Sertraline and Myalgias
Sertraline does not typically cause myalgias as a recognized adverse effect, though muscle pain is not listed among its common or even rare side effects in FDA labeling or major clinical reviews.
Evidence from FDA Labeling and Clinical Literature
The FDA-approved prescribing information for sertraline extensively documents adverse effects across multiple body systems but does not list myalgia or muscle pain among frequent, infrequent, or rare adverse reactions 1. The documented side effects primarily involve:
- Gastrointestinal disturbances (nausea, diarrhea/loose stools) 1, 2
- Sexual dysfunction (primarily ejaculatory disturbance in males) 1, 2
- Central nervous system effects (headache, dizziness, insomnia, somnolence) 1, 3
- Other effects (dry mouth, sweating, taste abnormalities) 4
Distinguishing from Medications That Do Cause Myalgias
It is important to differentiate sertraline from medications that genuinely cause muscle-related adverse effects. Bezafibrate, used for pruritus in cholangitis, explicitly lists myalgia and myopathy as potential side effects 5. This contrast highlights that when myalgia is a recognized adverse effect, it appears clearly in clinical guidelines and drug labeling.
Clinical Considerations
Alternative Explanations for Muscle Pain
If a patient on sertraline presents with myalgias, consider:
- Concurrent medications: Gabapentin, often prescribed alongside SSRIs, frequently causes lower extremity edema and may contribute to musculoskeletal complaints 6
- Underlying conditions: Depression itself is associated with somatic complaints including muscle pain 7
- Drug interactions: While sertraline has minimal cytochrome P450 interactions compared to other SSRIs, evaluate all concurrent medications 8, 4
Tolerability Profile
Multiple large-scale clinical trials and systematic reviews consistently demonstrate that sertraline's tolerability advantages over tricyclic antidepressants include:
- Minimal anticholinergic activity 2, 4
- Absence of cardiovascular effects 2, 3
- Low potential for serious adverse events 7, 4
- Similar tolerability in younger and elderly patients 4
The most common adverse events leading to discontinuation are gastrointestinal in nature, not musculoskeletal 1, 2.
Clinical Recommendation
If myalgias develop in a patient taking sertraline, investigate alternative causes rather than attributing them to the medication. The extensive clinical experience with sertraline across multiple patient populations, including elderly patients and those with medical comorbidities, has not identified myalgia as a characteristic adverse effect 7, 4. The FDA labeling, which comprehensively catalogs adverse reactions from clinical trials, does not include muscle pain in any frequency category 1.