Zoloft

Medically Reviewed by HaVy Ngo, Pharm.D.

Last Reviewed: Jun 06, 2022

Warnings

What are the risks of taking Zoloft (sertraline)?

Zoloft can cause serious health problems, especially in certain high-risk patients.

In children, adolescents, and young adults under the age of 24, sertraline (Zoloft) can increase the risk of suicidal thoughts and behavior. This risk is highest in the first few weeks of treatment and after dose changes. If you notice unusual mood changes or behaviors in children and adolescents or young adults while on Zoloft, let their health care provider know immediately.

Other serious risks of Zoloft use include:

Serotonin syndrome: This is a rare but potentially life-threatening condition in which there is too much serotonin in the brain. The risk of this condition is higher if someone takes other drugs that can increase serotonin levels in the brain, such as other antidepressants, lithium, triptans (medications used to treat migraines and cluster headaches), and St John’s Wort (a herbal supplement that is used to treat symptoms of depression. Symptoms of serotonin syndrome include fever, confusion, muscle spasms, muscle stiffness, sweating, fast heart rate, nausea, vomiting, diarrhea. You should seek medical attention right away if you experience these symptoms on Zoloft.
Bleeding risk: There can be an increased risk of bleeding when Zoloft is taken in combination with certain drugs like blood thinners, or NSAIDs such as Advil (ibuprofen), or aspirin. Be vigilant for signs and symptoms such as unexplained bruises, dark tarry stools, pink or red urine, or unusual bleeding from the gums or nose. Call your doctor immediately if you notice any of these symptoms.
Abnormal heart rhythm: Zoloft can cause your heart to beat irregularly. You should contact your doctor immediately or go to the emergency room if you experience symptoms such as fast heart rate, chest pain, difficulty breathing, or dizziness. The risk of this Zoloft complication is higher in people with heart rhythm problems or with a family history of heart disease, those with low magnesium or low potassium levels, and those on treatment with other drugs that also affect the heart rhythm.
Low sodium: Zoloft can lead to low sodium levels in the blood. Call your doctor without delay if you experience symptoms such as confusion, trouble concentration, memory difficulties, headache, or weakness. This risk is higher in patients who take diuretics (water pills) or become dehydrated.
Mania: People with bipolar disorder experience alternating periods of depression and mania. Someone with this condition may initially present with depression. Treating them with an antidepressant such as Zoloft can bring on a manic episode with symptoms such as overactivity, euphoria, and delusions.
Withdrawal: Stopping Zoloft suddenly can lead to withdrawal symptoms such as nausea, agitation, anxiety, flu-like symptoms, dizziness, and sleeping difficulties. The symptoms usually appear within 3 days of Zoloft cessation. Obtain medical advice from your doctor about slowly and safely coming off Zoloft.

Your doctor or pharmacist can discuss other treatments for depression and anxiety disorders if you are at risk of complications from Zoloft.

What should I tell my doctor before starting Zoloft (sertraline)?

Tell your health care professional about all your medical conditions—Zoloft is not suitable for people with certain medical conditions, including but not limited to people with liver disease, heart disease, seizure disorder, glaucoma, or bleeding disorders.

Also, tell your doctor about all your medications, including prescription drugs, over-the-counter medicines, vitamins, dietary supplements, and herbal products. Doing so can help avoid serious drug interactions.

Inform your doctor if you have previously had an allergic reaction to sertraline or any of the ingredients in Zoloft. Before taking the liquid preparation of Zoloft, tell your doctor if you are allergic to latex (the oral liquid comes with a latex rubber dropper).

Zoloft is classified as a pregnancy category C drug. This means that some animal studies have shown adverse effects on the fetus, and there are no adequate studies to establish Zoloft safety in humans. If you are pregnant, planning to get pregnant, or breastfeeding, tell your doctor before starting Zoloft. The potential benefits of Zoloft treatment in pregnant women may warrant using this medicine despite possible risks

What precautions should I take while on Zoloft (sertraline)?

Keep all your appointments with your doctor or health care professional while on Zoloft. Your doctor may need to change your Zoloft dose several times to find what works best for you.

Children and young adults under the age of 24 can experience changes in mood and behavior, including increased suicidal thoughts and ideations. Be vigilant for behavioral changes if you or anyone you know experiences any unusual changes in mental or emotional states while on Zoloft. Tell your doctor if you or anyone in your family has a history of suicide attempts or bipolar disorder.

Zoloft can make you dizzy or drowsy. When you first start taking Zoloft, do not drive, operate heavy machinery, or do anything that requires concentration before knowing how this medicine affects you.

Tell your doctor if you become pregnant while on Zoloft. This medicine should be used with caution in women who are pregnant or breastfeeding.

What are Zoloft (sertraline) interactions?

Taking Zoloft with some other medications can affect how each medication works. Drug interactions can also increase the risk of serious side effects. Your physician may choose a different antidepressant for you, change the dose or frequency of one or both medicines, or closely monitor you for side effects if certain medications are prescribed with Zoloft.

Using Zoloft with the following medications is not recommended:

pimozide (Orap)
MAO inhibitors (monoamine oxidase inhibitors) such as linezolid (Zyvox), isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), selegiline (Eldepryl, Zelapar, Emsam), methylene blue—(Zoloft should not be used in people on MAOI and within 14 days of stopping MAOI)
disulfiram (Antabuse) should not be taken with liquid sertraline concentrate

There can also be interactions between Zoloft and medicines such as:

cisapride
sparfloxacin
linezolid
dronedarone
toloxatone

This list does not describe all possible Zoloft interactions. Give your health care provider a complete list of your medications, including prescription and non-prescription drugs, vitamins and dietary supplements, and herbal remedies. Also, tell your health care provider if you smoke, drink alcohol, or use illegal drugs because some of these substances can cause serious health complications when used with prescription drugs.

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