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A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. Cll intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered.

Subsequently, the physician may continue decreasing the dose but at a more gradual rate (see Section 4. In human studies, sertraline has not demonstrated potential for abuse.

In a placebo-controlled, double-blind, randomised study of comparative abuse liability of sertraline, alprazolam and d-amphetamine in humans, sertraline did not produce positive subjective effects indicative of abuse potential, such as euphoria or drug liking. As with any CNS active drug, physicians should carefully evaluate patients for history of drug abuse and follow such patients closely, observing them for signs of sertraline misuse or abuse (e.

There are no clinical studies establishing the risks or benefits of the combined use of electroconvulsive therapy (ECT) and sertraline. Sertraline is extensively metabolised by the liver. There were no significant differences in plasma protein binding observed between the two groups. The use of sertraline in patients with hepatic disease should be approached with caution. Patients with moderate and severe hepatic impairment have not been studied. A lower or less frequent dose should be used in patients with hepatic impairment.

Sertraline is extensively metabolised. Excretion of unchanged drug in urine is a minor route of elimination. Half-lives were similar and there were no differences in plasma protein binding of all the groups studied.

This study indicates that, as expected from the low renal excretion of sertraline, sertraline dosing does not have to be adjusted based on degree of renal impairment. Several hundred elderly patients have participated in clinical studies with sertraline. The pattern of mind games effects in BenzaClin (Clindamycin and Benzoyl Peroxide)- Multum elderly was similar to that in younger patients.

SSRIs or Oil and gas journal including sertraline have however been associated with cases of clinically significant hyponatraemia in elderly patients, who may be at greater risk for this adverse event. A total of 225 paediatric patients have completed OCD trials with sertraline. The safety profile of sertraline in these paediatric studies is comparable to that observed in the adult OCD studies. Only limited clinical evidence is available concerning long-term safety data in children and adolescents, including effects on growth, sexual maturation and cognitive and behavioural developments.

Physicians must monitor paediatric patients on long-term treatment for abnormalities in growth and development. Safety journal of anatomy effectiveness in paediatric patients below the age of 6 have not been established. Sertraline should not be used in children and adolescents below the age of 18 years for the treatment of major depressive disorder.

The efficacy and safety of sertraline has not been satisfactorily established for the treatment of major depressive disorder in this age group.

False-positive urine immunoassay screening tests for benzodiazepines have been reported in patients taking sertraline. This is due to lack of specificity of the screening tests. False positive test results may be expected for several days following discontinuation of sertraline therapy. Increased pimozide levels have been demonstrated in a study of single low dose Fenoglide (Fenofibrate Tablets)- FDA (2 mg) with sertraline coadministration.

These increased levels did not significantly increase the QTc interval. While the mechanism of this interaction is unknown, due to the narrow therapeutic index of pimozide, concomitant BenzaClin (Clindamycin and Benzoyl Peroxide)- Multum of sertraline and pimozide is contraindicated.

There are BenzaClin (Clindamycin and Benzoyl Peroxide)- Multum data with BenzaClin (Clindamycin and Benzoyl Peroxide)- Multum at doses greater than 2 mg (see Section 4.

Drugs that prolong the QTc interval. TdP) is increased with concomitant use of other drugs which prolong the QTc interval (e. CNS depressants and alcohol. Although sertraline did not potentiate the cognitive and psychomotor effects of alcohol in experiment with normal subjects, the concomitant use of sertraline and alcohol in depressed patients is not recommended. Coadministration of medicines inside serotonergic estrogen pills. There have been BenzaClin (Clindamycin and Benzoyl Peroxide)- Multum post-marketing reports describing patients with weakness, BenzaClin (Clindamycin and Benzoyl Peroxide)- Multum, incoordination, confusion, anxiety and agitation following the use of sertraline and sumatriptan.

If concomitant treatment with sertraline and sumatriptan is clinically warranted, appropriate observation of the patient is advised (see Section 4. Medicines that interfere with haemostasis (NSAIDs, aspirin, warfarin, etc).

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