIs), likemoclobemide (to treat depression) and selegiline (to treat Parkinson'sdisease), the antibiotic linezolid and methylene blue (to treat high levelsof methaemoglobin in the blood). Do not use Sertraline together withthese medicines.
- Medicines to treat mental disorders such as psychosis (pimozide).
Do not use Sertraline together with pimozide.
Talk to your doctor if you are taking the following medicine:
- Herbal medicine containing St. John's Wort (Hypericum perforatum).The effects of St. John's Wort may last for 1-2 weeks.
- Products containing the amino acid tryptophan.
- Medicines to treat severe pain (e.g. tramadol).
- Medicines used in anaesthesia or to treat chronic pain (fentanyl).
- Medicines to treat migraines (e.g. sumatriptan).
- Blood thinning medicine (warfarin).
- Medicines to treat pain/arthritis (Non steroidal anti-inflammatory drug(NSAID) such as ibuprofen, acetylsalicylic acid (aspirin).
- Sedatives (diazepam).
- Diuretics (also called ‘water' tablets).
- Medicines to treat epilepsy (phenytoin, phenobarbital, carbamazepine).
- Medicines to treat diabetes (tolbutamide).
- Medicines to treat excessive stomach acid, ulcers and heartburn(cimetidine, omeprazole, lanzoprazole, pantoprazole, rabeprazole).
- Medicines to treat mania and depression (lithium).
- Other medicines to treat depression (such as amitriptyline, nortriptyline,nefazodone, fluoxetine, fluvoxamine).
- Medicines to treat schizophrenia and other mental disorders (such asperphenazine, levomepromazine and olanzapine).
- Medicines used to treat high blood pressure, chest pain or regulate therate and rhythm of the heart (such as verapamil, diltiazem, flecainide,propafenone).
- Medicines used to treat bacterial infections (such as rifampicin,clarithromycin, telithromycin, erythromycin).
- Medicines used to treat fungal infections (such as ketoconazole,itraconazole, posaconazole, voriconazole, fluconazole).
- Medicines used to treat HIV/AIDS and Hepatitis C (protease inhibitorssuch as ritonavir, telaprevir).
- Medicines used to prevent nausea and vomiting after an operation orchemotherapy (aprepitant).
Taking Sertraline with food and drink:
Sertraline tablets can be taken with or without food.
Alcohol should be avoided whilst taking Sertraline.
Sertraline should not be taken in combination with grapefruit juice, as this may increase the level of sertraline in your body.
Pregnancy, breast-feeding and fertility:
Ask your doctor or pharmacist for advice before taking any medicine.
The safety of sertraline has not fully been established in pregnant women. Sertraline will only be given to you when pregnant if yourdoctor considers that the benefit for you is greater than anypossible risk to the developing baby. If you are a woman capable ofhaving children you should use a reliable method of contraception(such as the contraceptive pill), when taking sertraline.
Make sure your midwife and/or doctor know you are on Sertraline. When taken during pregnancy, particularly in the last 3 months ofpregnancy, medicines like Sertraline may increase the risk of aserious condition in babies, called persistent pulmonaryhypertension of the newborn (PPHN), making the baby breathefaster and appear bluish. These symptoms usually begin during thefirst 24 hours after the baby is born. If this happens to your babyyou should contact your midwife and/or doctor immediately.
Your newborn baby might also have other conditions, which usually begin during the first 24 hours after birth. Symptoms include:
- trouble with breathing,
- a blueish skin or being too hot or cold,
- blue lips,
- vomiting or not feeding properly,
- being very tired, not able to sleep or crying a lot,
- stiff or floppy muscles,
- tremors, jitters or fits,
- increased reflex reactions,
- irritability,
- low blood sugar.
If your baby has any of these symptoms when it is born, or you are concerned about your baby’s health, contact your doctor or midwifewho will be able to advise you.
There is evidence that sertraline passes into human breast milk. Sertraline should only be used in women during breast-feeding, ifyour doctor considers that the benefit exceeds any possible risk tothe baby.
Some medicines like sertraline may reduce the quality of sperm in animal studies. Theoretically, this could affect fertility, but impact onhuman fertility has not been observed as yet.
Driving and using machines:
Psychotropic drugs such as sertraline may influence your ability to drive or use machines. You should therefore not drive or operate machinery, untilyou know how this medication affects your ability to perform these activities.
3. How to take Sertraline
Always take Sertraline exactly as your doctor has told you.
Sertraline tablets may be taken with or without food.
Take your medication once daily either in the morning or evening.
You should check with your doctor or pharmacist if you are not sure.
The usual dose is:
Adults:
Depression and Obsessive Compulsive Disorder
For depression and OCD, the usual effective dose is 50 mg/day. The daily dose may be increased in 50 mg increments and at intervals of atleast one week over a period of weeks. The maximum recommendeddose is 200 mg/day.
Panic disorder, Social anxiety disorder and Post Traumatic Stress Disorder:
For panic disorder, social anxiety disorder and post traumatic stress disorder, treatment should be started at 25 mg/day, and increased to 50mg/day after one week.
The daily dose then may be increased in 50 mg increments over a period of weeks. The maximum recommended dose is 200 mg/day.
Children and adolescents:
Sertraline must only be used to treat children and adolescents suffering from OCD aged 6-17 years old.
Obsessive Compulsive Disorder:
Children aged 6 to 12: the recommended starting dose is 25 mg daily. After one week, your doctor may increase this to 50 mg daily. Themaximum dose is 200 mg daily.
Adolescents aged 13 to 17: the recommended starting dose is 50 mg daily.
The maximum dose is 200 mg daily.
If you have liver or kidney problems, please tell your doctor and follow the doctor's instructions.
Your doctor will advise you on how long to take this medication for. This will depend on the nature of your illness and how well you are respondingto the treatment. It may take several weeks before your symptoms beginto improve. Treatment of depression should usually continue for 6 monthsafter improvement.
If you take more Sertraline than you should:
If you accidentally take too much Sertraline contact your doctor at once or go to the nearest hospital casualty department. Always take the labelledmedicine package with you, whether there is any medication left or not.
Symptoms of overdose may include drowsiness, nausea and vomiting, rapid heart rate, shaking, agitation, dizziness and in rare casesunconsciousness.
If you forget to take Sertraline:
If you forget to take a dose, do not take the missed dose. Just take the next dose at the right time.
Do not take a double dose to make up for a forgotten dose.
If you stop taking Sertraline:
Do not stop taking Sertraline unless your doctor tells you to.
Your doctor will want to gradually reduce your dose of Sertraline over several weeks, before you finally stop taking this medicine. If yousuddenly stop taking this medicine you may experience side effects suchas dizziness, numbness, sleep disturbances, agitation or anxiety,headaches, feeling sick, being sick and shaking. If you experience any ofthese side effects, or any other side effects whilst stopping takingSertraline, please speak to your doctor.
If you have any further questions on the use of this product, ask your doctor or pharmacist.
Sertraline® 50 mg film-coated tablets PLPI 20636/2522 Sertraline® 100 mg film-coated tablets PLPI 20636/2523
POM
4. Possible side effects
Like all medicines, Sertraline can cause side effects, although not everybody gets them.
If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.
Nausea is the most common side effect. The side effects depend on the dose and often disappear or lessen with continued treatment.
Tell your doctor immediately:
If you experience any of the following symptoms after taking this medicine, these symptoms can be serious.
- If you develop a severe skin rash that causes blistering (erythemamultiforme), (this can affect the mouth and tongue). These may besigns of a condition known as Stevens Johnson Syndrome, or ToxicEpidermal Necrolysis (TEN). Your doctor will stop your treatment inthese cases.
- Allergic reaction or allergy, which may include symptoms such as an itchyskin rash, breathing problems, wheezing, swollen eyelids, face or lips.
- If you experience agitation, confusion, diarrhoea, high temperature andblood pressure, excessive sweating and rapid heartbeat. These aresymptoms of Serotonin Syndrome. In rare cases this syndrome mayoccur when you are taking certain medicines at the same time assertraline. Your doctor may wish to stop your treatment.
- If you develop yellow skin and eyes which may mean liver damage.
- If you experience depressive symptoms with ideas of harming or killingyourself (suicidal thoughts).
- If you start to get feelings of restlessness and are not able to sit orstand still after you start to take Sertraline. You should tell your doctor ifyou start to feel restless.
- If you have a fit (seizure).
- If you have a manic episode (see section 2 “Take special care withSertraline”).
The following side effects were seen in clinical trials in adults.
Very common side effects (occurs in more than 1 out of 10 patients):
Insomnia, dizziness, sleepiness, headache, diarrhoea, feeling sick, dry mouth, ejacul*tion failure, fatigue.
Common side effects (occurs in between 1 and 10 out of 100 patients):
- Sore throat, anorexia, increased appetite,
- depression, feeling strange, nightmare, anxiety, agitation, nervousness,decreased sexual interest, teeth grinding,
- numbness and tingling, shaking, muscle tense, abnormal taste, lack ofattention,
- visual disturbance, ringing in ears,
- palpitations, hot flush, yawning,
- abdominal pain, vomiting, constipation, upset stomach, gas,
- rash, increased sweating, muscle pain, erectile dysfunction, chest pain.
- joint pain,
- Malaise.
Uncommon side effects (occurs in between 1 and 10 out of 1.000 patients):
- Chest cold, runny nose,
- hypersensitivity,
- low thyroid hormones,
- hallucination, feeling too happy, lack of caring, thinking abnormal,aggression,
- convulsion, involuntary muscle contractions, abnormal coordination,moving a lot, amnesia, decreased feeling, speech disorder, dizzinesswhile standing up, passing out, migraine,
- enlarged pupils,
- ear pain, fast heartbeat, high blood pressure, flushing,
- breathing difficulty, possible wheezing, shortness of breath, nose bleed,
- inflammation of the oesophagus, difficulty swallowing, haemorrhoids,increased saliva, tongue disorder, burping,
- eye swelling, purple spots on skin, face oedema, hair loss, cold sweat,dry skin, hives, itching,
- osteoarthritis, muscular weakness, back pain, muscle twitching,
- nighttime urination, unable to urinate, increase in urination, increase infrequency of urination, problem urinating, urinary incontinence,
- vagin*l haemorrhage, sexual dysfunction, female sexual dysfunction,menstrual irregularities, swelling in legs, chills, fever, weakness, thirst,increase in liver enzyme levels, weight decreased, weight increased.
Rare side effects (occurs in between 1 and 10 out of 10.000 patients):
- Intestine problem, ear infection, cancer, swollen glands, highcholesterol, low blood sugar,
- physical symptoms due to stress or emotions, drug dependence,psychotic disorder, paranoia, suicidal thoughts, sleep walking,premature ejacul*tion,
- severe allergic reaction,
- coma, abnormal movements, difficulty moving, increased sensation,sensory disturbance,
- glaucoma, tear problem, spots in front of eyes, double vision, light hurtseye, blood in the eye,
- problems controlling blood sugar levels (diabetes),
- heart attack, slow heart beat, heart problem, poor circulation of armsand legs, closing up of throat, breathing fast, breathing slow, difficultytalking, hiccups,
- blood in stool, sore mouth, tongue ulceration, tooth disorder, tongueproblem, mouth ulceration, problems with liver function,
- skin problem with blisters, hair rash, hair texture abnormal, skin odourabnormal, bone disorder,
- decreased urination, urinary hesitation, blood in urine,
- excessive vagin*l bleeding, dry vagin*l area, red painful penis andforeskin, genital discharge, prolonged erection, breast discharge,
- hernia, drug tolerance decreased, difficulty walking, sem*n abnormal,increase in blood cholesterol levels, injury, relaxation of blood vesselsprocedure.
- Cases of suicidal ideation and suicidal behaviours have beenreported during sertraline therapy or early after treatmentdiscontinuation (see section 2.).
After marketing sertraline, the following side effects have been reported:
- Decrease in white blood cells, decrease in clotting cells, endocrineproblem, low blood salt, increase in blood sugar levels,
- terrifying abnormal dreams, suicidal behaviour,
- muscular movement problems (such as moving a lot, tense muscles,difficulty walking and stiffness, spasms and involuntary movements ofthe muscles), sudden severe headache (which may be a sign of aserious condition known as Reversible Cerebral VasoconstrictionSyndrome (RCVS)),
- vision abnormal, unequal sized pupils, bleeding problems (such asstomach bleeding), progressive scarring of lung tissue (Interstitial LungDisease), pancreatitis, serious liver function problems, yellow skin andeyes (jaundice),
- skin oedema, skin reaction to sun, muscle cramps, breast enlargement,problems with clotting, bedwetting.
Side effects in children and adolescents
In clinical trials with children and adolescents, the side effects were generally similar to adults (see above). The most common side effects inchildren and adolescents were headache, insomnia, diarrhoea and feelingsick.
Symptoms that can occur when treatment is discontinued
If you suddenly stop taking this medicine you may experience side effects such as dizziness, numbness, sleep disturbances, agitation or anxiety,headaches, feeling sick, being sick and shaking (see section 3. “If youstop taking Sertraline”).
An increased risk of bone fractures has been observed in patients taking this type of medicines.
Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can alsoreport side effects directly via the Yellow Card Scheme at:www.mhra.gov.uk/yellowcard. By reporting side effects, you can helpprovide more information on the safety of this medicine.
5. How to store Sertraline
Keep out of the sight and reach of children.
Do not store above 25oC.
Do not use Sertraline after the expiry date which is stated on the pack.
The expiry date refers to the last day of that month.
If the medicines become discoloured or show any other signs of deterioration, consult your pharmacist who will tell you what to do.Medicines should not be disposed of via wastewater or household waste.Ask your pharmacist how to dispose of medicines no longer required.These measures will help to protect the environment.
6. Further informationWhat Sertraline contains
Sertraline 50 mg - Each film-coated tablet contains 50 mg sertraline (as hydrochloride)
Sertraline 100 mg - Each film-coated tablet contains 100 mg sertraline (as hydrochloride)
Other ingredients: Calcium hydrogen phosphate, hydroxypropylcellulose, hypromellose, magnesium stearate, microcrystalline cellulose, macrogol,polysorbate, sodium starch glycollate and titanium dioxide (E171).
What Sertraline looks like and contents of the pack
Sertraline 50 mg - White, capsular shaped, film-coated scored tablets marked 'ZLT 50' on one side and 'PFIZER' on the other.
Sertraline 100 mg - White, capsular shaped, film-coated tablets marked 'ZLT 100' on one side and 'PFIZER' on the other.
Each pack contains 30 or 60 film-coated tablets.
Manufacturer and Product Licence Holder
Manufactured by Pfizer Italia S.R.L., Borgo San Michele S.S. Km 50, Latina, Italy. Procured from within the EU by Product Licence holder:Star Pharmaceuticals Ltd., 5 Sandridge Close, Harrow, Middlesex HA11XD. Repackaged by Servipharm Ltd.
Leaflet issue and revision date (Ref.) 30.07.14[7]
