Starting Dose of Zoloft (Sertraline) for Adults
The recommended starting dose of Zoloft (sertraline) for adults is 50 mg once daily. 1
Dosing Guidelines by Condition
Sertraline dosing varies slightly depending on the condition being treated:
Major Depressive Disorder and Obsessive-Compulsive Disorder
- Start with 50 mg once daily 1
- Can be increased in 50 mg increments at intervals of at least one week
- Maximum dose: 200 mg daily
Panic Disorder, PTSD, and Social Anxiety Disorder
- Start with 25 mg once daily for one week 1
- Increase to 50 mg once daily after the first week
- Can be increased further if needed (up to 200 mg daily)
Premenstrual Dysphoric Disorder
- Start with 50 mg daily (either throughout the menstrual cycle or limited to luteal phase) 1
- Can be increased up to 150 mg daily if dosing throughout the cycle, or 100 mg daily if dosing during luteal phase only
Administration Considerations
- Sertraline can be administered at any time of day 2
- Should be given as a single daily dose 1
- No dosage adjustments are required for elderly patients based solely on age 3
- Dose changes should not occur at intervals of less than one week due to sertraline's 24-hour elimination half-life 1
Efficacy and Titration
The 50 mg starting dose is considered the optimal dose for most patients when considering both efficacy and tolerability 2. However, patients not responding adequately to the initial dose may benefit from dose increases up to a maximum of 200 mg daily 1.
Special Populations
- Elderly patients: No dosage adjustment required based on age alone 3
- Patients with hepatic impairment: Consider lower doses or less frequent dosing 1
Potential Side Effects to Monitor
Common side effects include:
- Dry mouth
- Headache
- Diarrhea
- Nausea
- Insomnia
- Somnolence
- Dizziness 3
Clinical Pearls
- Unlike some other SSRIs, sertraline has a relatively low potential for drug interactions at the cytochrome P450 enzyme system level, making it potentially advantageous in patients on multiple medications 3
- The therapeutic effect may not be fully evident until 2-4 weeks after starting treatment
- Sertraline has shown benefits for both depressive symptoms and anxiety symptoms 4
Remember that while 50 mg is the standard starting dose for most conditions (except panic disorder, PTSD, and social anxiety), clinical response should be evaluated after several weeks to determine if dose adjustments are needed.