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Can you take zoloft on an empty stomach


How and when to take sertraline

Dosage and strength

Sertraline is available as 25mg, 50mg or 100mg tablets.

The usual dose of sertraline is 50mg a day in adults. But your doctor may start you on a lower dose, then increase it gradually to a maximum dose of 200mg a day.

If you have liver problems, your doctor might give you a lower dose.

The usual dose of sertraline for children aged 6 to 12 is 25mg a day, but this may be increased to 50mg a day after a week.

The usual dose of sertraline for children aged 13 to 17 is 50mg a day.

Children aged 6 to 17 might have their dose increased up to 200mg a day, if needed.

How to take it

Take sertraline once a day. You can take it with or without food.

You can choose to take sertraline at any time, as long as you stick to the same time every day.

If you have trouble sleeping, it's best to take it in the morning.

How long to take it for

Once you're feeling better it's likely that you'll continue to take sertraline for several more months. Stopping before that time can make depression come back.

Most doctors recommend that you take antidepressants for 6 months to a year after you no longer feel depressed.

If you forget to take it

If you occasionally forget to take a dose, skip the missed dose and take your next dose the next day at the usual time.

Never take 2 doses at the same time to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

The amount of sertraline that can lead to an overdose varies from person to person.

Taking too much can cause symptoms such as:

  • being sick (vomiting)
  • shaking
  • feeling sleepy
  • feeling dizzy
  • fast heart rate
  • fits or seizures

Urgent advice: Contact 111 for advice now if:

  • you take more than your prescribed dose of sertraline

Go to 111.nhs.uk or call 111

If you need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the sertraline packet, or the leaflet inside it, plus any remaining medicine with you.

Stopping sertraline

If you have been feeling better for 6 months or more, your doctor may suggest coming off sertraline.

Your doctor will probably recommend reducing your dose gradually over several weeks, or longer if you have been taking sertraline for a long time.

This is to help prevent any withdrawal symptoms you might get as a reaction to coming off the medicine.

These can include:

  • feeling dizzy
  • feeling sick
  • numbness or tingling in the hands or feet
  • trouble sleeping
  • feeling agitated or anxious
  • headaches
  • shaking

Page last reviewed: 2 February 2022
Next review due: 2 February 2025

Sertraline FAQs: 24 Common Questions Answered

As a commonly used SSRI medication, sertraline is used by millions of people in the United States to treat major depressive disorder, anxiety and a range of other conditions.

Below, we’ve answered 30 of the most common questions about sertraline, covering everything from the medication’s benefits to side effects, common dosages, and more.

How Long Has Sertraline Been Available?

Sertraline was developed throughout the 1970s and 80s. The medication was approved by the FDA in 1991 to treat major depressive disorder (MDD, or depression) and has since been used as a common treatment for depression and other mental health and mood disorders.

Although sertraline was originally sold exclusively by Pfizer, today it’s commonly available as a generic medication from a range of different companies.

What Drug Class Does Sertraline Belong To?

Sertraline belongs to a class of drugs called selective serotonin reuptake inhibitors, or SSRIs. It works by increasing levels of serotonin, a hormone that’s involved in regulating certain aspects of your moods and behavior, in your brain and body.

Like other SSRIs, sertraline is used for a variety of purposes. It’s approved by the FDA to treat major depression, post-traumatic stress disorder, obsessive-compulsive disorder, premenstrual dysphoric disorder and social anxiety disorder.

How Many People Use Sertraline?

Sertraline is one of the most widely used antidepressants, as well as one of the most common prescription medications in the United States. Currently, tens of millions of people in the United States have prescriptions for sertraline. 

According to research published in the journal Pharmacy, sertraline ranks in the 20 most widely used prescription medications in the country.

According to one study using data from the 2013 Medical Expenditure Panel Survey, sertraline was by far the most commonly prescribed antidepressant in the United States.

How Does Sertraline Work?

As a selective serotonin reuptake inhibitor (SSRI), sertraline works by slowing down the rate at which your body reabsorbs serotonin, an important neurotransmitter. This leads to higher levels of serotonin activity in your brain.

This increase in serotonin levels can help to improve and regulate your moods, resulting in an improvement in the symptoms of depression, obsessive-compulsive disorder and certain types of anxiety.

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How Long Does it Take for Sertraline to Work?

Although sertraline is effective, it doesn’t always work immediately. Most of the time, it takes six to eight weeks for the full benefits of sertraline to take effect.

This is the amount of time required for sertraline to reach a steady state in your body, meaning it’s fully absorbed and active at a steady dosage every day.

It’s normal to experience some improvements from sertraline during the first one or two weeks of use. For example, you may notice that your sleep, appetite and energy levels improve after using sertraline for just a few weeks. 

It’s common for symptoms of depression, such as a low mood and a lack of interest in activities, to improve after using sertraline for six to eight weeks.

Make sure to inform your healthcare provider if you don’t notice any improvements after eight or more weeks of treatment with sertraline. 

What is Sertraline Used For?

Sertraline is a versatile medication that’s used to treat a variety of conditions. The most common uses for sertraline include treating:

  • Major depressive disorder (MDD) 

  • Obsessive-compulsive disorder (OCD) 

  • Posttraumatic stress disorder (PTSD) 

  • Body dysmorphic disorder (BDD) 

  • Social anxiety disorder (SAD) 

  • Premenstrual dysphoric disorder (PMDD)

Sertraline is also prescribed off-label to treat other conditions, including premature ejaculation (PE).

Is Sertraline the Same as Zoloft®?

Zoloft is the name for a specific brand of sertraline manufactured and marketed by Pfizer. When sertraline first came onto the market, it was only available as Zoloft.

The active ingredient in Zoloft is sertraline hydrochloride -- the exact same ingredient that’s used in unbranded, generic versions of sertraline. Today, sertraline is available under the brand name Zoloft and as a generic medication.

So, whether you’re using a Zoloft 100 mg pill or a sertraline 100 mg pill, or a Zoloft 25mg and a sertraline 25mg, your body will react similarly to each. 

Is Zoloft Safe?

Yes. Zoloft/sertraline is a safe and effective medication that’s been thoroughly tested in a wide range of clinical trials. It’s safely used by people of all ages, from young children to teenagers, adults and the elderly.

Like all medications, sertraline can cause some side effects. It can also interact with some other medications, supplements and natural substances. 

We’ve provided more information about these side effects and interactions in the four questions below.

What Are the Side Effects of Sertraline?

Like other SSRIs, sertraline can cause a range of side effects. Most side effects from sertraline are mild and transient, although some may be persistent or bothersome.

Potential side effects of sertraline include:

  • Lightheadedness

  • Syncope (fainting or passing out)

  • Nausea

  • Diarrhea

  • Dizziness

  • Sweating

  • Dry mouth

  • Tremor

  • Confusion

  • Hallucinations

  • Fatigue

  • Somnolence (drowsiness)

  • Rhinitis (nasal congestion)

  • Erectile dysfunction

  • Difficulty ejaculating

  • Reduced sexual desire

Like other antidepressants, sertraline may contribute to an increased risk of suicidal thoughts or behavior in children and young adults with depression. It may also cause some additional side effects in people above the age of 65.

For most people, sertraline only causes minor side effects. If you develop severe or bothersome side effects from sertraline, it’s important to inform your healthcare provider.

What If I Miss a Dose of Sertraline?

If you miss a dose of sertraline, take it as soon as you remember. The exception here is if it’s closer to your next dose. In that case, call your healthcare provider.

However, never double up on doses of sertraline, or consume more than what’s prescribed by your healthcare provider.

Can Sertraline/Zoloft Cause Side Effects in the First Week?

Antidepressants can potentially cause side effects at any time, including in the first few weeks of treatment. In fact, it’s far from uncommon for people to experience side effects in the first month of treatment with an antidepressant, only to have these side effects decline over time.

It’s common for your body to “get used to” an antidepressant over time, meaning the side effects you experience during the first week of treatment with sertraline may not continue forever.

Are Sertraline Interactions With Other Medications Possible?

Yes. Sertraline and other antidepressants can interact with other medications. In certain cases, drug interactions that involve sertraline may produce a risk of serotonin syndrome, a condition that can be life-threatening.

Make sure to inform your healthcare provider about any other medications, supplements and/or natural treatments you use before starting treatment with sertraline.

What Medications Should I Avoid While Using Sertraline?

Sertraline should not be taken with other medications that increase serotonin levels, including other antidepressants. It’s especially important not to use sertraline with monoamine oxidase inhibitors (MAOIs), an older class of antidepressants known for interactions.

MAOIs can cause interactions several weeks after the end of treatment. Make sure to let your healthcare provider know about any MAOIs or other antidepressants that you’ve recently used or are currently using, including medications taken in the last two weeks.

Other medications that may interact with sertraline include thioridazine, pimozide, linezolid and methylene blue. To keep yourself safe, inform your healthcare provider about any medications and supplements you use prior to starting treatment with sertraline.

​​How Long Does Diarrhea From Sertraline Last?

Diarrhea is a common side effect of sertraline. In fact, research shows that sertraline is slightly more likely to cause this side effect than other commonly used antidepressants.

As with many other sertraline side effects, diarrhea may develop during your first few weeks of using sertraline. If you have persistent diarrhea from sertraline, make sure that you drink plenty of fluids to keep your body hydrated.

Contact your healthcare provider for help if you have persistent diarrhea that doesn’t improve on its own.

Can Sertraline Cause Nausea?

Yes. Nausea is a common side effect of sertraline, as well as other antidepressants. Like many other common side effects, it tends to occur during the first few weeks of use and become less severe over time. 

Research suggests that between 17 and 26 percent of people who use antidepressants develop nausea at some point.

Of these people, 83 percent experience nausea after two weeks, with 32 percent continuing to experience nausea after using antidepressants for three months.

How Long Do Other Side Effects From Sertraline Last?

Like nausea and diarrhea, most side effects from sertraline occur during the first few weeks of using the medication.

It’s common for side effects to gradually become less apparent over the course of the first few weeks, as your body adjusts to the consistent dose of sertraline. If you have side effects from sertraline that don’t improve, it’s best to discuss them with your healthcare provider.

Is it Safe to Drive After Taking Sertraline?

If you feel dizzy, sleepy or fatigued after taking sertraline, you should not drive a car, ride a bike or operate any kind of motor vehicle after you take your medication. 

Like other side effects of sertraline, issues like dizziness and sleepiness often occur during the first few weeks of use. 

What About Sertraline Dosage, Forms and Strengths?

Sertraline is available as a tablet and as an oral solution. The tablet is the most common version of the medication.

In tablet form, the sertaline dosage range is usually 25mg, 50mg and 100mg. The typical starting dose for most conditions is 50mg per day, although a dose of 25mg per day may be used for children and people with certain anxiety disorders.

In oral solution form, sertraline is typically dosed at 20mg per milliliter. Make sure to follow your healthcare provider’s instructions and only use sertraline at the prescribed dose.

What’s a Normal Sertraline Dosage for Anxiety?

Sertraline is typically prescribed at a dosage of 25mg per day as a treatment for panic disorder, social anxiety disorder and post-traumatic stress disorder. For obsessive-compulsive disorder, it may be prescribed at a slightly higher starting dosage of 50mg per day.

Since anxiety disorders can vary in severity, your healthcare provider may adjust your dosage of sertraline based on your symptoms and response to the medication. 

Is Sertraline Available Over the Counter?

No. Sertraline is a prescription medication. Both the tablet and the solution versions of sertraline are only available with a prescription, meaning you’ll need to talk to a healthcare provider before you can purchase and use them. Sertraline is not sold over the counter in the United States.

What is Considered a High Dose of Sertraline?

A normal dosage is sertraline 50mg to sertraline 100 mg per day, which is typically prescribed to adults as a treatment for depression and some anxiety disorders.

Currently, the highest dose of Zoloft approved by the FDA is 200mg per day. A slightly lower maximum dosage of 150mg of sertraline per day (or 100mg daily during the luteal phase) is used to treat premenstrual dysphoric disorder.

If you’re prescribed sertraline at a high dose, your healthcare provider may instruct you to slowly increase your dosage over the course of several weeks.

Sertraline should only be used at the dosage recommended by your healthcare provider. Do not increase your sertraline dosage without first consulting your healthcare provider. 

When is the Best Time to Take Sertraline?

Two of the most common questions new patients have is: when is the best time to take Zoloft or sertraline? Should I take Zoloft in the morning or at night?

This drug is designed for use once per day. It’s safe to take it at any time of day, with or without food. Many people who experience nausea and other side effects from sertraline opt to take it at night in order to limit these adverse effects.

Since sertraline can interfere with sleep in a small percentage of users, many people also opt to take sertraline in the morning.

​​There’s no “perfect” time of day to take your tablet. Instead, it’s best to take it whenever it’s most convenient for you.

Does Food Affect Your Body’s Absorption of Sertraline?

You can take sertraline with or without food. Some research suggests that your body may better absorb sertraline if you consume it with a meal. It’s best to take sertraline at approximately the same time of day to ensure it maintains a steady state in your body.

How Long Does Sertraline Stay in Your System?

Sertraline has a half-life of approximately 24 hours, meaning it will typically reach half of its total concentration about one day after you take it.

It takes approximately 5.4 days for your body to get 99 percent of a standard sertraline dose out of your system.

How Long Can You Stay on Sertraline?

Clinical trials of sertraline show that it’s safe to use for the long-term, with many cases of people using sertraline for years at a time.

Your healthcare provider will advise you about how long you should continue using sertraline or other medication to treat your depression or anxiety. You may need to continue after you start to experience improvements in order to reduce your risk of relapse.

Many people who use sertraline for the long term (and most other antidepressant medications) are advised to gradually taper their dosage of the medication as they stop taking it, rather than stopping treatment abruptly.

It is important to discuss going off your medication with your healthcare provider prior to changing how you take it. 

What Should You Do if Sertraline Isn’t Working?

Antidepressants such as sertraline are generally effective, but not for everyone. Since everyone responds differently to medication, it’s entirely possible that you might not experience the same results from sertraline as other people.

If you don’t feel that sertraline is working effectively for you, the best approach is to talk about it with your healthcare provider. Your healthcare provider might recommend adjusting your sertraline dosage or switching to another type of antidepressant medication for better results.

How Long Does it Take for an Increased Dose of Sertraline to Work?

If you’re advised to increase your sertraline dosage, it may take several weeks before you start to experience improvements. Make sure to inform your healthcare provider if you don’t develop any improvements after adjusting your dosage of sertraline.  

What Happens When You Stop Taking Sertraline?

If you’re wondering how to ween off Zoloft 25 mg, 50 mg, 100 mg or any of the sertraline equivalents, it’s important to understand that you can’t just stop taking it. Sertraline has a relatively short half-life, meaning it will leave your body quickly if you decide to stop taking it abruptly.

Because of this, some people notice discontinuation symptoms such as insomnia, nausea and anxiety after stopping sertraline. These symptoms are commonly referred to as antidepressant discontinuation syndrome -- an issue that affects about 20 percent of people who abruptly stop using antidepressants.

To avoid these symptoms, your healthcare provider will recommend tapering down your dosage of sertraline over the course of several weeks. This helps you to gradually reduce the amount of sertraline in your body and reduce your risk of experiencing discontinuation issues. 

You should not abruptly stop taking sertraline because it doesn’t feel effective, or because you’d like to use a different medication. Instead, it’s always best to talk to your healthcare provider and let them know about your concerns.

Is it Possible to Overdose on Sertraline?

So, what happens if you take too much Zoloft or sertraline? Like with other SSRIs, taking too much sertraline can result in a range of potentially serious side effects.

Taking too much sertraline may cause serious symptoms, including the following:

  • Drowsiness

  • Dizziness

  • Agitation

  • Skin rash

  • Mania

  • Nausea

  • Vomiting

  • Seizures

  • Loss of consciousness

  • Hallucinations

  • Sweating

  • Fever

  • Confusion

  • Rapid heartbeat

  • Twitching and/or muscle stiffness

  • Loss of coordination

Sertraline overdoses can occur if you take too much sertraline at once, or if you combine your dose of sertraline with other drugs.  

Do not ever take more than your prescribed dose of sertraline. If you forgot to take sertraline on one day, do not take two tablets at once.

If you are concerned about a potential overdose situation, seek emergency medical assistance immediately.

Is it Possible to Lose Weight on Sertraline?

Yes. Although sertraline and other SSRIs are usually linked to weight gain, monitoring your food intake and activity can allow you to either lose weight or maintain your current body weight while you’re using sertraline.

Although experts aren’t yet fully aware of what causes weight gain on SSRIs, some researchers claim that SSRIs can interfere with people’s ability to “switch off” their urge to eat.

Despite this, there’s no evidence that sertraline affects your body’s metabolism and causes you to use fewer calories than normal. This means that you may lose or gain weight as you normally would by adjusting your calorie intake or activity level.

If you notice weight gain after starting sertraline and feel worried, it’s best to let your healthcare provider know when you next see them.  

Can Sertraline Treat Premature Ejaculation?

Yes. Although sertraline isn’t designed specifically to treat premature ejaculation, studies show that it can increase ejaculation latency --  the amount of time required for a man to orgasm and ejaculate during sex -- in men.

If you have premature ejaculation, your healthcare provider may prescribe sertraline off-label to help you control your symptoms and improve your sexual function. 

Our guide to sertraline and premature ejaculation goes into more detail about how and why PE occurs, as well as how SSRIs such as sertraline are often effective at delaying ejaculation and improving sexual stamina. 

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Learn More About Antidepressants

Sertraline is one of several common antidepressants used to treat depression, anxiety disorders and other mental health conditions.

You can learn more about these medications in our full list of antidepressants, which covers the most widely-used drugs for depression and anxiety.  

Concerned about your mental health? You can connect with a mental health provider online and access treatment from home using our range of mental health services, including psychiatry and online counseling. 

You can also learn proven strategies for dealing with depression, anxiety and other issues using our free mental health resources. 

14 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

  1. ZOLOFT (sertraline hydrochloride) tablets, for oral use. (2016, December). Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019839S74S86S87_20990S35S44S45lbl.pdf
  2. Singh, H.K. & Saadabadi, A. (2021, August 6). Sertraline. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK547689/
  3. Fuentes, A. V., Pineda, M.D. & Venkata, K.C. (2018, June). Comprehension of Top 200 Prescribed Drugs in the US as a Resource for Pharmacy Teaching, Training and Practice. Pharmacy. 6 (2), 43. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6025009/
  4. Moore, T.J. & Mattison, D.R. (2017, February). Adult Utilization of Psychiatric Drugs and Differences by Sex, Age, and Race. JAMA Internal Medicine. 177 (2), 274–275. Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2592697
  5. Sertraline (Zoloft). (2020, December). Retrieved from https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Sertraline-(Zoloft)
  6. Kamo, T., et al. (2016). Dosage, effectiveness, and safety of sertraline treatment for posttraumatic stress disorder in a Japanese clinical setting: a retrospective study. BMC Psychiatry. 16, 434. Retrieved from ​​https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5142275/
  7. InformedHealth. org. (2017, October 19). Treatment options for generalized anxiety disorder. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK279594/
  8. Sanchez, C., Reines, E.H. & Montgomery, S.A. (2014, July). A comparative review of escitalopram, paroxetine, and sertraline: are they all alike? International Clinical Psychopharmacology. 29 (4), 185–196. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4047306/
  9. Kelly, K., Posternak, M. & Jonathan, E.A. (2008, December). Toward achieving optimal response: understanding and managing antidepressant side effects. Dialogues in Clinical Neuroscience. 10 (4), 409–418. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181894/
  10. Going off antidepressants. (2020, March 25). Retrieved from https://www.health.harvard.edu/diseases-and-conditions/going-off-antidepressants
  11. How to taper off your antidepressant. (2020, January 29). Retrieved from https://www. health.harvard.edu/diseases-and-conditions/how-to-taper-off-your-antidepressant
  12. Gabriel, M. & Sharma, V. (2017, March 29). Antidepressant discontinuation syndrome. Canadian Medical Association Journal. 189 (21), E747. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449237/
  13. Wurtman, J.J. (2010, July 26). Reversing Antidepressant Weight Gain. Retrieved from https://www.psychologytoday.com/us/blog/the-antidepressant-diet/201007/reversing-antidepressant-weight-gain
  14. McMahon, C.G. (1998, September). Treatment of premature ejaculation with sertraline hydrochloride. International Journal of Impotence Research. ​​10 (3), 181-4, discussion 185. Retrieved from https://pubmed.ncbi.nlm.nih.gov/9788108/

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Antidepressant Pfizer Zoloft - "Antidepressant Zoloft - friend or foe?"

Before using medicines, consult a specialist.

Greetings, dear readers!!!

Finally, I am ripe for this review.

Why am I "for" antidepressants? - because some people cannot cope with their condition on their own and get out of the seemingly "vicious circle" into which they drive themselves. Someone has hard times, the loss of a loved one, someone "withdraws into himself" due to circumstances. May God grant everyone to cope on their own, to have a strong "psyche". But, alas, there are very few such "persistent wolverines" ....

This is not the first antidepressant I have ever taken and I have something to compare it to.

I have been taking Zoloft for the third month - at a dosage of 50 mg in the morning - and gradually life has improved.

The first week I felt nauseous - immediately after drinking and then for 2 hours - but I found a way out - if you do not take it on an empty stomach - there is no nausea. Even if it's against the rules. "Letting go" was about 5-7 days later, in the morning the mood was upbeat, and there were vital forces, some kind of energy, motivation to do something, to do something. People who have experienced depression and apathy understand what I'm talking about...

And one more bonus is a decrease in appetite - that is, there is practically no desire to eat, sometimes you force yourself - but this is the first 2 weeks, then everything is in order - but there is no bulimia, eat in moderation - and a few extra pounds will go away. I went through this with fluoxetine - and as everyone writes - they say cancellation - and it will return with interest - this is not a side effect - it’s that you again fall into depression and begin to “jam” emotions - of course, the weight will return with an increase - since on taking antidepressants, the usual portions are cut down by themselves and there is no hunting for harmful things and sweets (these are my personal feelings). If you cancel, your appetite will return sharply, and you will eat everything again .....

As for energy, if you go to the gym, your results will improve. I like that I'm not like an amoeba and I don't lie on the couch in the evenings with my thoughts, but I always do something. Sleep is good and deep. In general, anxiety and fears pass, you begin to see the world around you differently and enjoy life. For this I am grateful to him.

Another minus is a slight decrease in libido - in the first month I really noticed on my own, now everything is back to normal)))

If you have any questions - ask - I will be happy to answer you)))

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  • The feeling of happiness and harmony
  • helps with insomnia
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  • Elives anxiety thoughts
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    Arpimed

    Amitriptyline can be taken no earlier than 14 days after stopping the intake of MAO inhibitors.

    Warnings and precautions

    Talk to your doctor or pharmacist before using Amitriptyline.

    Arrhythmias and hypotension may occur with high doses of amitriptyline. This can also occur at regular doses if you suffer from heart disease.

    Prolongation of the QT interval

    Cardiac pathology called “prolongation of the QT interval” (which is recorded on the electrocardiogram, ECG) and arrhythmia (rapid or irregular heartbeat) was observed with the use of Amitriptyline. Tell your doctor if:

    • you have a slow heartbeat,
    • you have or have had problems where your heart is not able to supply the body with the blood it needs (a condition called heart failure),
    • are taking other medicines that can cause heart problems, or
    • have a disorder that leads to a decrease in the level of potassium or magnesium or an increase in the level of potassium in the blood
    • if you are preparing for surgery, as it may be necessary to stop taking amitriptyline before administering anesthetics. In case of emergency surgery, the anesthesiologist should be informed about the treatment with amitriptyline.
    • have an overactive thyroid or are taking thyroid medication.

    Suicidal thoughts and worsening of your depressive disorder

    If you are depressed, you may sometimes have suicidal thoughts and desire to hurt yourself. These may be increased the first time antidepressants are used, as these drugs take time to develop an effect, about 2 weeks or more.

    This is especially observed in the following categories of patients:

    • if you have had suicidal thoughts and desire to hurt yourself in the past,
    • if you are young. Data from clinical studies have shown that an increased risk of suicidal tendencies occurs in people under the age of 25 with psychiatric disorders treated with antidepressants.

    If you have suicidal thoughts and want to hurt yourself, call your doctor or go to the hospital right away.

    It may be helpful to tell a relative or close friend that you are depressed and ask them to read this leaflet. You can ask them to tell you if they think your depression or anxiety is getting worse, or if they are worried about changes in your behavior.

    Manic episode

    Some patients with manic-depressive illness may enter a manic phase. It is characterized by exuberant and rapidly changing ideas, hyperthymia (persistent high spirits), and excessive physical activity.

    Tell your healthcare provider if you have or have recently had health problems, especially if you have

    • narrow angle glaucoma (loss of vision due to an abnormal increase in intraocular pressure)
    • epilepsy, history of convulsions or seizures
    • difficulty urinating
    • prostate enlargement
    • diseases of the thyroid gland
    • bipolar disorder
    • schizophrenia
    • acute liver diseases
    • severe heart disease
    • pyloric stenosis (narrowing of the opening at the outlet of the stomach) and paralytic ileus (intestinal obstruction)
    • diabetes, because you may need to adjust the dose of your diabetes medicine.

    If you are using antidepressants such as selective serotonin reuptake inhibitors (SSRIs), your doctor may consider changing the dose of your medicine (see section Other drugs and Amitriptyline and section How to take Amitriptyline).

    Older people are more likely to experience certain side effects, such as dizziness with orthostatic hypotension (see section Possible side effects).

    Children and adolescents

    Depression, neuropathic pain, chronic tension headache and migraine prophylaxis

    Amitriptyline should not be used in children and adolescents under 18 years of age as safety and efficacy have not been established in this age group.

    Bedwetting

    • ECG should be performed prior to initiation of amitriptyline therapy to rule out long QT syndrome
    • Medicines in this group should not be taken concomitantly with anticholinergics (see also section Other medicines and Amitriptyline)
    • Suicidal thoughts and behavior may also develop during early antidepressant treatment for disorders other than depression; in the treatment of patients with bedwetting, the same precautions should be observed as in the treatment of patients with depression.

    Other medicines and Amitriptyline

    Some medicines can affect the way other medicines work and this can sometimes cause serious side effects.

    Tell your doctor or pharmacist if you are taking, have recently taken or may take any other medicines such as:

    • monoamine oxidase (MAO) inhibitors including phenelzine, iproniazid, isocarboxazid, nialamide, ortranylcypromine (used to treat depression) or selegiline (used to treat Parkinson's disease). They should not be taken during a course of treatment with amitriptyline (see section Do not take amitriptyline)
    • epinephrine, ephedrine, isoprenaline, norepinephrine, phenylephrine and phenylpropanolamine (they may be present in cough or cold mixtures and in some combination anesthetics)
    • high blood pressure medication, such as calcium channel blockers (eg diltiazem and verapamil), guanethidine, betanidine, clonidine, reserpine and methyldopa
    • Anticholinergics, eg certain drugs for Parkinson's disease and gastrointestinal disorders
    • thioridazine (used to treat schizophrenia)
    • tramadol (painkiller), nefopam or opioid analgesics
    • medicines for the treatment of fungal infections (including fluconazole, terbinafine, ketoconazole and itraconazole)
    • sedatives (including barbiturates)
    • antidepressants (including SSRIs (fluoxetine, paroxetine, fluvoxamine and bupropion)
    • medicines for certain heart conditions (including antiarrhythmics, beta-blockers such as amiodarone, disopyramide, propafenone)
    • cimetidine (used to treat stomach ulcers)
    • methylphenidate (used to treat ADHD)
    • ritonavir (used to treat HIV)
    • oral contraceptives
    • rifampicin (used to treat infection)
    • phenytoin and carbamazepine (used to treat epilepsy)
    • St. John's wort - herbal remedy for depression
    • thyroid hormone preparations
    • apraclonidine and brimonidine (used to treat glaucoma)
    • altretamine (used in the treatment of certain types of cancer)
    • disulfiram (used to treat alcohol dependence)
    • baclofen (muscle relaxant)
    • drugs for the treatment of angina pectoris of the inhalation or sublingual type (including nitroglycerin, isosorbide dinitrate)
    • sibutramine (appetite suppressant)
    • valproic acid.

    Also tell your doctor if you are taking, have recently taken or may be taking medicines that can affect your heart rate, including:

    • medicines for the treatment of palpitations (including quinidine and sotalol)
    • astemizole and terfenadine (used to treat allergic reactions and hay fever)
    • medicines used to treat certain mental illnesses (including pimozide and sertindole)
    • cisapride (used to treat certain types of indigestion)
    • halofantrine (used to treat malaria)
    • methadone (used for pain relief and drug detox)
    • diuretics (including furosemide).

    If you are having surgery with general or local anesthetics, you must tell your doctor that you are taking this drug.

    You must also tell your dentist that you are taking this drug before you use a local anesthetic.

    Amitriptyline with alcohol

    It is not recommended to drink alcohol during treatment with this medicine, as this may increase the sedative effect.

    Pregnancy and lactation

    If you are pregnant or breastfeeding, think you may be pregnant or are planning to become pregnant, please consult your healthcare professional.

    Amitriptyline is not recommended during pregnancy unless you and your doctor have discussed the risks and benefits of using the drug.

    If you are taking this drug during the last trimester of pregnancy, you should know that your newborn baby may have the following side effects such as irritability, increased muscle tension, tremors, irregular breathing, reluctance to drink fluids, loud crying, urinary retention and constipation.

    Your doctor will tell you to start/continue/stop breastfeeding or stop using this drug based on the benefits of breastfeeding for your baby and the benefits of therapy for you.

    Influence on the ability to drive and use mechanisms

    The drug may cause drowsiness, dizziness, especially at the beginning of treatment. It is unacceptable to drive or work with mechanisms if it negatively affects you.

    Important information about the ingredients of amitriptyline tablets

    Amitriptyline tablets contain lactose medicine.

    How to take Amitriptyline

    Amitriptyline should be taken exactly as directed by your doctor. If you have any doubts, you should consult your doctor or pharmacist.

    Not all dosage regimens are possible with different dosage forms and doses of the drug.

    The appropriate dosage form and dosage must be selected for starting 3 and subsequent increasing doses.

    Depression

    Adults :

    The recommended starting dose is 25 mg twice a day. Depending on the clinical effect, the dose may be increased up to 150 mg/day divided into two doses.

    Elderly patients (over 65 years of age) and patients with cardiovascular disease

    The recommended starting dose is 10-25 mg per day. Depending on the clinical effect, the dose may be increased to 100 mg / day, divided into two doses. If you are taking 100mg to 150mg of the drug, you may need to see your doctor more often.

    Use in children and adolescents

    Amitriptyline is not recommended for use in children and adolescents for the treatment of depression. See section 2 for more information.

    Neuropathic pain, chronic headaches tension-type headaches and migraine prophylaxis

    Your doctor will adjust the dose to your treatment according to your symptoms and response to your symptoms.

    Adults :

    The recommended starting dose is 10-25 mg in the evening.

    The recommended daily dose is 25-75 mg.

    Depending on the clinical effect, the dose may be gradually increased. If you are taking more than 100mg/day, you may need to see your doctor more often. Take the drug once a day or divide the dose into two doses, your doctor will tell you.

    Elderly patients (over 65 years of age) and patients with cardiovascular disease

    The recommended starting dose is 10-25 mg in the evening.

    Depending on the clinical effect of the drug, the dose may be gradually increased.

    If you are taking more than 75 mg/day, you may need to see your doctor more often.

    Use in children and adolescents

    Amitriptyline is not recommended for use in children and adolescents for the treatment of neuropathic pain, chronic tension headache and migraine prophylaxis. For more information, see What you need to know before you use Amitriptyline.

    Bedwetting

    Use in children and adolescents

    0029

  • Children 6 to 10 years: 10-20 mg daily. In this age group, appropriate release forms are used.
  • Children 11 years of age and older: 25-50 mg.

The dose should be increased gradually.

Should be taken 1 to 1.5 hours before bedtime.

Before starting treatment, your healthcare provider should perform an ECG to check for signs of a palpitations.

Your doctor will re-evaluate your condition after 3 months of treatment and, if necessary, perform a repeat ECG.

Do not stop taking this medicine without your doctor's advice.

Special Patient Populations

Patients with liver disease or known to be "slow metabolizers" are usually given lower doses.

Your doctor may take blood samples to check your amitriptyline level (see What you need to know before you use amitriptyline).

How and when to take Amitriptyline

The drug should be taken during or after a meal.

Tablets should be swallowed whole with water. Tablets should not be chewed.

Treatment period

Do not change the dose of the drug or stop taking the drug without consulting a doctor.

Depression

As with other drugs used to treat depression, this too can take several weeks before you feel any improvement in your condition.

In the treatment of depression, the duration of treatment is individual and is usually at least 6 months. The duration of treatment is determined by your doctor.

Continue taking Amitriptyline for as long as your doctor tells you to. The disease may persist for a long time. If you stop treatment too soon, the symptoms of the disease may recur.

Neuropathic pain, chronic headaches tension type and migraine prevention

It may take a few weeks for your condition to improve.

Talk to your doctor about the duration of treatment and continue taking the drug until the doctor stops it.

Bedwetting

Your doctor will determine if you need to continue treatment after 3 months of taking the drug.

If you have taken more Amitriptyline than recommended

If you have taken more Amitriptyline than prescribed by your doctor, contact your doctor or the nearest hospital emergency room immediately, even if you do not experience any discomfort or symptoms of poisoning . Take the medicine package with you if you go to the doctor or hospital.

Overdose symptoms include: