Sertraline important information

Sertraline is a prescription medication classified as a selective serotonin reuptake inhibitor (SSRI). It is commonly prescribed to treat major depressive disorder (depression), obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), social anxiety disorder, and premenstrual dysphoric disorder (PMDD). As with all prescription medications, sertraline may not be appropriate for everyone. For full prescribing information, view the drug label information.

Before using sertraline, what should I tell my doctor?

All medical conditions you have or have had, especially:

• • Bipolar disorder or a history of mania/hypomania
  • Seizures or epilepsy
  • Liver disease (sertraline is processed by the liver; dose adjustments may be needed)
  • Bleeding problems or easy bruising
  • Low sodium (hyponatremia), especially if you are older or take diuretics (“water pills”)
  • Glaucoma (especially narrow-angle glaucoma)
  • Heart rhythm problems
• All medications you are currently taking or plan to take, including:
• • Prescription medications
  • Over-the-counter drugs
  • Vitamins and supplements
  • Blood thinners or drugs that increase bleeding risk (e.g., warfarin, aspirin, NSAIDs like ibuprofen/naproxen)
  • Certain migraine medications (triptans), stimulants, or opioid pain medications
• Pregnancy and breastfeeding status
• • Tell your provider if you are pregnant, planning pregnancy, or breastfeeding.
• Any history of suicidal thoughts, self-harm, worsening depression, severe anxiety/agitation, or significant mood changes.
• Alcohol or recreational drug use
• Any allergies or prior adverse reactions to sertraline or other SSRIs

What are some of the side effects of this drug?

Some side effects are common and often mild, especially when starting sertraline or changing the dose. These may include:

• Upset stomach or indigestion
• Diarrhea
• Dry mouth
• Headache
• Dizziness
• Fatigue or drowsiness
• Trouble sleeping (insomnia) or sleepiness
• Increased sweating
• Tremor or feeling jittery/restless
• Sexual side effects (e.g., decreased libido, delayed ejaculation, difficulty achieving orgasm)
• Appetite or weight changes

Many side effects improve as your body adjusts. If side effects persist, become severe, or interfere with daily functioning, contact your healthcare provider.

What are side effects I should call my doctor about right away?

Seek urgent medical attention or contact your healthcare provider right away if you experience:

• Suicidal thoughts or behaviors, or new/worsening depression
• New or worsening anxiety, agitation, panic, irritability, aggression, or impulsivity
• Mania/hypomania symptoms, such as:
• • Unusually elevated or irritable mood
  • Decreased need for sleep
  • Racing thoughts, risky behavior, or unusually increased activity/talking
• Severe allergic reactions, such as:
• • Rash or hives
  • Swelling of the face, lips, tongue, or throat
  • Difficulty breathing
• Seizures
• Abnormal bleeding or bruising, black/tarry stools, coughing/vomiting blood
• Severe headache, vision changes, or eye pain
• Severe dizziness or fainting, chest pain, or irregular heartbeat
• Symptoms of low sodium, such as headache, confusion, weakness, severe fatigue, unsteadiness, or seizures
• Serotonin syndrome symptoms, such as:

• • Fever, sweating, shivering
  • Confusion, agitation
  • Rapid heart rate, blood pressure changes
  • Muscle stiffness, twitching, tremor, loss of coordination
  • Diarrhea

These symptoms may indicate serious or life-threatening reactions and require prompt evaluation.

Important safety information

• Suicidality risk: Antidepressants may increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults, particularly early in treatment or after dose changes. Monitoring is important.
• Do not stop abruptly: Stopping sertraline suddenly may cause discontinuation symptoms (e.g., dizziness, nausea, irritability, insomnia, “electric shock” sensations). Tapering should be supervised by a clinician.
• Bleeding risk: Sertraline may increase bleeding risk, especially when combined with NSAIDs (ibuprofen/naproxen), aspirin, warfarin, or other anticoagulants/antiplatelet agents.
• Serotonin syndrome risk: Combining sertraline with other serotonergic medications or supplements can increase risk.
• Liver considerations: People with liver impairment may require lower doses or closer monitoring.
• Alcohol and impairment: Alcohol may worsen side effects. Use caution with driving or hazardous activities until you know how sertraline affects you.

Do not take sertraline if you

• Are allergic to sertraline or any ingredient in the medication
• Are taking (or have taken within the last 14 days) a monoamine oxidase inhibitor (MAOI)
• Are taking pimozide (a medication that can cause serious heart rhythm problems when combined with sertraline)
• Are taking linezolid or intravenous methylene blue, unless specifically directed and monitored by a clinician (risk of serotonin syndrome)
• Have been told by a licensed healthcare professional that you should not take SSRIs

L-methylfolate important information

Before starting L-methylfolate, tell your healthcare provider all relevant medical information, including:

• All medical conditions you have or have had, especially:
• • Bipolar disorder, history of mania or hypomania
  • Seizure disorders
  • Pernicious anemia or known vitamin B12 deficiency (folate supplementation can improve anemia labs while underlying B12 deficiency may worsen neurologic injury if not treated)
  • Kidney disease (especially if you are on dialysis) or significant chronic illness
  • Any history of cancer, particularly if you have been told to avoid folate supplementation (follow oncology guidance)
• All medications and supplements you take, including:
• • Other folate-containing supplements or multivitamins
  • Medications that may interact with folate metabolism (your clinician will assess relevance), such as certain antiseizure medications
  • Any medications for mood disorders, including antidepressants and mood stabilizers
• Any allergies or prior adverse reactions to folate products or ingredients in the formulation
• Tell your provider if you have had suicidal thoughts, significant mood instability, or a history of manic symptoms.
• If you are pregnant, planning to become pregnant, or breastfeeding
• • Folate is often used in pregnancy, but dosing and indication should still be reviewed with your clinician, particularly for prescription-strength products.

What are some of the side effects of this drug?

Contact your healthcare provider right away or seek urgent care if you experience:

• Symptoms of a serious allergic reaction, such as:
• • Hives or widespread rash
  • Swelling of the face, lips, tongue, or throat
  • Trouble breathing
• New or worsening mood symptoms, such as:
• • Severe agitation, restlessness, or anxiety
  • Symptoms of mania/hypomania (e.g., unusually elevated or irritable mood, decreased need for sleep, racing thoughts, impulsive/risky behavior)
• Neurologic symptoms that could suggest untreated vitamin B12 deficiency, especially if you have risk factors:
• • New numbness/tingling in hands or feet
  • New balance problems or difficulty walking
  • New confusion or memory changes
 (These symptoms are not specific to L-methylfolate but warrant evaluation.)

What are some of the side effects of this drug?

• Vitamin B12 considerations: In certain individuals, folate supplementation may improve anemia-related lab values while vitamin B12 deficiency remains untreated, which can allow neurologic injury to progress. Your provider may recommend checking B12 levels if clinically indicated.
• Not a substitute for prescribed treatment: L-methylfolate should be used only as directed and should not replace other treatments recommended by your clinician.
• Mood activation risk: In people with bipolar disorder or a history of mania/hypomania, L-methylfolate may contribute to mood activation in some cases. Inform your provider of any bipolar history and report significant mood changes promptly.
• Medication and supplement overlap: Many multivitamins and supplements contain folate. Taking multiple folate-containing products may result in higher total intake than intended.

Do not take L-methylfolate if you

• Are allergic to L-methylfolate or any ingredient in the formulation
• Have been instructed by a licensed healthcare professional to avoid folate supplementation
• Have a known or suspected untreated vitamin B12 deficiency and have been told to address B12 first (follow your clinician’s guidance)

Important Notice


This content is for general informational purposes and does not replace medical advice. Always follow the guidance of your licensed healthcare provider. If you believe you are experiencing a medical emergency, call 911 or your local emergency number immediately.