Viagra and Zoloft: What You Need To Know About Their Interaction

It is well established that taking antidepressants is fraught with such serious side effects as erectile dysfunction (ED), decrease in sexual desire and anorgasmia in men. This article is dedicated to concomitant use of antidepressive drug Zoloft (sertraline) and Viagra (sildenafil), when depression therapy is required to continue and erectile function should be restored.

Zoloft and Viagra: a popular therapy tandem

Let us first understand why a combination of Zoloft and Viagra is so common. Sexuality is the fulcrum around which the intimate life and health of the couple revolve, often embarrassment and discomfort in the partners and in the individual, an emotional paralysis, a wall of silence and a climate of mutual subornment is in place, when sexual life becomes unhealthy.

The juvenile population today seems to be very exposed to possible sexual problems, and the need for sexual education programs is felt in order to train, inform and prevent it. From the anthropological point of view, the emotional and environmental conditions in which a boy today lives and grows have changed much more than his parents, becoming very complex and kaleidoscopic in terms of the experiences they have experienced.

Slowly, but consistently, there occurs a change in sexual intercourse dynamics, sex codes, and sexual intercourse, which are no longer latent and submerged, but explicitly explicit. Over the last twenty years, some decisive events related to female sexuality have been structured and have had a major influence on male sexuality and relationality: mastery of fertility, oral contraception that clearly dissociated the sphere of sexuality from procreative and the division of sexuality economic world with men.

The modern man, in fact, struggles with difficult paths of identity, which, with amplified and unresolved modes, are horizontally impacted. They are asked to be strong, independent, protective, impertinent and primitive, but at the same time being sensitive, gentle, capable of listening and tenderness. This double message, of a schizophrenic type, leads to a continuous fragmentation and destabilization of male role and identity, with obvious and deleterious repercussions on the sphere of sexuality.

The right of women to the sphere of pleasure and orgasm, which slowly replaced the reassuring simulation of non-existent orgasms, deeply changes the balance of the couple, placing the male universe in face of a new tedious responsibility, namely to keep the erection as long as possible, to the satisfaction of the companion’s pleasure.

In young people, who have no body memory of previous horizontal successes, the repeated sexual demands of unwanted and unwanted women trigger fears, anxieties, performance anxiety, anxiety not to be up to the role and sexual demands and not to feel sufficiently prepared. The often-resulting eruptive deficit is the manifest expression of a ‘deep existential discomfort’, relational and sexual, with obvious and consequent repercussions on self-esteem, narcissism and male identity.

Today, the concept of sexual and sexual health prevention is constantly being promoted, which is of crucial importance to stem the rampant phenomenon of self-medication in the sexual sphere. The andrologist becomes the first referent for the male discomfort, a new mental image that keeps settling on the collective imagination of young people. Of fundamental importance is synergy and reciprocity in the work between andrology and psycho-sexologist, both in a diagnostic phase and in a subsequent therapeutic phase, in order not to medicalize the delicate sphere of sexuality and to give young serenity and sexual health joy, good humor and self-esteem.

Zoloft and erectile function in men

Zoloft (sertraline) is an oral drug belonging to the class of SSRI inhibitors. SSRIs (selective serotonin reuptake inhibitors) are a set of pharmaceutical molecules that fall under selective serotonin reuptake inhibitors or so-called non-tricyclic antidepressants. Such drugs are generally used in psychiatry in the form of psychopharmaceuticals for the therapy of psychopathologies such as obsessive-compulsive disorder or major depression since, by preventing normal recaptation and physiological elimination of serotonin, they are able to counteract any deficiency of this neurotransmitter, re-equilibrated, from a strictly organic point of view, the disturbances caused by its possible shortage. These drugs do not directly stimulate the production of new serotonin, but inhibit reabsorption in the brain by the pre-synaptic membrana (re-uptake) proteins and its elimination in the intestine by accumulating over time until restoring normal values. MDMA causes a state of euphoria thanks to the inhibition of re-uptake of serotonin, in subjects who do not already have deficiency of this hormone in the brain.

The first clinical effects of this class of drugs occur from the second week and may take up to four weeks or more to reach maximum effectiveness. Therapy is normally extended for a few months. By not creating addiction to the drug, they are preferred to anxiolytics in the treatment of general anxiety disorder (GAD). In many cases, however, in the absence of addiction and dependence, SSRI therapy is prolonged over time until it becomes a true maintenance therapy.

In the vast majority of cases, side effects are mild and self-limiting, mostly falling within the headache and gastrointestinal disorders. The most common side effects are: headache, nausea, appetite loss (in some cases this causes these medicines to be used in the treatment of certain eating disorders), increased appetite, insomnia, tremors, sexuality disorders (e.g. delayed ejaculation in man and anorgasmia in woman).

In some cases it has also been shown that these molecules, such as tricyclic drugs, may give rise to QT interval and cause arrhythmias. Generally the intake of these drugs – particularly fluoxetine – is strongly advised against pregnancy and lactation; If it is necessary to continue the therapy at this stage, the choice usually applies to sertraline or other molecules. In any case, the psychiatrist, in collaboration with the patient, must always make a careful assessment of the risk / benefit ratio in the pregnancy use of these drugs.

Concurrently with the suspension of an SSRI, discontinuation of therapy or switch to another drug, patients with various symptoms such as dizziness, asthenia, but also symptoms that correlate with the treated disease such as anxiety, agitation, insomnia. These symptoms are usually mild and self-limiting and can be reduced by a gradual suspension of the drug.

Sertraline hydrochloride is a selective serotonin reuptake inhibitor (SSRI) antidepressant drug prescribed for the treatment of depression in adult patients, including depression associated with anxiety symptoms. It was introduced to the market by Pfizer in 1991 with the trade names of Zoloft and Lustral.

Sertraline is primarily used to cure major depression in adult ambulatory patients as well as obsessive-compulsive disorder (DOC), panic and social anxiety disorders in both adults and children. Like all medications in this category, there are numerous side effects described, with varying frequency, so treatment with this type of drug should be performed on a precise therapeutic indication. Since 2005 the drug is available as a generic drug with the sole active ingredient name.

Sertraline treatment should be discontinued gradually to reduce the risk of abstinence (nausea, dizziness, headache, vomiting, muscle aches, acatisia, sleep disturbances). In most patients, symptoms of abstinence are resolved in 2-3 weeks, but in a limited number of patients they have been prolonged for a longer period (2-3 months). Sertraline withdrawal symptoms may occur, as well as at the end of the treatment, in the dose variation, on the change from one antidepressant to another, or when the dose is not taken. Never abruptly discontinue sertraline therapy when symptoms of abstinence appear. In the French database of spontaneous reports of adverse drug reactions, the onset of serotonin reuptake inhibitors (SSRIs) up to 2000, it was found that sertraline was the least reported (1 signaling) for withdrawal syndrome (the most reported was paroxetine, 29 reports).

Selective serotonin reuptake inhibitors (SSRIs) are not registered for the treatment of depression in pediatric patients. For sertraline, paroxetine and venlafaxine there is no evidence of efficacy in the treatment of depression in children. The use of SSRIs in this class of patients has been associated with an increase in suicidal behavior (suicidal ideation, suicide attempt, self-restraint) compared to placebo (in particular for paroxetine and venlafaxine, for fluvoxamine the literature data are scarce). Depression is a rare disease in the child (prevalence 0.5%), increases in adolescence (3% prevalence) and is associated with significant suicidal risk.

Based on the available clinical trials, serotonin reuptake inhibitors (SSRIs) possess minimal cardiac adverse effects and thus represent a viable therapeutic option in the treatment of depression in cardiac patients. In these patients an indirect risk of using SSRI could result from the hyponatraemia associated with this class of antidepressants. Among SSRIs, the National Institute for Health and Clinical Excellence recommends the use of sertraline.

In patients with diabetes, sertraline administration may affect glycemic control. Increasing the serotoninergic tone induced by the anti-depressant, in fact, seems to increase secretion and insulin sensitivity. In the literature there is a case of a type 2 diabetic patient treated with the only diet, who faced a glycemic decompensation after sertraline intake. The dosage of antidiabetic drugs, oral hypoglycemic drugs and insulin may therefore require an adjustment when administered in combination with sertraline.

Carefully assess the risk / benefit ratio before administering sertraline to pregnant women. Depression may hit up to 20% of pregnant women and has been associated with late uterine growth and low birth weight at the baby. Untreated maternal depression may also alter the mother-to-infant relationship (poor parental ability). Although clinical studies on the use of selective serotonin reuptake inhibitors (SSRIs) (considered as a therapeutic class) have shown a low risk of congenital anomalies, the analysis of single drugs revealed sertraline correlation with septic heart defects and onphalocele (absent abdomen). Exposure to SSRI during the third trimester of pregnancy may result in the onset of SSRI withdrawal syndrome and persistent pulmonary hypertension in the infant. The most common symptoms of abstinence syndrome include: agitation, irritability, hypo / hypertonia, hyperriflessia, drowsiness, problems with sucking, persistent crying. More rarely, hypoglycaemia, respiratory distress, thermoregulation abnormalities, convulsions have occurred. Persistent Pulmonary Hypertension (PPHN) is a severe pathology requiring intensive therapy and can cause anomalies in neurological development and death. The incidence is equal to 1/100 newborns exposed to SSRI in the second half of the pregnancy compared with an incidence of 1/1000 live births in the general population. Probably this disease is related to effects of serotonin on cardiovascular development. The transplacental passage of SSRIs may cause bleeding in the infant. There are no known effects of exposure to SSRIs on the neuro-behavioral development of children. In pregnant women in sertraline therapy, fetal ecological monitoring at week 20 is recommended to detect possible fetal malformations and the monitoring of signs and / or symptoms related to neonatal toxicity (respiratory distress, jaundice, convulsions, persistent pulmonary hypertension)

Sertraline is excreted in small quantities in breast milk, but any passage in the breast-fed baby has not been associated with neonatal toxic effects. Sertraline, together with paroxetine, represents the first-line drug in the treatment of depression in pregnancy in the class of selective serotonin reuptake inhibitors (SSRIs).

Concentrate for oral solution of sertraline: The concentrate for oral solution of sertraline contains ethanol (12%), glycerol and butylhydroxytoluene. Ethanol content should be considered when administering to patients with liver disease, alcoholism, epilepsy, patients with cerebral trauma or cerebral pathology, pediatric patients. High doses of glycerol can cause headache, abdominal pain and diarrhea. Butyl hydroxytoluene may cause irritation to eyes, skin and mucous membranes.

Safety of Zoloft, Viagra and other relevant drug interactions

Sertraline can interact with a lot of substances and it is therefore necessary for the doctor to carefully evaluate the therapies that the subject is likely to follow. Sertraline should not be used in combination with MAOI drugs and an eventual treatment with the first should not be started earlier than two weeks after discontinuation of treatment with the latter. Treatment with sertraline should be discontinued at least 7 days before initiating any treatment with IMAO drugs.

Concomitant administration of sertraline and pimozide is also contraindicated. The concomitant use of sertraline and alcohol, as well as of sertraline and drugs that depress the central nervous system (eg carbamazepine, haloperidol, etc.) are not recommended. If sertraline is to be administered to patients under lithium treatment, careful monitoring is required. The same can be said of subjects treated with triptans.

Sertraline may interact with warfarin (an anticoagulant) causing a slight increase in prothrombin time; the latter should therefore be closely monitored if warfarin subjects initiate (or terminate) a treatment with sertraline.

Like other SSRIs, sertraline also can interact with drugs that have action on platelet function (acetylsalicylic acid, ticlopidine, NSAIDs etc.) Causing an increase in the risk of bleeding.

Sertraline, especially if taken at high doses, may interact with antiarrhythmic agents such as propafenone and flecainide. Tricyclic antidepressants and antipsychotics, as well as with antiepileptic drugs (sertraline antagonize anticonvulsant effects), are antiviral agents (a higher plasma concentration of antivirals or a reduction of sertraline) can interact with the active principle.

It is possible to increase the risk of seizures in patients taking atomoxetine (a drug used in attention deficit syndrome). SSRIs, including sertraline, antagonize the anticonvulsant effects of barbiturates. Sertraline may increase the plasma concentration of bupropion, a second generation antidepressant. The association of zolpidem and sertraline may result in an increase in sedative effects.

Other interactions may be with cimetidine (an antihistamine), ciproeptadine (an antihistamine), clozapine (an antipsychotic), donepezil (palliative therapy of Alzheimer’s disease), oxycodone (an analgesic), duloxetine (an antidepressant), lithium neuropsychiatric disorders, there is a risk of central nervous system toxicity etc.). The use of sertraline should be avoided even with herbal preparations (a herbal remedy known as St. John’s wort) or centella. Concomitant administration of sertraline and alcohol (or alcohol) should be avoided. It should be remembered, however, that when taking a particular drug, you should always consult your doctor or a specialist before taking any medicine of a different type.

As for Viagra used alongside with Zoloft, no interaction whatsoever is established between these two drugs. However, it would be worthwhile to diagnose the nature of the ED problem: circulatory, psychogenic, hormonal etc. so that more symptomatic therapy can be given. Please contact an expert healthcare provider before you decide taking any of the above medications.

Assessing your psychic condition, the repercussions on the sphere of sexuality, should also be evaluated. Plan a visit to andrologist in order to receive a certain diagnosis, then therapy is established accordingly.

Note: As a disclaimer, we should mention that this article was created with the intention of providing educational materials. It cannot be viewed or used as a substitute for professional medical advice. We are not responsible for any health concerns.