Before you take Zoloft

You should not take Zoloft in any of the following situations unless you have first discussed the risks with your doctor. The doctor may want to adjust the dosage of Zoloft you take. Alternatively, you may need separate treatment for any of the illnesses or conditions you have before you take Zoloft.

As a general warning, you must not drink alcohol while you are taking Zoloft because this increases the risk that you will experience adverse side-effects. For the converse reason, do not take the concentrated liquid form of Zoloft if you are also taking disulfiram (Antabuse). Disulfiram is a drug used to treat chronic alcoholism. It works by producing an acute and unpleasant reaction about ten minutes after consuming alcohol. The liquid form of Zoloft may contain alcohol. You will not find the result of mixing the two pleasant.

Special tests may be required to decide whether you should take Zoloft and, if so, in what dosage if you have:

• any disease of, or damage to, the brain;
• had a heart attack or any other sign of a cardiovascular disease;
• any degree of mental retardation;
• a history of mental illness including bipolar disorder — there is a risk that any subsisting manic condition may be activated;
• have had thoughts of suicide or you have already made one or more suicide attempts, particularly if you are younger than 24 years — there are very specific warnings not to take Zoloft (see the article on side-effects);
• a history of drug abuse;
• liver or a kidney disease sufficiently severe to require you to be on dialysis — when you take Zoloft, the level of serotonin rises more rapidly in the blood stream which increases the chance of side-effects — in such cases, your doctor may lower the dosage or tell you to take your doses less often;
• below average body weight — Zoloft may cause a slight weight loss in some people but, in a small percentage of cases, more significant weight loss occurs. This can be dangerous if your weight is already below average.

A small number of people taking Zoloft have had seizures. The risk of having a seizure becomes more real if you have:

• a history of seizures, say, because of epilepsy;
  
• recently had a head injury; or
• if you are already taking any of the more common sedatives or tranquillisers such as Valium, pain killers such as Tramadol (Ultram), or medicine to control the symptoms of nausea and vomiting.

Finally, you should be aware of the following problems:

1. The following drugs and medications represent a danger. You must get medical advice if you are already taking:

• any of the standard medications for migraine headaches such as naratriptan (Amerge);
• any of the standard sleeping pills or tranquillisers;
• any of the oral treatments for diabetes such as tolbutamide (Orinase);
• one of the antidepressants such as Selegiline and Moclobemide (Aurorix and Manerix) that work as Monoamine Oxidase Inhibitors (MAOIs). These drugs are normally used to treat more serious cases of atypical depression but, more recently, they have been prescribed to help people quit smoking. This latter use has made these drugs slightly more common in the general population. You are warned that the reaction to this mixture can be serious and, in a few cases, fatal. You must allow at least fourteen days to pass when you stop taking an MAOI before it is safe to take Zoloft. After you stop taking Zoloft, you must also wait at least fourteen days before you start taking an MAOI.
• tricyclic antidepressants such as amitriptyline (Elavil) and trimipramine (Surmontil);
• pimozide (Orap) supplied as an antipsychotic drug of last resort;
• nonsteroidal anti-inflammatory medications (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin);
• warfarin in any of its branded forms such as Corumadin and Marevan which is used as an anticoagulant to relieve the danger of a thrombosis or embolism;
• digoxin (Lanoxin, Lanoxicaps) which is used to treat a number of heart conditions and flecainide (Tambocor) which is prescribed to treat arrhythmia.

This is not a complete list. There are other drugs that can affect the way in which Zoloft works in your body. It is in your own interests to give your doctor a complete list of all the drugs, non-prescription medications, and health and herbal products that you are taking. Then, after starting to take Zoloft, do not start to take any new medicine or products (even something as apparently innocent as vitamins) without first consulting your doctor.

2. If you are planning to become pregnant or are already pregnant, you are warned that Zoloft and the other SSRI antidepressants can cause serious damage to your baby while in the womb. The result may be that your baby will be born with life-threatening lung problems. But it is possible that a mother may lapse into depression during pregnancy. If this happens, consult your doctor before taking any antidepressant. If you become pregnant while taking Zoloft, do not stop taking the medication without first talking to your doctor. Further, if you take Zoloft immediately after giving birth, it can pass into breast milk and threaten the health of your baby.

3. You should not give Zoloft to anyone younger than eighteen years unless a doctor gives specific approval. Zoloft has been approved by the Food and Drugs Administration (FDA) in the USA and by other regulatory bodies, but only for children who have obsessive-compulsive disorder (OCD). No regulatory body has approved Zoloft for the treatment of depression in children.