Nursing Teaching on Contraindications for Sertraline Use

 Nurse educated the patient and caregiver on the contraindications for using Sertraline as follows:

  1. Do not take sertraline, if you ever manifested any allergic responses to intake of sertraline or any other medications belonging to the same group as sertraline, such as, fluoxetine, citalopram, and escitalopram. In the event of an allergic response with any of these medications, check with your physician regarding your safety with intake of sertraline.
  2. Sertraline can interact with a number of other medications and can precipitate serious reactions. If you are being newly started on sertraline, discuss with your physician regarding all other medications you are currently taking and their safety with sertraline. Also, if you have been taking sertraline for long, discuss with your physician regarding your history of sertraline intake, when you are being started on any new medication.
  3. Alcohol, opioid pain medications, such as, hydrocodone and codeine, a number of OTC cough medications, antihistamines, and antianxiety medications can further add to the dizziness and confusion caused by sertraline. This can result in compromised safety, falls, and accidents and so, must be avoided taken together with sertraline.
  4. Sertraline carries significant risk for obstruction to the drainage of fluid (aqueous humor) inside the eye. This blockage of fluid in the eye can result in increase in the intraocular pressure, eye pain, headache, blurred vision with haloes around light, compromised vision, and glaucoma. So, sertraline is contraindicated or cautiously administered in glaucoma patients. Individuals with history of glaucoma must discuss with their physician on safety with sertraline intake.
  5. Sertraline carries the risk of causing and/or aggravating cardiac arrhythmias. Individuals with cardiac arrhythmias can present with episodes of chest pain, rapid heart rate, palpitations, dizziness, and shortness of breath, and can lead to severe debility and death. Sertraline is contraindicated or cautiously administered in individuals with history of cardiac arrhythmias.
  6. Sertraline can also interact with many antibacterial and antifungal antibiotics, other antidepressants, and antipsychotic medications, resulting in development or aggravation of underlying cardiac arrhythmias, leading to debility and sudden cardiac death. Avoid taking sertraline along with medications belonging to the above-mentioned groups, to prevent any dangerous arrhythmias from developing.
  7. Sertraline intake carries the risk of causing seizures, especially in individuals with history of seizures. Individuals can present with sudden episodes of loss of consciousness, intense convulsions with muscle contractions, bowel and bladder incontinence. Sertraline is contraindicated or cautiously administered in individuals with history of seizures.
  8. Sertraline intake can thin the blood and increase risk for bleeding in the skin and mucus membranes. This risk is further more in individuals concurrently taking blood thinners and anticoagulants, such as, aspirin, warfarin, Xarelto, and Eliquis. Some other antidepressants and antipsychotic medications also contribute to thinning of blood and episodes of bleeding. Administration of sertraline along with these medications can also precipitate dangerous bleeding episodes. Check with your physician on the safety with sertraline use and the possibility for interaction with other medications on your list.
  9. Sertraline use in expectant mothers could harm the unborn baby and result in birth defects. So, sertraline should be cautiously used or avoided for an alternative drug during pregnancy and in women planning for pregnancy. Women in the child-bearing age group, taking sertraline on a regular basis, must employ effective contraceptive measures in order to avoid getting pregnant.
  10. Serotonin is one chemical in the brain, which in permissible amounts, is believed to reduce anxiety and promote happiness and well-being. Very excessive concentrations of serotonin in the brain can lead to serotonin syndrome. Individuals with serotonin syndrome can present with mania, excitement, hallucinations, agitation, insomnia, pounding heartbeat, very rapid heart rate, overactive reflexes, and diarrhea. Sertraline use, especially along with other antidepressants acting on the same lines, such as, fluoxetine, citalopram, and escitalopram, can significantly increase the serotonin levels in the body and lead to development of serotonin syndrome. Sertraline use along with a few other antidepressants, such as, phenelzine, selegiline, and tranylcypromine can also significantly increase the serotonin levels in the body and lead to development of serotonin syndrome. Sertraline use is discouraged along with these medications. Caution must be exercised even when discontinuing on any of the above mentioned antidepressant medications with potential to increase serotonin levels and starting on sertraline, by observing a window period of atleast 2 weeks, before the transition to sertraline is made. This helps with complete elimination of these medications from the body, reduce the risk for interaction with sertraline, and reduce risk for development of serotonin syndrome.
  11. Sertraline is extensively metabolized in the liver and metabolites are excreted in the urine. If liver function is deficient, the metabolism of Sertraline can be compromised. In this case, sertraline can stay in the body for prolonged duration of time in comparison to normal leading to increased blood levels of the medication for longer periods of time. This can lead to increased risk for side-effects and consequent toxicity. So, Sertraline could be cautiously administered or avoided for an alternative medication, in individuals with hepatic dysfunction. Periodical labs for liver function could be ordered and individuals monitored for development of any toxic symptoms. Discuss with your physician regarding history of compromised liver function, if any.