Sertraline Starting Dose Recommendations
The recommended starting dose of sertraline is 25-50 mg once daily, with 50 mg being the standard effective therapeutic dose for most conditions. 1
General Dosing Guidelines
- For major depressive disorder and obsessive-compulsive disorder (adults): Start with 50 mg once daily 1
- For panic disorder, PTSD, and social anxiety disorder: Start with 25 mg once daily for one week, then increase to 50 mg once daily 1
- For adolescents with depression: 25 mg daily is the recommended starting dose 2
Condition-Specific Considerations
Depression
- Start at 50 mg once daily 1, 3
- The 50 mg starting dose is considered the optimal dose when considering both efficacy and tolerability for most patients 3
- For adolescents: Start at 25 mg daily 2
Anxiety Disorders
- Start at 25 mg once daily for one week
- Then increase to 50 mg once daily 1
Pruritus in Cholestatic Liver Disease
- When used for cholestatic pruritus, sertraline is typically started at lower doses and titrated up to 100 mg daily 2
- Note: Sertraline is considered a fourth-line treatment for cholestatic pruritus after cholestyramine, rifampicin, and naltrexone 2
Dose Titration
- Dose increases should not occur at intervals of less than 1 week due to sertraline's 24-hour elimination half-life 1
- If needed, dose can be increased in 50 mg increments to a maximum of 200 mg daily 1
- Research suggests that for many patients, continuing treatment at 50 mg yields similar response rates compared to dose escalation to 150 mg 4
Special Populations
- Elderly patients: No dosage adjustments are warranted based solely on age 5
- Patients with renal impairment: No specific dose adjustment required 6
- Liver disease: Exercise caution and consider lower starting doses 7
Administration Timing
- Sertraline can be administered once daily at any time of day (morning or evening) 1
- For patients with gallbladder issues, morning administration may be preferred 2
Common Side Effects to Monitor
- Gastrointestinal: nausea, diarrhea, dry mouth
- Neurological: headache, insomnia, somnolence, dizziness
- Other: sweating, sexual dysfunction 5
Important Precautions
- Contraindicated with monoamine oxidase inhibitors (MAOIs) 2
- Monitor closely for clinical worsening, suicidality, and unusual behavior changes, especially during the initial few months of therapy or at times of dose changes 2
- Avoid starting at higher doses as this may increase the risk of deliberate self-harm or suicide-related events 2
Clinical Pearl
When initiating sertraline, starting at the recommended dose (25-50 mg) rather than higher doses not only improves tolerability but also reduces the risk of behavioral activation and suicide-related events, particularly in younger patients 2.