Sertraline Discontinuation Protocol
A gradual reduction in sertraline dose rather than abrupt cessation is strongly recommended when discontinuing treatment to minimize withdrawal symptoms. 1
Washout Period for Sertraline
Sertraline has an elimination half-life of approximately 26 hours 2, which necessitates a proper tapering schedule when discontinuing. The FDA label explicitly recommends "a gradual reduction in the dose rather than abrupt cessation" 1.
Standard Tapering Schedule
For patients on standard doses of sertraline (50-200 mg):
- Week 1-2: Reduce dose by 50% of original dose
- Week 3-4: Reduce to 25% of original dose
- Week 5: Discontinuation
Extended Tapering Schedule
For patients who have been on:
- Higher doses (>100 mg daily)
- Long-term treatment (>1 year)
- Have history of discontinuation symptoms
A more gradual 4-6 week taper with smaller incremental reductions is recommended:
- Consider alternating day dosing in the final week
- Allow at least 2 weeks between each dose reduction
Switching to Another Medication
When switching from sertraline to another medication, specific guidelines apply:
- When switching to a non-MAOI medication: Complete the sertraline taper before initiating the new medication when possible
- When switching to an MAOI: Allow at least 14 days between discontinuing sertraline and starting an MAOI 1
- When switching from an MAOI to sertraline: Allow at least 14 days after stopping the MAOI before starting sertraline 1
Managing Withdrawal Symptoms
Common withdrawal symptoms may include:
- Dizziness
- Nausea
- Headache
- Paresthesia ("brain zaps")
- Irritability
- Anxiety
Management Approach:
- For mild symptoms: Reassurance that symptoms are typically transient
- For moderate symptoms: Slow down the taper rate or return to previous dose temporarily
- For severe symptoms: Return to previous effective dose immediately and consult healthcare provider
Special Populations
- Hepatically impaired patients: Use a lower or less frequent dose when tapering 1
- Elderly patients: Standard tapering schedule can be followed as sertraline pharmacokinetics are similar to younger adults 3
- Pregnant women in third trimester: Special consideration needed as neonates exposed to sertraline late in the third trimester have developed complications requiring prolonged hospitalization 1
Clinical Pearls
- Sertraline is often better tolerated during discontinuation than shorter half-life SSRIs due to its longer elimination half-life
- Monitoring is essential during the tapering process, especially in the first 1-2 weeks after each dose reduction
- Patient education about potential withdrawal symptoms improves compliance with the tapering schedule
- The optimal dose for most patients is 50 mg daily 4, which may be relevant when considering the final steps of tapering
Remember that discontinuation symptoms are not indicative of addiction but rather a physiological response to medication withdrawal, and proper tapering significantly reduces their occurrence and severity.