Can sertraline (selective serotonin reuptake inhibitor) cause nausea?

Sertraline and Nausea

Yes, sertraline commonly causes nausea as a side effect, and it is one of the most frequent reasons patients discontinue the medication. 1, 2

Evidence on Sertraline and Nausea

The FDA drug label for sertraline explicitly lists nausea as one of the common side effects 1. According to the American College of Physicians clinical practice guideline, nausea and vomiting are the most common reasons for discontinuation of treatment with SSRIs, including sertraline 2.

Incidence and Characteristics

• Nausea typically occurs early in treatment, often within the first few weeks 1
• It is generally mild to moderate in severity 3
• The symptom tends to be transient, decreasing in frequency with continued treatment 3

Management of Sertraline-Induced Nausea

For patients experiencing nausea with sertraline:

1. Timing of administration:

   • Taking sertraline with food may help reduce nausea 1
   • Evening dosing may be beneficial if daytime nausea is problematic

2. Dosing strategy:

   • Start with a lower dose and gradually increase
   • The FDA label notes that sertraline tablets may be taken with or without food 1
   • For anxiety disorders, starting with a subtherapeutic "test" dose may be advisable as initial adverse effects can include nausea 2

3. Duration expectations:

   • Inform patients that nausea often improves after the first few weeks of treatment 3

Comparative Incidence Among Antidepressants

The American College of Physicians guideline notes that sertraline has a higher rate of diarrhea compared to several other antidepressants (bupropion, citalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, and venlafaxine) 2. While specific comparative rates for nausea aren't provided for sertraline individually, SSRIs as a class are associated with gastrointestinal side effects including nausea.

Special Populations

In elderly patients (≥60 years), nausea remains one of the most frequently reported adverse events with sertraline at doses of 50-150 mg/day 4, 5. The tolerability profile is generally similar between younger and elderly patients.

Clinical Implications

When prescribing sertraline:

• Warn patients about the possibility of nausea before starting treatment
• Reassure them that this side effect often diminishes over time
• Consider starting at lower doses (25-50mg) and titrating up slowly
• If nausea is severe or persistent, consider alternative SSRIs or different classes of antidepressants

The benefit-risk assessment should consider that while nausea is common, sertraline is generally well-tolerated compared to older antidepressants like tricyclics, which have more anticholinergic and cardiovascular effects 4.