The US National Hurricane Center (NHC) said Sara would bring "life-threatening and potentially catastrophic flash flooding and mudslides" through the weekend.
The Honduran emergency management agency (COPECO) has put four Caribbean departments -- Islas de la Bahia, Atlantida, Colon and Gracias a Dios -- on red alert for 72 hours, urging evacuations from danger zones.
President Xiomara Castro said emergency services had been activated to deal with "damage already caused by the rains," warning that Sara's impacts "could become a catastrophic event."
"Citizens should pay attention to instructions and move to safe shelters, away from rivers," she said on X.
Heavy rainfall will cause life-threatening flash flooding and mudslides in Belize, El Salvador, eastern Guatemala, western Nicaragua and the Mexican state of Quintana Roo, the NHC added.
Alerts have also been issued in Panama and Costa Rica, which have both recorded several storm-related deaths in recent weeks.
Sara will slowly move near the northern coast of Honduras over the next couple of days and bring isolated areas up to 30 inches (76 centimeters) of rain, the NHC said.
It is expected to approach Belize and Mexico's Yucatan Peninsula late this weekend, it added.
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