Can sertraline damage the kidneys? (3+ risk factors)
In this article, we will discuss whether sertraline damages the kidneys. We will explore the importance of kidney health, potential side effects of sertraline, kidney function, related research, factors influencing kidney damage, managing kidney health when using sertraline and when to consult the healthcare provider.
Can sertraline damage the kidneys?
Yes, it is possible, in the case of an overdose of sertraline of pre-existing kidney disease of the patient. However, Sertraline has not been shown to cause damage to the kidneys when taken according to the prescription of the physician. However, this drug is cleared by the kidney. People with reduced kidney function are therefore more likely to encounter severe adverse effects due to an accumulation of the drug in the body.
Sertraline is a selective serotonin reuptake inhibitor that is commonly prescribed for depression and anxiety disorders. This drug is metabolized in the liver by CYP3A4 and CYP2B6. The drug is eliminated mostly by the kidney as conjugates (1) under a half-life of 22-36 hours. Its elimination may be therefore affected in patients with reduced kidney function.
How do the kidneys function?
Kidneys play the role of removing wastes and excess fluid from the body. This way, they maintain a balance of water, electrolytes and salts in the body (1). They also produce erythropoietin. The kidneys also serve are critical organs in the removal of toxins from the body. These toxins include medication like sertraline.
The kidneys play a secondary role after the first pass of liver metabolism to metabolize sertraline. The liver breaks sertraline down into metabolites which are passed to the kidneys for elimination through urine (2).
How can sertraline damage the kidneys?
Although sertraline is not known to cause damage to the kidneys of healthy adults, animal studies have shown different results. The medication has been shown to increase urea and creatinine levels in rats treated with sertraline (3). Histological examinations of the kidney tissue also showed changes which signify an acute kidney injury. Patients who suspect kidney injury after using the medication should therefore consult their healthcare provider for an accurate diagnosis.
People with pre-existing kidney disease should also take this medication with caution. Sertraline is metabolized in the liver and excreted majorly through the kidneys. The administration of this medication in patients with reduced renal function should be carefully considered due to reduced clearance. There may be more pronounced adverse effects in this population of patients and dose modifications through a qualified healthcare provider may be required (4).
What are the potential side effects of sertraline?
Potential side effects of sertraline include:
- Serotonin syndrome; confusion, hallucinations, seizures and changes in blood pressure (1)
Are there studies linking sertraline to kidney damage?
Several studies have established the safety of sertraline in patients with kidney damage. Given that depression is a common psychiatric condition in patients with kidney disease, the use of SSRIs in mitigation has been explored in great depth. In one study, the use of sertraline was tested and found to be safe and efficacious in patients with chronic kidney disease patients and those who were undergoing dialysis (4).
This study proves the safety of sertraline over antidepressants like tricyclic antidepressants. Although individual responses may vary, sertraline is safer for people with kidney issues.
What are the risk factors associated with sertraline-induced kidney damage?
Sertraline is not directly associated with kidney damage. However, considering its mode of elimination (through the kidneys), the drug may have implications for patients with preexisting kidney conditions, paediatrics, geriatrics, in cases of high doses, patients who have used the drug for a long time, and people who are using the sertraline with other drugs with likely interactions. The basis of induction of kidney damage depends on individual variability, hydration status, electrolytes balance and metabolic status of the patients.
a. Preexisting kidney conditions
People with pre-existing renal conditions like CKD may require dosage adjustments because this drug is excreted through the kidney. Dosage adjustments ensure serum levels are within the therapeutic range. Sertraline has also been associated with the development of hyponatremia (low sodium levels in the blood). Severe cases of hyponatremia affect how kidneys work which also affects the elimination of sertraline. Considering that nausea is one of the adverse effects of sertraline, dehydration due to vomiting may also affect kidney function.
Age can indirectly affect the risk of sertraline-induced kidney damage through metabolic, and renal function, comorbidities and polypharmacy. As people become older, a decline in age-related metabolism factors of the liver becomes more evident (5). This affects the elimination of sertraline. Kidney function also declines with age. As people age, they are also more prone to comorbidities like diabetes and hypertension whose medication may affect liver function. They may also be taking multiple drugs at the same time which increases the risk of sertraline-induced kidney damage.
c. High doses or prolonged use
High doses and prolonged use increase the risk of hyponatremia and dehydration. This increases the risk of sertraline-induced kidney damage.
d. The use of other medications and substances
Concomitant administration of sertraline with other medications may diminish its elimination as they compete for liver metabolic enzymes. This increases the reputation of sertraline in the blood and the risk of adverse effects. The administration of sertraline and NSAIDs also increases the risk of kidney damage since they both affect renal function. Coadministration with diuretics also affects electrolyte balances which increase the likelihood of kidney damage.
Can you take sertraline when having kidney disease?
Yes. Sertraline has been proven to be efficacious in managing depression in certain kidney diseases. For instance, the drug has been proven safe in haemodialysis patients but only when provided in proper doses (6). In another study on CKD patients, sertraline use resulted in more adverse effects including nausea and vomiting (7).
The high incidence of adverse effects could be attributed to low clearance of the drug due to diminished kidney function in the patient population. Dosage modifications are therefore required for patients with reduced kidney function to reduce drug toxicity. bearing this in mind, it is important to take sertraline in prescribed doses. Any pre-existing kidney disease should be communicated to the prescriber to enable them to make an informed health decision.
How do you monitor and prevent kidney damage?
To monitor and prevent kidney damage when using sertraline, always take the medication as prescribed. You should also attend regular checkups to assess kidney function when using the medication for the long term. Also, inform your healthcare provider about any preexisting kidney conditions and any other medication you might be taking when using sertraline. This helps them make an informed decision when prescribing.
What can we conclude about the Sertraline?
In this article, we have addressed the question “Can Sertraline Damage the Kidneys?”. While sertraline is one of the safest medications in patients with preexisting kidney diseases, age, preexisting kidney conditions, high doses, prolonged use and coadministration with other medications may induce kidney injury.
My advice for using sertraline is that one should only use this medication when prescribed by qualified healthcare personnel. You should adhere to safe medication use by taking the drug at the prescribed time and dosage. Any unbearable adverse effects noted should be promptly communicated to the prescriber for intervention or advice.
In case of a preexisting kidney or liver disease, you should communicate with the prescriber so that they can make an informed health decision.
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Stowe ZN, Hostetter AL, Owens MJ, Ritchie JC, Sternberg K, Cohen LS, Nemeroff CB. The pharmacokinetics of sertraline excretion into human breast milk: determinants of infant serum concentrations. Journal of Clinical Psychiatry. 2003 Jan 1;64(1):73-80.
De Vane CL, Liston HL, Markowitz JS. Clinical pharmacokinetics of sertraline. Clinical pharmacokinetics. 2002 Dec;41:1247-66.
Hussein AM, Faris SA, Madlool ZS. Effect of sertraline and fluoxetine on some biochemical parameters and histological changes in male and female laboratory rats Rattus norvegicus. Journal of Education for Pure Science. 2019 Jun 1;9(2).
Mar PL, Raj SR. Postural orthostatic tachycardia syndrome: mechanisms and new therapies. Annual review of medicine. 2020 Jan 27;71:235-48.
Turnheim K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Experimental gerontology. 2003 Aug 1;38(8):843-53.
Kubanek A, Paul P, Przybylak M, Kanclerz K, Rojek JJ, Renke M, Bidzan L, Grabowski J. Use of sertraline in hemodialysis patients. Medicina. 2021 Sep 9;57(9):949.
Hedayati SS, Gregg LP, Carmody T, Jain N, Toups M, Rush AJ, Toto RD, Trivedi MH. Effect of sertraline on depressive symptoms in patients with chronic kidney disease without dialysis dependence: the CAST randomized clinical trial. Jama. 2017 Nov 21;318(19):1876-90.