From the Research
Management of rhabdomyolysis in a patient taking sertraline requires immediate discontinuation of the medication and aggressive supportive care. The patient should be hospitalized for intravenous fluid administration, typically normal saline at 200-300 mL/hour initially, to maintain urine output of 200-300 mL/hour until myoglobin is cleared from the kidneys 1.
Key Considerations
- Urine alkalinization with sodium bicarbonate may be considered to prevent myoglobin precipitation in the renal tubules, though this remains controversial 2.
- Careful monitoring of electrolytes, particularly potassium, calcium, and phosphorus, is essential as hyperkalemia and hypocalcemia can occur.
- Renal function should be closely monitored through serum creatinine and BUN measurements.
- Creatine kinase (CK) levels should be tracked until they begin to decrease.
- In severe cases with acute kidney injury or severe electrolyte abnormalities, renal replacement therapy may be necessary 3.
Post-Recovery Management
After recovery, alternative antidepressant options from different classes should be considered, such as mirtazapine, bupropion, or vortioxetine, as cross-reactivity within SSRIs may occur 4.
Mechanism and Risk Factors
The mechanism of sertraline-induced rhabdomyolysis likely involves serotonergic effects on muscle tissue or idiosyncratic reactions, though it is a rare adverse effect of SSRI therapy 5.
Clinical Approach
A high degree of suspicion for complications like rhabdomyolysis in patients taking sertraline, especially when combined with risk factors such as alcohol consumption or strenuous exercise, is crucial for early intervention and management 2, 1.