Alternative Routes for Sertraline Administration
Sertraline is only available as an oral formulation (tablets and oral concentrate), and there are no FDA-approved alternative routes of administration such as intravenous, intramuscular, subcutaneous, transdermal, or rectal formulations. 1
Available Oral Formulations
For patients with swallowing difficulties, sertraline offers two oral options:
Oral concentrate (20 mg/mL): This liquid formulation must be diluted immediately before administration in 4 oz (½ cup) of water, ginger ale, lemon/lime soda, or orange juice ONLY—no other liquids should be used. 1
Tablets: These can potentially be crushed and mixed with soft foods or liquids, though this is not explicitly addressed in the FDA labeling. 1
Critical Limitations
There are no parenteral, transdermal, sublingual, buccal, or rectal formulations of sertraline available. 1, 2, 3 The pharmacokinetic profile of sertraline makes alternative routes impractical:
Sertraline undergoes extensive first-pass hepatic metabolism after oral administration, with slow absorption and peak plasma concentrations occurring 6-8 hours post-dose. 3, 4
The elimination half-life is approximately 22-36 hours (average 26-32 hours), making once-daily oral dosing therapeutically effective. 2, 3, 4
Oral bioavailability and pharmacokinetics have only been studied and established for oral administration. 3, 4
Clinical Approach for Patients Unable to Swallow
If a patient cannot take oral medication in any form, sertraline must be discontinued and an alternative antidepressant with parenteral formulations should be considered. 1 The FDA labeling explicitly states that when urgent psychiatric treatment is needed and oral administration is not feasible, "other interventions, including hospitalization, should be considered." 1
Important Drug Interaction Caveat
When sertraline is used concurrently with cholestyramine (e.g., for cholestatic pruritus), the two medications must be spaced at least 4 hours apart to prevent binding and loss of sertraline efficacy. 5, 6
Discontinuation Considerations
If sertraline must be stopped due to inability to administer orally, gradual tapering over 10-14 days is recommended whenever possible to minimize withdrawal symptoms, rather than abrupt cessation. 6, 1