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Hen driving a car or operating machinery. Use in patients with concomitant illness - Clinical experience with Zoloft in patients with certain concomitant systemic illness is limited. Caution is advisable in using Zoloft in patients with diseases or conditions that could affect metabolism or hemodynamic responses. Zoloft has not been evaluated or used to any appreciable extent in patients with a recent history of myocardial infarction or unstable heart disease. Patients with these diagnoses were excluded from clinical studies during the product's premarket testing. However, the electrocardiograms of 774 patients who received Zoloft in double-blind trials were evaluated and the data indicate that Zoloft is not associated with the development of significant ECG abnormalities. Liver impairment - As might be predicted from its primary site of metabolism, liver impairment can affect the elimination of sertraline. The elimination half-life of sertraline was prolonged in a multiplestudy of patients with mild, stable cirrhosis, with a mean of 52 hours compared to 22 hours seen in subjects without liver disease. The AUC and the C max were shown to be approximately three fold greater in comparison to normal subjects. There were no significant differences in plasma protein binding observed between the two groups. This suggests that the use of sertraline in patients with liver disease must be approached with caution. If Zoloft is administered to patients with liver disease, a lower or less frequent dose should be considered. Renal impairment - In patients with mild to moderate renal imp