Schizophrenia.com

Sertraline (Zoloft) and falling down?

Hello everyone, I hope your day is allowing you to cope. I haven’t posted in the medications section before but I’m hoping someone can help me, I’ve been googling and can’t find much so thought I’d try and see if anyone else has had the same problem.

I seem to be falling for no reason rather a lot well I seem to just go flying or fall straight to the ground. My mum says I can’t be twisting my ankles because they’d be sore and I’d struggle to carry on walking as I have ligament damage in one of my ankles but she’s going to get me some ankle supports and see what happens. In the past couple of days I’ve fallen about 10 times today during a span of walking twenty minutes on flat ground I fell four times, it’s worrying me and I’ve scraped my face and elbow pretty badly; what I don’t get is it’s happening on even ground.

The only thing that has changed is my sertraline was increased from 50mg to 100mg about a week or so ago and this has coincided with the fact that it’s starting to kick in about now but I can’t find anything about sertraline and falling, only that it increases in older adults with psychotic depression on olanzapine, but I’m on chlorpromazine and I’m 21.

I know there is meant to be an interaction between omeprazole and sertraline but there is little information on what the interactions may be. I am aware that this may be something else like I’m fitting or something which terrifies me and doesn’t help my head. I’m scared and don’t know what is happening I’m finally getting my head together but now my body is out of control and failing me I get a lot of pain and physical issues so this isn’t rare to me but the falling does scare me. I’m waiting for my mum to go to the pharamasict; get the ankle supports and ask him about it, I know they will just say go to the doctors, I hate going to the doctors, they’ll probably try to tell me it’s panick attacks when I’m not remotely panicked but I think it may be necessary, my mum is a nurse so is on top of things, we’re aware if I wasn’t schiz we’d go to the doctor with no question, falling without cause is serious but because I am who I am we’re testing things out before going.

What I want to know is whether anyone else has had this experience or falling for no cause on any other med, what was it? Did it go when you were taken off the med or had dosage decreased? I seemed to function fine on 50mg, I seem to react to every med I go on but this is by far scariest if it is a side effect. I also wouldn’t mind opinions on anything I don’t know what I want really, just help.

I hope your day continues on an even keel, take care,
Meg.

1 Like

Meg,

The only thing that comes to mind is the chlorpromazine. Do you fall immediately upon standing? Chlorpromazine can cause that. Aside from that, I’m stumped.

Me neither, I don’t know whats causing your falling. I would have thought anti psychotics would relax you in that regard, but then Im not sure.

Might the sertraline be causing it? Im not sure.

I had problems with chlorpromazine. That med made me sickly. I took it in tablet form and it had a bad effect on me. It left me feeling nauseous. Whether I was unstable or not Im cant recall but maybe the interaction of the two meds isn’t suiting. In any case chlorpromazine is only meant to be taken short term. I was only ever on it for up to 10 days when in hospital and then changed over to another anti psychotic.

Hope this helps.

Also, this is from Wikipedia on chlorpromazine…it says below that chlorpromazine can cause low blood sugar when interacted with certain drugs… I highlighted the relevant bit in BOLD for easy viewing…Scroll Down to end of paragraph two

Interactions[edit]

Consuming food prior to taking chlorpromazine orally limits its absorption, likewise cotreatment with benztropine can also reduce chlorpromazine absorption.[1] Alcohol can also reduce chlorpromazine absorption.[1] Antacids slow chlorpromazine absorption.[1] Lithium and chronic treatment with barbiturates can increase chlorpromazine clearance significantly.[1] Tricyclic antidepressants (TCAs) can decrease chlorpromazine clearance and hence increase chlorpromazine exposure.[1] Cotreatment with CYP1A2 inhibitors like ciprofloxacin, fluvoxamineor vemurafenib can reduce chlorpromazine clearance and hence increase exposure and potentially also adverse effects.[1] Chlorpromazine can also potentiate the CNS depressant effects of drugs like barbiturates, benzodiazepines, opioids, lithium and anaesthetics and hence increase the potential for adverse effects such as respiratory depression and sedation.[1]

It is also a moderate inhibitor of CYP2D6 and also a substrate for CYP2D6 and hence can inhibit its own metabolism.[9] It can also inhibit the clearance of CYP2D6 substrates such as dextromethorphan and hence also potentiate their effects.[9] Other drugs like codeine and tamoxifen which require CYP2D6-mediated activation into their respective active metabolites may have their therapeutic effects attenuated.[9] Likewise CYP2D6 inhibitors such as paroxetine or fluoxetine can reduce chlorpromazine clearance and hence increase serum levels of chlorpromazine and hence potentially also its adverse effects.[1] Chlorpromazine also reduces phenytoin levels and increases valproic acid levels.[1] It also reduces propanolol clearance and antagonises the therapeutic effects of antidiabetic agents, levodopa (a Parkinson’s medication. This is likely due to the fact that chlorpromazine antagonises the D2 receptor which is one of the receptors dopamine, a levodopa metabolite, activates), amfetamines and anticoagulants.[1] It may also interact with anticholinergic drugs such as orphenadrine to produce hypoglycaemia (low blood sugar).[1]

Chlorpromazine may also interact with epinephrine (adrenaline) to produce a paradoxical fall in blood pressure.[1]Monoamine oxidase inhibitors (MAOIs) and thiazide diuretics may also accentuate the orthostatic hypotension experienced by those receiving chlorpromazine treatment.[1] Quinidine may interact with chlorpromazine to increase myocardialdepression.[1] Likewise it may also antagonise the effects of clonidine and guanethidine.[1] It also may reduce the seizure threshold and hence a corresponding titration of anticonvulsant treatments should be considered.[1] Prochlorperazine and desferrioxamine may also interact with chlorpromazine to produce transient metabolic encephalopathy.[1]

Other drugs that prolong the QT interval such as quinidine, verapamil, amiodarone, sotalol and methadone may also interact with chlorpromazine to produce additive QT interval prolongation.[1]

What I posted above concerning chlorpromazine is on Wikipedia. But if you look it up, be sure to scroll down the page on Wikipedia as the page seems to tail off at adverse effects. But when you scroll past that, there is loads more literature on the subject of chlorpromazine. Just a tip! as I missed it myself when I looked it up.

The first thing I thought of when I was reading your post was if you were drinking enough water? I had a spell of falls that turned out to be from dehydration a couple of years ago. I’m taking 200ml Zoloft right now with no problems. Sorry I’m not much help.

I have been on sertraline for many years without anything like that. Everyone is different. I couldnt say what is causing this--but even though you dont want to see the doctor, maybe go anyway? That way, you won`t have to worry or be scared. Hope things turn around soonx

Sertraline can cause weakness by itself. Added to chlorpromazine, sertraline increases the levels of chlorpromazine in the bloodstream, which can cause hypotension (low blood pressure).

One of the symptoms of low blood pressure is falling from lack of blood flow to the brain. Add that to the weakness already caused by the sertraline, and you have a large risk of falls.

Sertraline and chlorpromazine are to be used together with caution. Chlorpromazine levels in the blood should be checked periodically. And blood pressure should be assessed at each visit.

I hope this helps you!

Blessings,

Anthony

Source:
Epocrates Mobile, 2014

Thank you everyone for your very informative posts, me and mum had a talk, I’m going to eat regularly and drink plenty as well as wear ankle supports and if I still fall then we’re going to the doctor, see what they say. Our main concern is that this is some form of drop attacks as the pharamasict said it could be reacting with my gabapentin/neurontin despite me not being epileptic he said it could still cause it. I’m confused and wondering why my psychiatrist put me on it if she knew any of this particularly if it interacts with chlorpromazine but then again I was put on it in an emergency so maybe she didn’t have time to think through it. Thanks everyone, I feel like the walking wounded today but this info helps and I have taken it all into account. I think it may be inevitable that a trip to the docs is going to happen I just get so embarrassed going, I haven’t seen my main doctor since I was admitted to hospital, I have gained a lot of weight and changed very much I’m scared he will hate me and show it but I know this is illogical, he should be professional and I’m hoping he will be if I need to visit.

Anyway thank you again this means a lot,
Take care everyone,
Meg.

1 Like

Okay I’ve fallen a few more times and we’ve booked an appointment with one of the more experienced doctors at my local surgery but the earliest was the 12th so have to wait am seeing my nurse before then so will ask him too, do you think it would be a reasonable request not to come completely off the sertraline until after my exam in June (it’s on the 3rd)? I was fine on 50mg, and last time I came off my Citalopram due to health I got overwhelmed by depression and negative symptoms I think I nearly had another break and I just can’t risk that right now I have one more assignment after the one I’m working on and revision, I need my head after the 3rd June they can do whatever. I’m quite scared really I’m hoping he’s quite reasonable, I know he’s amazing with my nan and was with my grandad I’m just hoping he’s not full of judgement. I hate going to the health doctors :(, I’m trying not to let my head stuff take over and it’s getting harder.

I hope you’re all coping as you best can, take care,
Meg.