What are the effects of an overdose of Zoloft (sertraline)?

From the Guidelines

If you've accidentally taken too much Zoloft (sertraline), you should contact poison control (1-800-222-1222) or seek emergency medical attention immediately. Symptoms of Zoloft overdose can include nausea, vomiting, dizziness, drowsiness, agitation, tremor, rapid heartbeat, dilated pupils, and in severe cases, seizures or serotonin syndrome, as reported in a study on the assessment and treatment of children and adolescents with anxiety disorders 1. The severity depends on how much you took above your prescribed dose.

Key Considerations

• While waiting for medical help, do not try to induce vomiting unless directed by a healthcare professional.
• Be prepared to tell medical personnel exactly how much Zoloft you took and when you took it.
• Zoloft is an SSRI antidepressant that increases serotonin levels in the brain, and taking too much can lead to excessive serotonin, which can be dangerous, potentially causing serotonin syndrome, characterized by mental status changes, neuromuscular hyperactivity, and autonomic hyperactivity 1.

Important Facts

• Even if you feel fine after taking extra Zoloft, it's still important to seek medical advice as symptoms may develop later or be subtle at first.
• The margin of safety of SSRIs in overdose is greater than for other antidepressants, but deaths have been reported following very large ingestions, highlighting the need for prompt medical attention 1.
• Close monitoring for suicidality is recommended, especially in the first months of treatment and following dosage adjustments, although this is more relevant to the initiation of treatment rather than an overdose scenario 1.

From the FDA Drug Label

Of 1,027 cases of overdose involving sertraline hydrochloride worldwide, alone or with other drugs, there were 72 deaths (circa 1999) Among 634 overdoses in which sertraline hydrochloride was the only drug ingested, 8 resulted in fatal outcome, 75 completely recovered, and 27 patients experienced sequelae after overdosage to include alopecia, decreased libido, diarrhea, ejaculation disorder, fatigue, insomnia, somnolence and serotonin syndrome. The most common signs and symptoms associated with non-fatal sertraline hydrochloride overdosage were somnolence, vomiting, tachycardia, nausea, dizziness, agitation and tremor. Overdose Management Treatment should consist of those general measures employed in the management of overdosage with any antidepressant. Ensure an adequate airway, oxygenation and ventilation. Monitor cardiac rhythm and vital signs. General supportive and symptomatic measures are also recommended. Induction of emesis is not recommended Gastric lavage with a large-bore orogastric tube with appropriate airway protection, if needed, may be indicated if performed soon after ingestion, or in symptomatic patients. Activated charcoal should be administered.

If you have accidentally taken too much Zoloft, seek medical attention immediately. The treatment for overdose involves:

• Ensuring an adequate airway, oxygenation, and ventilation
• Monitoring cardiac rhythm and vital signs
• General supportive and symptomatic measures
• Gastric lavage may be indicated if performed soon after ingestion
• Activated charcoal should be administered No specific antidotes for sertraline are known 2.

From the Research

Accidental Zoloft Overdose

• If you have accidentally taken too much Zoloft, it is essential to seek medical attention immediately, especially if you are experiencing any symptoms other than mild effects, such as vomiting, somnolence, mydriasis, or diaphoresis 3.
• Asymptomatic patients or those with mild effects following isolated unintentional acute SSRI ingestions of up to five times an initial adult therapeutic dose can be observed at home with instructions to call the poison center back if symptoms develop 3.
• The poison center should consider making follow-up calls during the first 8 hours after ingestion, and patients could be referred to an emergency department if the observation would take place during normal sleeping hours of the patient or caretaker 3.

Serotonin Syndrome

• Serotonin syndrome is a rare and potentially life-threatening toxic state caused by an adverse drug reaction that leads to excessive central and peripheral serotonergic activity, which can occur after the use of serotonergic agents alone or in combination with monoamine oxidase inhibitors 4, 5.
• The clinical manifestations of serotonin syndrome are diverse and nonspecific, which may lead to misdiagnosis, and can range in severity from mild to life-threatening 4, 5.
• Management of serotonin syndrome involves withdrawal of the offending agent(s), aggressive supportive care to treat hyperthermia and autonomic dysfunction, and occasionally the administration of serotonin antagonists, such as cyproheptadine or chlorpromazine 4, 5.

Treatment and Prevention

• Induction of emesis is not recommended in cases of SSRI overdose 3.
• The use of oral activated charcoal can be considered, but there are no data to suggest a specific clinical benefit, and the routine use of out-of-hospital oral activated charcoal in patients with unintentional SSRI overdose cannot be advocated at this time 3.
• Single-dose activated charcoal (SDAC) can be effective in increasing clearance when given 1.5 to 4 hours post-overdose, decreasing the area under the curve, and decreasing the maximum plasma concentration (Cmax) of sertraline 6.