What is the recommended dosing for sertraline (selective serotonin reuptake inhibitor - SSRI)?

Sertraline Dosing Recommendations

For adults with major depressive disorder, the recommended starting dose of sertraline is 50 mg once daily, with potential increases up to a maximum of 200 mg daily based on clinical response. 1

Initial Dosing by Indication

Major Depressive Disorder and Obsessive-Compulsive Disorder (Adults)

• Starting dose: 50 mg once daily 1
• Dose range: 50-200 mg/day 1
• Dose adjustments should not occur at intervals less than 1 week (due to 24-hour elimination half-life) 1

Panic Disorder, PTSD, and Social Anxiety Disorder (Adults)

• Starting dose: 25 mg once daily for 1 week 1
• Increase to 50 mg once daily after first week 1
• Maximum dose: 200 mg/day 1

Premenstrual Dysphoric Disorder

• Starting dose: 50 mg/day (either daily throughout menstrual cycle or limited to luteal phase) 1
• Dose range: 50-150 mg/day 1
• Dose increases at 50 mg increments per menstrual cycle 1

Pediatric OCD

• Children (6-12 years): 25 mg once daily 1
• Adolescents (13-17 years): 50 mg once daily 1
• Maximum dose: 200 mg/day 1

Titration Guidelines

1. Begin with recommended starting dose for the specific indication
2. Assess response after at least 1 week (due to 24-hour elimination half-life) 1, 2
3. For patients not responding adequately, increase dose in increments of 50 mg at intervals of at least 1 week 1
4. Continue titration until clinical response or maximum dose of 200 mg/day is reached 1

Administration Considerations

• Sertraline can be administered once daily, either morning or evening 1, 2
• May be taken with or without food (taking with food can help manage GI side effects) 3
• Steady-state plasma concentrations are typically achieved after approximately 7 days of consistent dosing 4

Special Populations

Elderly Patients

• No dosage adjustment required based solely on age 2, 5
• Standard adult dosing is appropriate (50-200 mg/day) 5
• Elderly patients generally tolerate sertraline well with similar side effect profile to younger adults 5

Renal/Hepatic Impairment

• No specific dosage adjustments required for renal impairment 4
• Use caution in hepatic impairment (sertraline undergoes extensive hepatic metabolism) 6

Duration of Treatment

• For major depressive disorder: Maintenance treatment for several months beyond acute response is recommended 1
• Clinical trials have demonstrated maintained efficacy for up to 44 weeks following 8 weeks of initial treatment 1
• For PTSD: Maintained efficacy for up to 28 weeks following 24 weeks of treatment 1
• For social anxiety disorder: Maintained efficacy for up to 24 weeks following 20 weeks of treatment 1

Monitoring and Management

• Monitor for clinical response and adverse effects
• Watch for emergence of suicidal thoughts or behavior, especially in children, adolescents, and young adults up to 24 years 3
• Closer monitoring is recommended during the first few months of treatment and following dose adjustments 7

Common Side Effects Management

• Gastrointestinal disturbances: Take with food, consider temporary dose reduction 3
• Sleep disturbances: Adjust dosing time (morning for activating effects, evening for sedating effects) 3
• Sexual dysfunction: Consider dose reduction or switching to another antidepressant 3

Important Cautions

• Avoid combination with MAOIs due to risk of serotonin syndrome 7, 3
• Use with caution in patients with bipolar disorder due to risk of triggering mania 3
• Slow tapering is recommended when discontinuing to avoid withdrawal effects 3

Sertraline's pharmacokinetic profile supports once-daily dosing with a half-life of 22-36 hours 6, and its relatively low potential for drug interactions makes it a favorable choice, particularly in elderly patients who may be on multiple medications 5.