Recommended Dosage of Sertraline (Zoloft) for Adults
For adults, sertraline (Zoloft) should be initiated at 50 mg once daily for most indications, with a maximum recommended dose of 200 mg daily. 1
Initial Dosing by Indication
- Major Depressive Disorder and Obsessive-Compulsive Disorder: Start with 50 mg once daily 1
- Panic Disorder, Post-Traumatic Stress Disorder, and Social Anxiety Disorder: Start with 25 mg once daily for one week, then increase to 50 mg once daily 1
- Premenstrual Dysphoric Disorder: Start with 50 mg daily (either throughout the menstrual cycle or limited to the luteal phase) 1
Dosage Adjustments
- Dose increases should not occur at intervals of less than 1 week due to sertraline's 24-hour elimination half-life 1, 2
- For patients not responding to 50 mg daily, the dose may be increased in 50 mg increments up to a maximum of 200 mg daily 1, 3
- Sertraline can be administered once daily at any time of day (morning or evening) 1, 4
Special Considerations
- No dosage adjustments are required for elderly patients based solely on age 1, 5
- Sertraline is well tolerated compared to other antidepressants, with less effect on metabolism of other medications compared to other SSRIs 3
- Common side effects include dry mouth, headache, diarrhea, nausea, insomnia, somnolence, constipation, dizziness, sweating, and taste abnormalities 5
Clinical Pharmacokinetics
- Sertraline is slowly absorbed following oral administration with peak plasma concentrations at 6-8 hours 2, 6
- The elimination half-life ranges from 22-36 hours, making once-daily dosing effective 2
- Steady-state plasma concentrations are typically achieved after about 7 days of consistent dosing 6
Treatment Duration
- For major depressive disorder, maintenance treatment is often required beyond the acute response phase 1
- Clinical trials have demonstrated maintained antidepressant efficacy for up to 44 weeks following 8 weeks of initial treatment at doses of 50-200 mg/day (mean dose 70 mg/day) 1
- Patients should be periodically reassessed to determine the need for continued maintenance treatment 1
Common Pitfalls to Avoid
- Avoid rapid dose escalation; allow at least one week between dose increases to minimize side effects 1, 2
- Do not discontinue sertraline abruptly; gradual tapering over 10-14 days helps limit withdrawal symptoms 3
- Be aware of potential drug interactions, although sertraline has a lower potential for drug interactions compared to other SSRIs 5, 6
- For most patients, 50 mg/day is the optimal dose when considering both efficacy and tolerability 4