Alcoholism sertraline

Pettinati HM, Volpicelli JR, Kranzler HR, et al Sertraline treatment for alcohol dependence interactive effects of medication and alcoholic subtype. Alcohol Clin Exp Res 24 1041-1049, 2000... 

Pettinati HM, Volpicelli JR and Kranzler HR (2000). Sertraline treatment for alcohol dependence Interactive effects of medication and alcohol subtype. Alcohol Clinical and Experimental Research, 24, 1041-1049. 

Like sertraline, these two drugs are selective serotonin reuptake inhibitors. Fluoxetine is prescribed for depression, bulimic binge-eating and vomiting, obsessive-compulsive disorder, obesity, alcoholism, and anorexia among other ailments. Paroxetine is used for depression and obsessive-compulsive disorder. Interestingly the three top antidepressants are chemically unrelated to each other, except for being amines, and are unrelated to earlier tricyclic antidepressants. 

In a 12-week trial involving nearly 200 adult outpatients with PTSD, preliminary data showed a significantly larger decrease in the Clinician-Administered PTSD Scale (CAPS) total score for sertraline (43%) than for placebo (31%). Sertraline also was shown to have positive effects on quality of life ( 274). In addition, sertraline has been shown to be effective in the treatment of PTSD with co-morbid alcoholism (275). 

Brady KT, Sonne SC, Roberts JM. Sertraline treatment of comorbid posttraumatic stress disorder and alcohol dependence. J Clin Psychiatry 1995 56 502-505. 

The earliest and unfortunately still one of the commonest treatments of social phobia is self-medication with alcohol. The behaviorally disinhibiting actions of alcohol allow many social phobics to engage in social contacts that would otherwise be impossible. Legitimate therapeutic drugs for social phobia are now being discovered at a fast pace (Fig. 9—7). In fact, one of the SSRIs (paroxetine) already has been formally approved for use in the treatment of social phobia, and several other SSRIs and antidepressants are rapidly accumulating evidence of their efficacies in this condition as well. Specifically, studies of all five SSRIs (paroxetine, fluvoxamine, fluoxetine, sertraline, and citalopram) have indicated their efficacy in social phobia. Currently, SSRIs are considered first-line treatments for social phobia. 

Heimann and March (1996) reported about a 15-year-old with a long history of chronic, low grade depression who became manic after 1 month on sertraline. Her behaviors included physical aggression toward a peer, intoxication with alcohol, and sexual promiscuity. Behaviors such as this can, unfortunately, ruin a child s life. 

Rarely lethal in monotherapy overdose vomiting, sedation, heart rhythm disturbances, dilated pupils, agitation fatalities have been reported in sertraline overdose combined with other drugs or alcohol... 

Use of sertraline oral concentrate is contraindicated with disulfiram due to the alcohol content of the concentrate... 

Asymmetric transfer hydrogenation with a chiral ruthenium complex is an alternative option for preparation of substituted phenethyl alcohols, which are important building blocks for the agricultural fungicide, (S)-MA20565 [47]. In the enantioselective synthesis of antidepressant sertraline (50), different chiral secondary alcohols have been proposed as pivotal intermediates (Scheme 14). Reduction of the keto ester 46 catdyzed by oxazaborolidine 45 provides chiral intermediate 47 in 90% ee [48]. Alternatively, reductive fragmentation of C2-symmetric oxa-tricyclic alkene 48 with DIBAL catalyzed by a BINAP-Ni complex generates a novel intermediate 49 in 88 % yield with 91% ee [49]. 

SLC6A4 Serotonin transporter 5 -HTTLPR VNTR Alcohol Ondansetron, sertraline... 

Kranzler HR, Armeli S, Tennen H, Covault J, Feinn R, Arias AJ, Pettinati H, Oncken C (2011) A double-blind, randomized trial of sertraline for alcohol dependence moderation by age of onset [corrected] and 5-hydroxytryptamine transporter-linked promoter region genotype. J Clin Psychopharmacol 31 22-30... 

In this process (Fig. 22), ketone 61 underwent reduction with an over-stoichiometric amount of borane in THF in the presence of 5 mol % of the proline-derived Corey s oxa-zaborolidine 62 to afford alcohol 63 in 100% yield and 92% e.e. SN2 displacement carried out on the alcohol mesylate with a higher-order cuprate gave adduct 64, that was transformed first into tetralone 65 by a triflic acid-promoted Friedel-Crafts-type reaction, and then into sertraline 66 (86% e.e.) by imine formation and borohydride reduction. 

Current data suggest no clinically significant pharmacokinetic interaction between sertraline and alcohol. This is due, probably, to the fact that alcohol is metabolized by the hepatic cytochrome P450 enzyme CYP2E1. The latter does not metabolize sertraline. Moreover, CPY2E1 rarely metabolizes any of the other regularly used psychiatric drugs. 

Acetazolamide Alcohol (ethanol) Contraceptives Dichlorphenamide Sertraline... 

The primary uses for the SSRIs include MMD and bipolar depression (fluoxetine, paroxetine, sertraline, and citalopram), atypical depression (i.e., depressed patients with unusual symptoms, e.g., hypersomnia, weight gain, and interpersonal rejection sensitivity fluoxetine, paroxetine, sertraline, and citalopram), anxiety disorders, panic disorder (sertraline and paroxetine), dysthymia, premenstrual syndrome, postpartum depression, dysphoria, bulimia nervosa (fluoxetine), obesity, borderline personality disorder, obsessive-compulsive disorder (fluvoxamine, fluoxetine, paroxetine, and sertraline), alcoholism, rheumatic pain, and migraine headache. Among the SSRIs, there are more similarities than differences however, the differences between the SSRIs could be clinically significant. 

The sertraline precursor is a chiral alcohol with the stereogenic centre adjacent to an aromatic ring. An obvious approach is to make the hydroxyl group by asymmetric reduction of the corresponding ketone. CBS reduction is a possibility, as is a ruthenium-catalysed hydrogenation using the ligand TsDPEN (p. 1115 of the textbook). 

Citalopram, escitalopram, fluoxetine, paroxetine and sertraline have no s nificant pharmacokinetic interaction with alcohol, but... 

Sertraline (in doses of up to 200 mg for 9 days) was found not to impair cognitive or psychomotor performance, and it also appeared not to increase the effects of alcohol. ... 

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