Comparative Clinical Review of Sertraline and Fluoxetine: Safety Profiles, Pharmacoki-netics, and Therapeutic Dosing in Major Depressive Disorder

Abstract

Major depressive disorder (MDD) and anxiety disorders have been revolutionized by selective serotonin reuptake inhibitors (SSRIs). Of these, sertraline and fluoxetine are two of the most commonly used antidepressant medications. Even though both drugs share the same mechanism of action (serotoninergic reuptake inhibitors), they differ in a number of pharmacokinetic aspects and side-effect and clinical nuances for which they have been available. This review aims to provide a complete comparison of the two drugs, namely sertraline and fluoxetine, and to provide a specific focus on the adverse effects that these drugs have on specific organs (liver, heart, CNS and sexual function), as well as on their ADME parameters (C_max, T_max, AUC and half-life), and to provide information about the main pharmacodynamic parameters of the two drugs. Further, clinical dosage regimens and patient-specific factors such as pregnancy and comorbidities are taken into account. The information on clinical trials and pharmacological effects is synthesized in this review, with the aim of highlighting the subtle differences between these SSRIs and providing guidance in the choice of SSRI, in everyday practice. Delineating the agent-specific profile of these agents is important for the individualized treatment of depression, and for increasing compliance and avoiding adverse events in different patient populations.