From the Guidelines
Sertraline is not typically associated with causing orthostatic hypotension, and in fact, it has been shown to improve symptoms in patients with idiopathic orthostatic hypotension. According to the study published in the American Journal of Kidney Diseases 1, sertraline has been demonstrated to improve hemodynamic parameters in patients with idiopathic orthostatic hypotension. However, it's essential to note that sertraline can cause dizziness, insomnia, fatigue, somnolence, and headache as side effects, which may be related to its impact on blood vessel tone and blood pressure regulation through serotonin pathways.
If a patient experiences symptoms like dizziness or lightheadedness when standing up while taking sertraline, they should not stop the medication abruptly but consult their healthcare provider. The provider may recommend strategies such as rising slowly from sitting or lying positions, staying well-hydrated, avoiding alcohol, and monitoring blood pressure. In some cases, the doctor might adjust the sertraline dosage, suggest taking it at a different time of day, or consider an alternative medication if symptoms are severe.
It's also important to consider the guidelines for managing orthostatic hypotension, as outlined in the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope 1, which recommends non-pharmacological approaches as the first-line treatment, including increased salt and fluid intake, physical counter-pressure maneuvers, and compression garments. However, the most recent guideline on hypertension management, the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1, emphasizes the importance of testing for orthostatic hypotension before starting or intensifying blood pressure-lowering medication and pursuing non-pharmacological approaches as the first-line treatment.
In the context of sertraline use, it's crucial to prioritize the patient's overall health and adjust treatment strategies accordingly, taking into account the potential risks and benefits of the medication, as well as the patient's individual needs and medical history.
From the FDA Drug Label
The most common signs and symptoms associated with non-fatal sertraline hydrochloride overdosage were somnolence, vomiting, tachycardia, nausea, dizziness, agitation and tremor... Other important adverse events reported with sertraline hydrochloride overdose (single or multiple drugs) include... hypotension...
Orthostatic hypotension is not explicitly mentioned in the drug label as a common sign or symptom associated with sertraline overdosage. However, hypotension is listed as an important adverse event reported with sertraline hydrochloride overdose.
- It can be inferred that sertraline may cause hypotension, which could potentially lead to orthostatic hypotension in some cases.
- However, without direct evidence, it is uncertain whether sertraline can cause orthostatic hypotension. 2
From the Research
Sertraline and Orthostatic Hypotension
- Sertraline, a selective serotonin reuptake inhibitor, has been studied for its effects on blood pressure, including orthostatic hypotension 3, 4, 5.
- A study published in 1998 found that sertraline reduced hemodialysis hypotension in patients with end-stage renal disease, suggesting a possible mechanism of sertraline-induced attenuation of paradoxical sympathetic withdrawal 3.
- In contrast, a case report from 1996 described a patient who developed orthostatic hypotension after discontinuing sertraline, suggesting that sertraline withdrawal can induce orthostatic hypotension 4.
- A review of sertraline's pharmacodynamic and pharmacokinetic properties published in 1992 noted that sertraline has minimal anticholinergic activity and is essentially devoid of cardiovascular effects, but may be associated with gastrointestinal disturbances and male sexual dysfunction 6.
- A more recent review published in 2021 discussed the effects of antidepressant drugs, including sertraline, on blood pressure, and noted that selective serotonin reuptake inhibitors like sertraline have limited effects on autonomic system activity and a lower impact on blood pressure 5.
Mechanisms and Clinical Implications
- The exact mechanisms by which sertraline affects blood pressure are not fully understood, but may involve modulation of serotoninergic and adrenergic pathways 3, 5.
- Clinicians should be aware of the potential effects of sertraline on blood pressure, particularly in patients with cardiovascular comorbidities or those taking antihypertensive medications 5.
- Orthostatic hypotension is a common cardiovascular disorder that can have significant clinical implications, including impairment of quality of life and increased risk of adverse events such as falls and mortality 7.