Lustral

What is it?

An antidepressant and 5HT reuptake inhibitor, available as scored, white, capsule-shaped tablets in two strengths containing 50 or 100mg of sertraline hydrochloride and marked PFIZER with LTL-50 or LTL-100 respectively.

Medical Uses

Depression and anxiety, prevention of relapse or further bouts of depression, obsessive compulsive disorder, post-traumatic stress disorders inwomen.

Dosage

Adults, depression with anxiety, 50mg each day to begin, with the dose being continued for maintenance; obsessive compulsive disorder, 50mg once each day at first with the usual maintenance being in the order of 50 to 200mg each day. Post-traumatic stress disorder, 25mg once each day at first for 1 week then a maintenance dose of 50mg once each day. Any dose increases should be implemented carefully by 50mg increments over several weeks to a daily maximum of 200mg. Then the lowest effective dose should be used for maintenance. Children, for obsessive compulsive disorder only and to be supervised by specialist physician, aged 6 to 12 years, 25mg each day at first for 1 week, then increasing to 50mg daily. Aged 13 to 17 years, 50mg each day at first, increasing if necessary at weekly intervals by 50rng increments to a daily maximum of 200mg.

Special Care

Pregnancy, breastfeeding, diabetes, epilepsy, anyone undergoing electroconvulsive therapy, kidney disease, mild to moderate liver disease, previous mania or hypomania, suicidal tendencies. Drug should be stopped if patient develops manic phase. Risk of bleeding disorders affecting skin (eg. purpura) in patients with history of bleeding or those taking antiplatelet drugs. Drug should be gradually withdrawn.

Avoid Use

Children under 6 years, severe liver disorders.

Possible Drug and Food Interactions

Lithium, tryptophan, MAOIs, moclobemide, selegiline, sumatriptan, tramadol, TCADs, fenfluramine, cimetidine, NSAIDs, other serotonergic agents, tolbutamide, warfarin, drugs acting on central nervous system, drugs affecting blood platelets, St John's Wort.

Known Side Effects

Nausea, diarrhoea, tremor, increased sweating, indigestion, dry mouth, delay in ejaculation, insomnia, sleepiness, dizziness, muscle and joint pains, headaches, malaise, skin rashes, vision disturbance, rapid heartbeat, feelings of panic, low blood pressure on rising upright, nervousness, angioedema (in which there is widespread swelling) anaphylactoid reactions, raised prolactin levels in blood, symptoms of depersonalisation. Symptoms of serotonin syndrome, retention of urine, aggression, psychotic reactions, disordered movements. Withdraw drug immediately in event of fits occurring. In rare cases, pancreatitis, severe liver effects, low blood sodium levels, abnormal platelet function and laboratory test results, appearance of mania or hypomania. Withdrawal of symptoms when drug is stopped.