What are the available doses of sertraline (selective serotonin reuptake inhibitor - SSRI)?

Available Doses of Sertraline

Sertraline is available in doses of 25 mg, 50 mg, 100 mg, and 200 mg tablets, as well as a 20 mg/mL oral concentrate solution that requires dilution before administration. 1

Dosage Forms and Strengths

• Tablets: 25 mg, 50 mg, 100 mg, and 200 mg
• Oral Concentrate: 20 mg/mL (requires dilution before use) 2

Standard Dosing Protocol

The dosing regimen for sertraline follows a structured approach:

1. Initial Dose:

   • Standard starting dose: 25-50 mg daily 1
   • Lower starting dose (25 mg) recommended for:
     • Elderly patients
     • Patients with hepatic impairment
     • Medication-sensitive individuals

2. Dose Titration:

   • Increase in 25-50 mg increments
   • Allow 1-2 weeks between dose adjustments
   • Maximum dose: 200 mg daily 1

3. Therapeutic Range:

   • 50-200 mg daily
   • 50 mg daily is considered the optimal therapeutic dose for most patients with depression, balancing efficacy and tolerability 3

Special Population Considerations

Pediatric Dosing

• For children ages 6-12 with OCD: Starting dose of 25 mg/day
• For adolescents ages 13-18 with OCD: Starting dose of 50 mg/day
• Maximum dose: 200 mg/day 2
• Mean dose in pediatric studies: 157 mg/day 2

Elderly Patients

• Lower starting dose (25 mg)
• Slower titration
• No specific maximum dose adjustment required based solely on age 4

Hepatic Impairment

• Lower starting dose (25 mg)
• Slower titration schedule 1

Renal Impairment

• No specific dose adjustment required 1

Administration Guidelines

• Sertraline is generally given as a single daily dose
• May be administered at any time of day
• Oral concentrate must be diluted before administration 2
• When discontinuing, dose should be gradually tapered over 10-14 days to minimize withdrawal symptoms 1

Clinical Considerations

The dose selection should be guided by clinical response and tolerability. While 50 mg daily is considered the optimal dose for most patients with depression 3, the dose may need to be increased for patients who do not show adequate response after 2-4 weeks of treatment.

For patients with OCD, doses up to 200 mg daily may be required for optimal symptom control 5.

Common Pitfalls to Avoid

• Starting at too high a dose, which may increase initial side effects
• Increasing the dose too quickly (allow 1-2 weeks between adjustments)
• Not allowing sufficient time at therapeutic dose (4-8 weeks) before determining efficacy
• Abrupt discontinuation rather than gradual tapering

Sertraline's pharmacokinetics support once-daily dosing with an elimination half-life of 22-36 hours 6, making it convenient for patients and potentially improving adherence.