What dose of sertraline should I restart with after a break?

Restarting Sertraline After a Break

When restarting sertraline after a break, you should begin with 50 mg daily rather than immediately resuming at 100 mg to minimize side effects while maintaining efficacy.

Dosing Recommendations

The optimal approach to restarting sertraline depends on how long you've been off the medication:

• For short breaks (less than 2 weeks): Start with 50 mg daily for 3-7 days, then increase to your previous dose of 100 mg if tolerated 1
• For longer breaks (more than 2 weeks): Begin with 50 mg daily for 7-14 days before increasing to 100 mg 1, 2

This approach is supported by evidence showing that 50 mg/day is the usually effective therapeutic dose for most patients and represents the optimal balance between efficacy and tolerability 2.

Rationale for Starting at 50 mg

1. Minimizes side effects: Starting directly at 100 mg after a break increases the risk of initial side effects such as:

   • Gastrointestinal disturbances (nausea, diarrhea)
   • Headache
   • Insomnia
   • Sexual dysfunction 3, 4

2. Pharmacokinetic considerations: Sertraline has an elimination half-life of approximately 26 hours, with steady-state concentrations achieved after about 7 days of consistent dosing 3, 5

3. Tolerability advantage: The incidence of side effects is directly related to both dosage and dosage regimen, with lower initial doses producing fewer side effects 4

Monitoring During Restart

• Watch for common side effects during the first 1-2 weeks
• If side effects are minimal at 50 mg, increase to 100 mg after 7-14 days
• If significant side effects occur, remain at 50 mg longer before attempting to increase the dose

Special Considerations

• Elderly patients: No dose adjustment needed specifically for age 2
• Patients with panic disorder: The 50 mg starting dose is also appropriate for anxiety disorders 6

Common Pitfalls to Avoid

1. Rushing the titration: Increasing the dose too quickly can lead to unnecessary side effects
2. Starting too high: Beginning immediately at 100 mg after a break increases discontinuation risk due to side effects
3. Irregular dosing: Sertraline should be taken at the same time each day to maintain consistent blood levels

By following this approach of starting at 50 mg and gradually increasing to your previous dose of 100 mg, you'll maximize your chances of successfully restarting sertraline with minimal side effects.