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1. Lebanese International university school of pharmacy PHAR-200 Instructor: DR.Nermine Chouman Drug consult (Zoloft) Ali Naserdin Haya Hijazi Mirona Badran Zahraa Ghadban Zaharaa Ramadan Fall 2023-2024

2. Outline:

3. Introduction: - Can Zoloft(sertraline) be administered to R.B a pregnant female patient admitted to the room 506-A on the pregnancy floor who is experiencing depression and does not have any other medical conditions ?

4. Depression is a constant feeling of sadness and loss of interest, which stops you doing your normal activities. The primary symptoms of depression (loss of energy, motivation, and emotional connection to the world) and panic disorder (multiple panic attacks, usually provoked by specific types of exposures) are likely to be more devastating and overwhelming when the two conditions manifest concurrently. Pregnancy is a period of stress for women and can be a risk factor for depressive illness.

5. Sertraline is used to treat depression, panic attacks, obsessive compulsive disorder, post-traumatic stress disorder, social anxiety disorder (social phobia), and a severe form of premenstrual syndrome (premenstrual dysphoric disorder).This medication may improve your mood, sleep, appetite, and energy level and may help restore your interest in daily living. It may decrease fear, anxiety, unwanted thoughts, and the number of panic attacks. It may also reduce the urge to perform repeated tasks that interfere with daily living. Sertraline is known as a selective serotonin reuptake inhibitor (SSRI). It works by helping to restore the balance of a certain natural substance (serotonin) in the brain.

6. Subjective data: Patient’s name: Rania Barakat Age: 25 Gender: female Weight:80kg Height: 166cm

7. Chief complaint : shortness in breath, chest pain, tingly and numb hands , Pounding very fast heart rate, Described as (Like i'm having a heart attack ) History of present illness: A 25 years old female eight months pregnant presented to the hospital with a rapid heart beat, sweating, chest pain, shivering, shortness of breath and depression . In addition to swollen legs and heartburn from pregnancy . Past medical history: None Past surgical history: none Social History: No healthy diet ,office work (no exercise and activity ) Family History: her mother had struggled with depression for two years previously but now she cured. Vaccination status: not reported Allergies : no allergies

8. Objective : R.B vital signs appeared normal except her heart rate . She looked conscious and cooperative . She has slight edema on her feet . PSYCH : mental status exam is abnormal . Lab blood values showed a slight increase in Na level (155mmol / L). Heart rate: 85beats per minute Respiratory rate: 20 breaths per minute Temperature: 36,5°c her electrocardiogram shows tachycardia during exercise.

9. Assessment: Based on all the following information, the patient was diagnosed to have a mild depression during her pregnancy . Risk factors include family history and pregnancy. In fact, NEJM study showed that there were no significant associations between maternal use of sertraline overall during early pregnancy and congenital heart defects or most other categories or subcategories of birth defects. Associations were observed between sertraline use and three types of birth defects, but the absolute risks were very small, and these observations require confirmation by other studies.

10. Another study published in can family physician also found that major fetal malformations and exposure to this drug during pregnancy do not appear to be associated. Some minor perinatal complications have been reported. Data on the long-term developmental outcomes of children exposed to sertraline in utero are limited .

11. In addition to study published in Canadian Society of Pharmacology and Therapeutics, it have shown that sertraline use during pregnancy is associated with a small risk for preterm birth. Data on neonates having a lower birth weight are inconclusive. Again the consensus is that use of antidepressants for treatment of depression or anxiety during pregnancy is acceptable.

12. Finally, according to the study of national capital poison control, we have found that Sertraline can be taken during pregnancy, but the liquid formulation of the drug contains alcohol and should not be consumed by pregnant people. Sertraline does cross the placenta and may impact fetal development, but this is often outweighed by the risks of untreated or undertreated depression during pregnancy.

13. the right dose: -initially, she can take 25mg PO qid . This dose may increased by 25mg at week interval; but not exceed 200mg per day.(Medscape study)

14. P lan and conclusion: The therapeutic goal is to minimize the symptoms of pregnancy and depression . For that she was given only 25 mg of zoloft (half tablet) q.i.d , in addition to Gastrisec for heartburn and to protect her stomach. The patient needs also to be counseled about the necessity of low sodium diet.

15. After reviewing the complete data profile as you notice above, this patient can take 25 mg of zoloft per day only. Thank you for your drug consult. Please do not hesitate to contact me for any more information. Sincerely, Ali Naserdin –Haya Hijazi– Mirona Badran – Zahraa Ghadban – Zaharaa Ramadan

16. References: Alwan.S , Reefhuis.J , Rasmussen.S.A , Olney.R.S …,(2007),Use of selective serotonin-reuptake inhibitors in pregnancy and the risk of birth defects, The new England journal of medcine,356;26 Misri.S , Burgmann.A , Kostaras.D .(2000),Are SSRIs safe for pregnant and breastfeeding women?, Le medicine de famille canadien, vol:46;626-633 Popul.J . (2010), Deppression and anxiety during pregnancy, Canadian society of pharmacology and therapeutics. vol:17(3)e-363-e369 Angha.K , Shihabudheen.P . (2021,JUL,29),What you should know about sertraline (Zoloft), Poison control, https:// www.poison.org/articles/sertraline Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature. https ://reference.medscape.com/drug/zoloft-sertraline-342962