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When using antidepressant medications, including sertraline (Zoloft), it is crucial to be informed about potential risks and precautions. Below are important safety warnings and guidelines for use:

• Worsening Depression and Suicidal Thoughts: Antidepressants may lead to a worsening of depression or the emergence of suicidal thoughts, especially in individuals under 25 years of age. This risk is heightened during the initial months of treatment and when adjusting the dosage. If you or someone around you notices any signs of suicidal thoughts, unusual behavior, or mood changes like anxiety, irritability, or restlessness, seek medical assistance immediately.

• Serotonin Syndrome: There is a risk of developing serotonin syndrome, a potentially life-threatening condition, when taking sertraline (Zoloft), particularly if combined with other medications that increase serotonin levels. Symptoms include rapid heart rate, sweating, confusion, and muscle stiffness. Prompt medical help is necessary if these symptoms occur.

• Risk of Bleeding: The use of sertraline (Zoloft) may elevate the risk of significant bleeding, especially if taken alongside blood-thinning medications such as aspirin or warfarin. Look out for unusual bruising, bleeding, or dark stools, and contact a healthcare provider if these occur.

• Bipolar Disorder Considerations: Antidepressants like sertraline (Zoloft) can trigger manic episodes in individuals with bipolar disorder. It is important to assess the risk of bipolar disorder before starting treatment, and to monitor for any behavioral changes such as racing thoughts or increased talkativeness.

• Glaucoma Risk: Sertraline (Zoloft) can exacerbate or induce angle-closure glaucoma. Regular eye check-ups are advised, and any changes in vision should be promptly reported to a healthcare professional.

• Heart Rhythm Concerns: The medication may lead to QT prolongation, affecting heart rhythm. This risk is compounded by factors such as electrolyte imbalances or concurrent use of other heart-affecting medications. Regular heart monitoring may be necessary, and immediate medical attention is required if symptoms like chest pain or fainting occur.

• Low Sodium Levels: Sertraline (Zoloft) can cause hyponatremia, particularly in the elderly or those on diuretics. Symptoms of low sodium, such as confusion or headaches, demand urgent medical evaluation.

Contraindications: This medication should not be used if you are taking or have recently taken MAO inhibitors, linezolid, methylene blue, pimozide, or disulfiram (for the liquid form of sertraline). Consult a healthcare provider if any of these apply to you.

It is essential to discuss any concerns with a healthcare professional and keep them informed of all medications you are taking to ensure safe and effective treatment.

Common side effects:

• nausea
• diarrhea
• difficulty sleeping
• dry mouth
• drowsiness
• loss of appetite
• increased sweating
• upset stomach

Less common but important to monitor:

• irregular heartbeat
• tremors
• changes in vision
• decreased interest in sex
• changes in sexual ability
• muscle cramps or weakness
• unusual weight loss

Serious side effects:

• serious allergic reactions
• serotonin syndrome
• severe bleeding
• suicidal thoughts or behavior
• painful or prolonged erection

Interactions with high risk of serious adverse effects and should be avoided:

• MAO inhibitors (isocarboxazid, Linezolid, Metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, Rasagiline, safinamide, Selegiline, Tranylcypromine)
• Pimozide

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Antiplatelet drugs (such as Clopidogrel)
• NSAIDs (such as Ibuprofen, Naproxen)
• Blood thinners (such as Dabigatran, Warfarin)
• Other SSRIs (such as Fluoxetine, paroxetine)
• SNRIs (such as Duloxetine, Venlafaxine)
• MDMA ('ecstasy')
• St. John's wort
• Tryptophan

Interactions with low risk that usually do not require a change in therapy:

• Alcohol
• Marijuana (cannabis)
• Antihistamines (such as Cetirizine, diphenhydramine)
• Drugs for sleep or anxiety (such as Alprazolam, Diazepam, Zolpidem)
• Muscle relaxants
• Opioid pain or cough relievers (such as codeine, hydrocodone)
• Aspirin