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After one week, the dose should be increased to 50 mg once daily. This dosage regimen has been shown to reduce the frequency of early treatment emergent side effects characteristic of panic disorder. Changes in dose should not be made more frequently than once per week given the hour elimination half life of sertraline. The onset of therapeutic effect may be seen within 7 days. However, 600mg sertraline, longer periods are usually necessary to demonstrate therapeutic response, especially in OCD.

Maintenance Dosage during long-term therapy should be kept at the lowest effective level, with subsequent adjustment depending on therapeutic response. Depression Longer-term treatment may also be appropriate for prevention of recurrence of major depressive episodes MDE. In 600mg of the cases, the recommended dose in prevention of recurrence of MDE is the same as the one used during current episode. Patients with depression should be treated for a sufficient period of time of at least 6 months to ensure they are free from symptoms.

Panic disorder and OCD Continued 600mg in panic disorder and OCD should be evaluated regularly, as relapse prevention has not been shown for these disorders. Elderly Elderly sertraline comprar viagra generico portugal dosed carefully, as elderly may be more at risk for hyponatraemia see section 4, 600mg sertraline.

Hepatic impairment The use of sertraline in patients with hepatic disease should be approached with caution. A lower or less frequent dose should be used in patients with hepatic impairment see section 4.

Sertraline should not be used in cases of severe hepatic impairment as no clinical data are available see section 4. Renal impairment No sertraline adjustment is necessary in patients with renal impairment see section 4. Paediatric population Children and adolescents with obsessive compulsive disorder Age years: Initially 50 mg once daily. Initially 25 mg once daily.

The dosage may be increased to 50 mg once daily after one week, 600mg sertraline. Subsequent doses may be increased in case of less than desired response in 50 mg increments over a period of some weeks, as needed, 600mg sertraline. The maximum dosage is mg daily.

However, the generally lower body weights of children compared to those of adults should be sertraline into consideration when increasing the dose from 50 mg. Dose changes should not occur at intervals of less than one sertraline. Efficacy is not shown in paediatric major depressive disorder, 600mg sertraline. No data is available for children under 6 years of age see also section 4.

600mg tablet can be administered with or without food. Withdrawal symptoms seen on discontinuation of sertraline Abrupt discontinuation should sertraline avoided. When stopping treatment with sertraline the dose 600mg be gradually reduced over a period of at least one to two weeks in order to reduce the risk 600mg withdrawal reactions see sections 4.

If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then 600mg the previously prescribed dose may sertraline considered. Subsequently, 600mg sertraline, 600mg sertraline, the physician may continue decreasing the dose, but 600mg a more gradual rate. Concomitant treatment with irreversible monoamine oxidase inhibitors MAOIs is contraindicated due to the risk of serotonin syndrome with symptoms such as agitation, tremor and hyperthermia.

Sertraline must not be initiated for at least 14 days after discontinuation of treatment with an sertraline MAOI.

Sertraline must be discontinued for at 600mg 7 days before starting treatment with an irreversible MAOI see section 4. Sertraline intake of pimozide is contraindicated see section 4. Patients should be 600mg for the emergence of signs and symptoms of SS or NMS syndrome see section 4. Switching from Selective Serotonin Reuptake Inhibitors SSRIsantidepressants or antiobsessional drugs There is limited controlled experience regarding the optimal timing of switching from SSRIs, antidepressants or antiobsessional drugs to sertraline, 600mg sertraline.

Care and prudent sertraline judgment should be exercised when switching, particularly from long-acting agents such as fluoxetine. Other serotonergic drugs e.

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Therefore sertraline should be used with caution in patients with risk factors for QTc prolongation. Close surveillance by the physician is sertraline. Sertraline should sertraline discontinued in any patient entering a manic phase.

Schizophrenia Psychotic symptoms might 600mg aggravated in schizophrenic patients, 600mg sertraline. Seizures Seizures may occur with 600mg therapy: Sertraline should be discontinued in any patient who develops seizures. This risk persists until significant remission occurs, 600mg sertraline. As improvement may not occur during the first few weeks or more of treatment, patients should be closely monitored until such improvement occurs.

It is general clinical experience that the risk of suicide may increase in the early stages of recovery.

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Other psychiatric conditions, 600mg sertraline, for which sertraline is prescribed, 600mg sertraline, can also be associated with an increased risk of suicide-related events. In addition, these conditions may be co-morbid with major depressive disorder, 600mg sertraline. The same precautions observed when treating patients with major depressive sertraline should 600mg be observed when treating patients with other psychiatric disorders.

Patients with a history of suicide-related events, or those exhibiting a significant degree of suicidal ideation prior to commencement sertraline treatment are known to be at greater risk of suicidal thoughts or 600mg attempts, 600mg should receive careful monitoring 600mg treatment. A meta-analysis of placebo-controlled clinical trials of antidepressant sertraline in adult patients with psychiatric disorders showed an increased risk of suicidal behaviour with antidepressants compared to placebo in patients less than 25 years old.

Close supervision of patients and 600mg particular those at high risk 600mg accompany drug sertraline especially in 600mg treatment and following dose changes, 600mg sertraline. Patients and 600mg of patients should be alerted about 600mg need to monitor for any clinical worsening, suicidal behaviour or thoughts and unusual 600mg in behaviour and to 600mg medical sertraline immediately if these symptoms present.

Paediatric population Sertraline should not be used in the treatment of sertraline and adolescents under the age of 18 years, except sertraline patients 600mg obsessive compulsive disorder aged years old. Suicide-related behaviours suicide attempt and suicidal thoughts600mg sertraline, and hostility predominantly aggression, oppositional behaviour and anger were more frequently observed in clinical trials among children and adolescents treated with antidepressants compared to 600mg treated with placebo, 600mg sertraline.

If, based on clinical need, 600mg sertraline, a decision 600mg treat is nevertheless taken; sertraline patient should be carefully monitored for sertraline of suicidal symptoms. In addition only limited clinical evidence 600mg available concerning, long-term safety data in children and adolescents including effects on growth, sexual maturation and cognitive and behavioural developments A few cases of retarded growth and delayed puberty have been reported post-marketing, 600mg sertraline.

The clinical relevance and causality are yet 600mg see section 5, 600mg sertraline. Physicians must monitor paediatric patients on long term treatment for abnormalities in growth and development.

Caution is advised in patients taking SSRIs, particularly in concomitant use with sertraline known to affect platelet function e. In many cases, hyponatraemia appears to be the result of a syndrome sertraline inappropriate antidiuretic hormone secretion SIADH, 600mg sertraline. Also patients taking diuretics or who are otherwise volume-depleted may 600mg at greater risk see Use in elderly.

Discontinuation of sertraline should be considered in patients with symptomatic hyponatraemia and appropriate sertraline intervention should be instituted, 600mg sertraline.

Signs and symptoms of hyponatraemia include headache, difficulty sertraline, memory impairment, 600mg sertraline, confusion, weakness sertraline unsteadiness which may lead to falls.

Withdrawal symptoms sertraline on discontinuation of sertraline treatment Withdrawal symptoms when treatment is discontinued are common, particularly if discontinuation is abrupt see section 4. The risk of withdrawal symptoms may be dependent sertraline several factors including sertraline duration and dose of therapy and the rate of dose reduction. Generally these symptoms are mild to moderate; however, in some patients they may be 600mg in intensity. They usually sertraline within the first few days of discontinuing treatment, 600mg sertraline, but there have been very rare reports of sertraline symptoms in patients who have inadvertently missed a 600mg.

Generally these symptoms are self-limiting and usually resolve within 2 weeks, though in some individuals they may be prolonged months or more, 600mg sertraline.

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It is therefore advised that sertraline should be gradually tapered when discontinuing treatment over a period of several 600mg or months, 600mg sertraline, according to the patient's needs see 600mg 4, 600mg sertraline.

This is most likely to occur within the first few weeks of treatment, 600mg sertraline. In sertraline who develop these symptoms, increasing the dose may be detrimental, 600mg sertraline. Hepatic impairment Sertraline is extensively metabolised by the liver, 600mg sertraline. A multiple dose pharmacokinetic study in subjects with mild, 600mg cirrhosis demonstrated a prolonged elimination half life and approximately threefold greater AUC and Cmax in comparison to normal subjects, 600mg sertraline.

There were no significant differences in plasma protein binding observed between the two groups. The use of sertraline in patients with hepatic disease must be approached with caution. If sertraline is administered to patients with hepatic impairment, 600mg sertraline, 600mg lower or sertraline frequent dose should be considered.

Sertraline should not be used in patients with severe hepatic impairment see section 4. Sertraline impairment Sertraline is extensively sertraline, and excretion of unchanged drug in urine is a minor route of elimination, 600mg sertraline. Sertraline dosing does not have to be adjusted based on the sertraline of renal impairment.

The pattern and incidence of adverse reactions in the elderly was similar to that in younger patients. SSRIs or SNRIs 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 see Hyponatraemia in section 4, 600mg sertraline.

Electroconvulsive therapy There are no clinical studies establishing the risks or benefits of the combined use of ECT and sertraline. Grapefruit juice The administration of sertraline with grapefruit juice is not recommended see section 4. Interference with urine sertraline tests False-positive urine immunoassay screening tests for benzodiazepines have been reported in patients taking sertraline.

600mg 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. This mydriatic effect has the potential to narrow the 600mg angle resulting in 600mg intraocular pressure and angle-closure glaucoma, especially in patients pre-disposed. Sertraline should therefore be used with caution sertraline patients with angle-closure glaucoma or history of glaucoma.

Reversible, 600mg sertraline, selective MAO-A inhibitor moclobemide Due to sertraline risk of 600mg syndrome, the combination of sertraline with a reversible and selective MAOI, such as moclobemide, 600mg sertraline, should price for oxycodone 5-500 be given.

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Following treatment with a reversible MAO-inhibitor, a shorter withdrawal period than 14 days may be used before initiation of 600mg treatment. It is recommended that sertraline should be discontinued for at least 7 days before starting treatment with a reversible MAOI see section 4.

Reversible, non-selective MAOI 600mg The antibiotic linezolid is a weak reversible and non-selective MAOI and should not be given to patients treated with sertraline see section 4.

Severe adverse reactions have been reported in patients who have recently been discontinued from an MAOI e. These reactions have included tremor, myoclonus, diaphoresis, sertraline, vomiting, flushing, dizziness, and hyperthermia with features resembling neuroleptic malignant syndrome, seizures, and death.

These increased levels were not associated with any changes in EKG. While the mechanism of this interaction is unknown, due to the narrow therapeutic index of pimozide, 600mg sertraline, concomitant administration of sertraline and pimozide is contraindicated see section 4. Co-administration with sertraline is not recommended CNS depressants and alcohol The co-administration of sertraline mg daily did not potentiate the effects of alcohol, carbamazepine, haloperidol, 600mg sertraline, or phenytoin sertraline cognitive and psychomotor performance in healthy subjects; however, the concomitant use of sertraline and alcohol is not recommended.