What class is Zoloft (sertraline)?

Zoloft (Sertraline) Drug Classification

Zoloft (sertraline) is a Selective Serotonin Reuptake Inhibitor (SSRI) antidepressant medication. 1, 2

Pharmacological Classification Details

Sertraline belongs to the SSRI class of medications, which work primarily by inhibiting the reuptake of serotonin in the central nervous system. This mechanism increases serotonin availability in the synaptic cleft, which is believed to be responsible for its therapeutic effects.

Key Characteristics of Sertraline as an SSRI:

• Mechanism of Action: Selectively inhibits serotonin reuptake with minimal effects on norepinephrine or dopamine reuptake 2
• Chemical Structure: (1S-cis)-4-(3,4-dichlorophenyl)-1,2,3,4-tetrahydro-N-methyl-1-naphthalenamine hydrochloride 2
• Pharmacokinetics: Metabolized by the liver, primarily through the cytochrome P450 system 2

Clinical Applications

As an SSRI, sertraline is FDA-approved for multiple psychiatric conditions:

• Major depressive disorder
• Obsessive-compulsive disorder (OCD) 3
• Panic disorder
• Post-traumatic stress disorder (PTSD)
• Social anxiety disorder 1
• Premenstrual dysphoric disorder (PMDD) 2

Distinguishing Features Among SSRIs

Sertraline has several distinguishing characteristics compared to other medications in the SSRI class:

• Drug Interactions: Lower potential for pharmacokinetic drug interactions compared to fluoxetine, fluvoxamine, and paroxetine 4
• CYP450 Effects: Less potent inhibitor of cytochrome P450 isoenzymes than other SSRIs 4
• Side Effect Profile: May have a more favorable side effect profile in head-to-head comparisons with other SSRIs 4
• Breastfeeding Safety: Transfers in lower concentrations to breast milk compared to some other SSRIs 1

Dosing Considerations

Standard dosing parameters for sertraline include:

• Starting Dose: 25 mg daily
• Maximum Dose: 200 mg daily 1, 5
• Administration: Can be taken as a daily dose or in some cases as situational dosing (for conditions like premature ejaculation) 1

Common Side Effects

As with other SSRIs, sertraline may cause:

• Gastrointestinal disturbances (nausea, diarrhea)
• Sexual dysfunction
• Headache
• Sleep disturbances (insomnia or somnolence)
• Risk of serotonin syndrome when combined with other serotonergic medications 5, 6

Clinical Implications

Understanding sertraline's classification as an SSRI is important for:

1. Predicting potential drug interactions (particularly with MAOIs, triptans, and other serotonergic medications)
2. Recognizing the risk of discontinuation syndrome if stopped abruptly
3. Monitoring for class-specific adverse effects like sexual dysfunction and hyponatremia
4. Being aware of the black box warning regarding increased risk of suicidal thinking and behavior in children, adolescents, and young adults 1

Sertraline's relatively favorable side effect profile and lower potential for drug interactions make it a commonly prescribed first-line SSRI for various psychiatric conditions.