Metabolism appears to be hepatic, with first-pass metabolism and minimal renal excretion of unchanged drug. Steady-state levels are achieved after 1 week of normal daily dosage. The elimination half-life is approximately 26 hours. Dosage adjustments are recommended for patients with mild, stable cirrhosis due to the half-life increase from 22 to 52 hours following a single dose. Seizures have not been reported during therapy with sertraline, despite overdoses as high as 6,000 mg.
All effective antidepressants can transform depression into mania in predisposed individuals.
The usual presentation of this switch is the sudden appearance of insomnia. The antidepressant should be held and appropriate therapy to treat the manic symptoms initiated. All antidepressants should be used with caution in depressed patients because of the possibility of suicidal ideation. Close monitoring of the patient is essential during the initial stages of therapy and sertraline prescribed in the smallest quantity consistent with good management. Sertraline should be used with caution in patients with hepatic disease or severe cardiac disease because metabolism can be delayed.