Fluoxetine vs Sertraline
FluoxetineSertraline
Selective Serotonin Reuptake Inhibitor (SSRI)Drug ClassSelective Serotonin Reuptake Inhibitor (SSRI)
Increases serotonin levels by inhibiting its reuptake in the brain.Mechanism of ActionIncreases serotonin levels by inhibiting its reuptake in the brain.
Major Depressive Disorder (MDD) - Obsessive-Compulsive Disorder (OCD) - Bulimia Nervosa - Panic Disorder - Premenstrual Dysphoric Disorder (PMDD)Primary IndicationsMajor Depressive Disorder (MDD) - Obsessive-Compulsive Disorder (OCD) - Panic Disorder - Post-Traumatic Stress Disorder (PTSD) - Social Anxiety Disorder (SAD) - Premenstrual Dysphoric Disorder (PMDD)
Capsules, tablets, oral solution (10 mg, 20 mg, 40 mg)Dosage FormsTablets, oral solution (25 mg, 50 mg, 100 mg)
Initial: 10–20 mg/day; Max: 80 mg/dayUsual DosageInitial: 25–50 mg/day; Max: 200 mg/day
4–6 weeks for full effectOnset of Action4–6 weeks for full effect
Long-lasting due to active metabolite (7–9 days)Duration of EffectShorter (about 24 hours)
4–6 days (active metabolite: up to 16 days)Half-Life22–36 hours
Liver (CYP2D6)MetabolismLiver (CYP2B6, CYP2C19)
Urine and fecesExcretionUrine and feces
- Nausea - Insomnia - Drowsiness - Dry mouth - Sweating - Sexual dysfunctionCommon Side EffectsNausea - Diarrhea - Insomnia - Dry mouth - Sweating - Sexual dysfunction
Serotonin syndrome - Suicidal thoughts - Seizures - QT prolongationSerious Side EffectsSerotonin syndrome - Suicidal thoughts - Seizures - Hyponatremia
MAO inhibitors - Pimozide - Thioridazine - HypersensitivityContraindicationsMAO inhibitors - Pimozide - Disulfiram (oral solution) - Hypersensitivity
MAOIs: Risk of serotonin syndrome - NSAIDs: Increased bleeding risk - CYP2D6 inhibitors: Altered metabolismDrug InteractionsMAOIs: Risk of serotonin syndrome - NSAIDs: Increased bleeding risk - CYP3A4 inhibitors: Altered metabolism
Caution in liver impairment - Lower doses for elderlyUse in Special PopulationsCaution in liver impairment - Monitor sodium in elderly
Category CPregnancy CategoryCategory C
Can be passed into breast milk; monitor infant for side effectsBreastfeedingCan be passed into breast milk; monitor infant for side effects
Mood changes - Signs of serotonin syndrome - QT prolongation risksMonitoring ParametersMood changes - Signs of serotonin syndrome - Sodium levels (elderly)
Long half-life reduces withdrawal risk - Effective for bulimia and PMDDBenefitsBroad spectrum for anxiety disorders - Effective for OCD and PTSD
Higher risk of QT prolongation - Longer washout period (5 weeks for MAOIs)DrawbacksHigher risk of hyponatremia - Requires gradual dose adjustment
Generally affordable; available as genericCostGenerally affordable; available as generic
Longer half-life; requires less frequent dosingKey DifferencesShorter half-life; quicker to clear - Approved for PTSD and SAD
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