Gabapentin Vs. Zoloft: Drug Comparison

Gabapentin is an anticonvulsant medication that works by affecting the brain's neurotransmitters to reduce nerve-related pain and prevent seizures. Its FDA-approved indications include the treatment of partial seizures and neuropathic pain associated with conditions including postherpetic neuralgia (pain following shingles). Off label, gabapentin is commonly used for anxiety, fibromyalgia, and chronic pain management. It is available in oral forms such as capsules, tablets, and solutions. Common side effects include drowsiness, dizziness, and fatigue, while serious risks include respiratory depression when combined with central nervous system (CNS) depressants like opioids. Caution is advised when prescribing to patients with respiratory issues or those taking sedatives.

Zoloft^® (sertraline) is a selective serotonin reuptake inhibitor (SSRI) used to treat mood disorders by increasing available serotonin levels in the brain, which helps improve mood and reduce symptoms of anxiety and depression. Its FDA-approved indications include the treatment of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder (PD), post-traumatic stress disorder (PTSD), social anxiety disorder (SAD), and premenstrual dysphoric disorder (PMDD). Off-label uses may include the treatment of eating disorders and generalized anxiety disorder (GAD). Zoloft is available in tablet and oral solution forms, typically taken once daily. Common side effects include nausea, dizziness, insomnia, and sexual dysfunction, and it carries a boxed warning for an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults, particularly during the initial treatment period.

Anticonvulsant

Selective serotonin reuptake inhibitor (SSRI)

Gabapentin is indicated for:

• Postherpetic neuralgia in adults

• Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization, in adults and pediatric patients 3 years and older with epilepsy

Zoloft (sertraline hydrochloride) is indicated for the treatment of:

• Major depressive disorder (MDD)

• Obsessive-compulsive disorder (OCD)

• Panic disorder (PD)

• Posttraumatic stress disorder (PTSD)

• Social anxiety disorder (SAD)

• Premenstrual dysphoric disorder (PMDD)

• Typically taken orally once, twice, or three times daily

• Comes in 100 mg, 300 mg, and 400 mg capsules

• Typically taken orally once daily

• Comes in 25 mg, 50 mg, and 100 mg tablets and 20 mg/mL oral solution

Most common adverse reactions (incidence ≥8% and at least twice that for placebo) were:

Postherpetic neuralgia:

• Dizziness

• Sleepiness

• Swelling in the extremities

Epilepsy in patients >12 years of age:

• Sleepiness

• Dizziness

• Poor muscle control

• Fatigue

• Uncontrolled eye movements

Epilepsy in patients 3 to 12 years of age:

• Viral infection

• Fever

• Nausea and/or vomiting

• Slepiness

• Hostility

Most common adverse reactions (≥5% and twice placebo) in pooled placebo-controlled MDD, OCD, PD, PTSD, SAD and PMDD clinical trials were:

• Nausea

• Diarrhea/Loose stool

• Tremor

• Indigestion

• Decreased appetite

• Excessive sweating

• Ejaculation failure

• Decreased libido

• Known hypersensitivity to gabapentin or its ingredients

• Drug interactions: morphine

• Concomitant use of monoamine oxidase inhibitors (MAOIs), or use within 14 days of stopping MAOIs

• Concomitant use of pimozide

• Known hypersensitivity to sertraline or excipients

• Zoloft oral solution only: Concomitant use of disulfiram

• Drug interactions: protein-bound drugs, CYP2D6 substrates

• Drug reaction with eosinophilia and systemic symptoms (multiorgan hypersensitivity)

• Anaphylaxis and angioedema

• Driving impairment; somnolence/sedation and dizziness

• Increased seizure frequency may occur in patients with seizure disorders if gabapentin is abruptly discontinued

• Suicidal behavior and ideation

• Respiratory depression: May occur with gabapentin when used with concomitant central nervous system (CNS) depressants, including opioids, or in the setting of underlying respiratory impairment

• Neuropsychiatric adverse reactions in children 3 to 12 years of age

• Pregnancy: Based on animal data, may cause fetal harm

• Serotonin syndrome

• Increased risk of bleeding

• Activation of mania/hypomania

• Seizures

• Angle closure glaucoma

• QTc prolongation

• Sexual dysfunction

• Pregnancy: Third trimester use may increase risk for persistent pulmonary hypertension and withdrawal in the neonate

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients.

Closely monitor for clinical worsening and emergence of suicidal thoughts and behaviors.

*This information is from the gabapentin label used by ACI Healthcare USA, Inc. See the Full Prescribing Information for more complete information. This information may not be accurate for all medications that include the active ingredient gabapentin.

*This information is from the label for brand name Zoloft^®. See the Full Prescribing Information for more complete information. Sertraline, the active ingredient in Zoloft, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient sertraline.