Maximum Dose of Sertraline
The maximum recommended dose of sertraline (Zoloft) is 200 mg per day for most indications. 1
Dosing Guidelines by Indication
Major Depressive Disorder and Obsessive-Compulsive Disorder (Adults)
- Initial dose: 50 mg once daily
- Dose range: 50-200 mg/day
- Maximum dose: 200 mg/day 1
Panic Disorder, PTSD, and Social Anxiety Disorder
- Initial dose: 25 mg once daily for one week, then increase to 50 mg once daily
- Dose range: 50-200 mg/day
- Maximum dose: 200 mg/day 1
Premenstrual Dysphoric Disorder
- Initial dose: 50 mg/day (either daily throughout menstrual cycle or limited to luteal phase)
- Dose range: 50-150 mg/day (when dosing daily) or 50-100 mg/day (when dosing during luteal phase)
- Maximum dose: 150 mg/day 1
Pediatric OCD
- Children (6-12 years): Initial dose of 25 mg once daily
- Adolescents (13-17 years): Initial dose of 50 mg once daily
- Dose range: 25-200 mg/day
- Maximum dose: 200 mg/day 1
Dosing Considerations
Titration
- Dose changes should not occur at intervals of less than 1 week due to sertraline's 24-hour elimination half-life 1
- For patients not responding to initial doses, incremental increases of 50 mg/day at weekly intervals are recommended 1, 2
Administration
- Sertraline should be administered once daily, either in the morning or evening 1
- No dosage adjustments are warranted for elderly patients solely based on age 3
Therapeutic Plasma Concentration
The recommended therapeutic plasma concentration range for sertraline is 10-50 ng/mL, with a level 3 recommendation for routine monitoring 4. However, plasma concentrations can vary widely (up to 15-fold) in patients receiving usual antidepressant dosages between 50-150 mg/day 5.
Important Considerations
- The starting dose of 50 mg/day is considered the usually effective therapeutic dose for most patients with depression 2
- Sertraline has a relatively favorable side effect profile compared to tricyclic antidepressants, particularly in elderly patients 3
- Sertraline has minimal inhibitory effects on major cytochrome P450 enzymes, resulting in fewer drug-drug interactions compared to some other SSRIs 5, 3
Common Side Effects
At the maximum dose, patients should be monitored for common adverse effects including:
- Gastrointestinal: dry mouth, diarrhea, nausea, constipation
- Neurological: headache, insomnia, somnolence, dizziness
- Other: sweating, taste abnormalities 3
While 200 mg/day is the maximum recommended dose for most indications, it's worth noting that the optimal balance between efficacy and tolerability for most patients with depression is often achieved at the starting dose of 50 mg/day 2.