Lustral tablets contain the active ingredient sertraline hydrochloride, which is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI). (NB. Sertraline tablets are also available without a brand name, ie as the generic medicine.)
Antidepressant medicines act on nerve
cells in the brain. In the brain there are numerous different chemical
compounds called neurotransmitters. These act as chemical messengers
between the nerve cells. Serotonin is one such neurotransmitter and has
various functions that we know of.
When serotonin is released from nerve
cells in the brain it acts to lighten mood. When it is reabsorbed into
the nerve cells, it no longer has an effect on mood. It is thought that
when depression occurs, there may be a decreased amount of serotonin
released from nerve cells in the brain.
SSRIs work by preventing serotonin
from being reabsorbed back into the nerve cells in the brain. This
helps prolong the mood lightening effect of any released serotonin. In
this way, sertraline helps relieve depression.
Sertraline may also be used in the
treatment of obsessive compulsive disorder and post-traumatic stress
disorder. It is not fully understood how it works in these conditions.
It may take between two to four weeks
for the benefits of this medicine to appear, so it is very important
that you keep taking it, even if it doesn't seem to make much
difference at first. If you feel your depression has got worse, or if
you have any distressing thoughts or feelings in these first few weeks,
then you should talk to your doctor.
Depression and other pschiatric illnesses are
associated with an increased risk of suicidal thoughts, self-harm, and
suicide. You should be aware that this medicine may not start to make
you feel better for at least two to four weeks. However, it is
important that you keep taking it in order for it to work properly and
for you to feel better. If you feel your depression or anxiety has got
worse, or if you have any distressing thoughts, or feelings about
suicide or harming yourself in these first few weeks, or indeed at any
point during treatment or after stopping treatment, then it is very
important to talk to your doctor.
This medicine may reduce your ability to
drive or operate machinery safely. Do not drive or operate machinery
until you know how this medicine affects you and you are sure it won't
affect your performance.
It is recommended that you avoid drinking alcohol while taking this medicine.
SSRI antidepressants have been associated
with the development of unpleasant or distressing restlessness and the
need to move, often accompanied by an inability to sit or stand still.
This is most likely to occur within the first few weeks of treatment.
If you experience these symptoms you should consult your doctor.
Antidepressants may cause the amount of
sodium in the blood to drop - a condition called hyponatraemia. This
can cause symptoms such as drowsiness, confusion, muscle twitching or
convulsions. Elderly people may be particularly susceptible to this
effect. You should consult your doctor if you develop any of these
symptoms while taking this medicine, so that your blood sodium level
can be checked if necessary.
If you experience seizures (convulsions or
fits) while taking this medicine, consult your doctor immediately, as
you will need to stop treatment with this medicine. This also applies
if you suffer from epilepsy and experience more seizures than normal
after starting this medicine.
You should not suddenly stop taking this
medicine, as this can cause withdrawal symptoms such as dizziness,
sleep disturbances (including intense dreams), nausea, headache, a
feeling of weakness, pins and needles and anxiety. Withdrawal symptoms
are temporary and are not due to addiction or dependence on the
medicine. They can usually be avoided by stopping the medicine
gradually, usually over a period of weeks or months, depending on your
individual situation. Follow the instructions given by your doctor when
it is time to stop treatment with this medicine. On very rare occasions
some people have experienced withdrawal symptoms after accidentally
missing a dose of this medicine.
Following a review of the safety and efficacy
of SSRIs to treat depression in children under 18 years of age
(unlicensed use), the Committee on Safety of Medicines (CSM) has
concluded that the risks of sertraline outweigh the benefits for
treating depressive illness in this age group. If you are under 18 and
taking sertraline for depression you should consult your doctor for
advice, but do not suddenly stop taking it as this can cause withdrawal
symptoms. Sertraline may be used for obsessive-compulsive disorder in
children aged six years and over, but is not recommended for younger
children.
This medicine should not be used if you are
allergic to one or any of its ingredients. Please inform your doctor or
pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using
this medicine and inform your doctor or pharmacist immediately.
Pregnancy and Breastfeeding
Certain medicines should not be
used during pregnancy or breastfeeding. However, other medicines may be
safely used in pregnancy or breastfeeding providing the benefits to the
mother outweigh the risks to the unborn baby. Always inform your doctor
if you are pregnant or planning a pregnancy, before using any medicine.
The safety of this medicine in pregnancy has
not been established. It should therefore be used with caution during
pregnancy, and only if the benefits to the mother outweigh any risks to
the foetus. Seek medical advice from your doctor.
This medicine passes into breast milk,
however the effect of this on the nursing infant is unknown. For this
reason women who need to take this medicine should consider not
breastfeeding. Seek medical advice from your doctor.
Side effects
Medicines and their possible side
effects can affect individual people in different ways. The following
are some of the side effects that are known to be associated with this
medicine. Because a side effect is stated here, it does not mean that
all people using this medicine will experience that or any side effect.
Disturbances of the gut such as nausea, vomiting, diarrhoea or abdominal pain
Indigestion (dyspepsia)
Loss of appetite
Shaking, usually of the hands (tremor)
Dizziness
Difficulty in sleeping (insomnia)
Sleepiness (somnolence)
Increased sweating
Dry mouth
Sexual problems
Headache
Anxiety and agitation
Pins and needles (paraesthesia)
Changes in blood pressure
Seizures
Loss of memory (amnesia)
Liver disorders
The side effects listed above may not include all of the side effects reported by the drug's manufacturer.
For more information about any other possible risks associated with
this medicine, please read the information provided with the medicine
or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your
doctor or pharmacist what medicines you are already taking, including
those bought without a prescription and herbal medicines, before you
start treatment with this medicine. Similarly, check with your doctor
or pharmacist before taking any new medicines while taking this one, to
ensure that the combination is safe.
Sertraline should not be taken at the
same time as monoamine oxidase inhibitor medicines (MAOIs). These
include monoamine oxidase inhibitor antidepressants such as phenelzine,
tranylcypromine and moclobemide, the antibiotic linezolid and the
anti-Parkinson's medicine selegiline. Sertraline should not be started
until at least at least a day after stopping moclobemide or linezolid,
and at least two weeks after stopping other monoamine oxidase
inhibitors. Similarly, treatment with any MAOIs should not be started
until at least two weeks after stopping treatment with sertraline.
Sertraline must not be taken with the antipsychotic medicine pimozide.
Sertraline should not be taken in
combination with benzodiazepines or other tranquilisers by people who
need to drive or operate machinary.
There may be an increased risk of side
effects if sertraline is taken with the following medicines, which also
enhance the activity of serotonin in the brain:
lithium
triptans for migraine, eg sumatriptan
tramadol
tryptophan.
The herbal remedy St John's wort should not be taken with sertraline for the same reason.
Sertraline may increase the blood levels of the following medicines:
clozapine
some tricyclic antidepressants (imipramine, desipramine, nortriptyline and possibly amitriptyline).
Sertraline may increase the effect of
anti-blood-clotting medicines (anticoagulants) such as warfarin, and
this may increase the risk of bleeding. If you are taking an
anticoagulant with this medicine, your blood clotting time should be
regularly monitored.
As SSRIs have been associated with
bleeding abnormalities, the following medicines, which are known to
affect the ability of the blood to clot, should be used with caution
with sertraline:
tricyclic antidepressants
some antipsychotic medicines
some antisickness medicines, eg prochlorperazine
aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
ticlopidine
dipyridamole.
Treatment with this medicine may alter
control of blood sugar in people with diabetes, who may need an
adjustment in their dose of insulin or antidiabetic tablets. People
with diabetes should discuss this with their doctor.
Sertraline blood levels may be increased by cimetidine and this may increase the risk of sertraline side effects.
Other medicines containing the same active ingredient
Sertraline tablets are available without a brand name, ie as the generic medicine.
