How to Restart Sertraline 100mg
When restarting sertraline 100mg, begin with a lower dose of 25-50mg daily for 1-2 weeks before increasing to the target dose of 100mg to minimize side effects and optimize tolerability. 1, 2
Recommended Restart Protocol
Step 1: Initial Restart Dose
- Start with 25-50mg once daily (morning or evening) for the first 1-2 weeks 1, 2
- Take at the same time each day to maintain consistent blood levels 3
- Monitor for initial side effects which may include gastrointestinal disturbances (nausea, diarrhea) 4
Step 2: Dose Titration
- After 1-2 weeks at the lower dose, increase to 100mg once daily if the initial dose is well tolerated 1
- Titrate gradually to minimize adverse effects such as anxiety, agitation, or gastrointestinal symptoms 1
- If significant side effects occur during titration, consider extending the time at the lower dose before increasing 5
Step 3: Maintenance
- Once at 100mg daily, continue at this dose as it is considered an effective therapeutic dose for most patients 2
- Full therapeutic effect may take 3-4 weeks to achieve 6
- Monitor for continued efficacy and tolerability 4
Important Considerations
Potential Side Effects During Restart
- Initial anxiety or agitation may occur when restarting, particularly if dose is increased too rapidly 5
- Gastrointestinal effects (nausea, diarrhea) are common but usually transient 4
- Sexual dysfunction may occur but often decreases with continued treatment 4
Special Precautions
- Avoid abrupt discontinuation as this may lead to discontinuation syndrome (dizziness, fatigue, sensory disturbances, anxiety, irritability) 1
- If previously on other serotonergic medications, ensure adequate washout period to avoid serotonin syndrome 1
- Do not combine with MAOIs due to risk of serotonin syndrome 1
Dosing Flexibility
- Sertraline can be administered at any time of day 2
- Food does not significantly affect absorption 3
- No dose adjustment is typically needed for elderly patients 2
Clinical Pearls
- Rapid dose escalation may increase risk of behavioral activation or side effects 5
- The therapeutic effect of sertraline is not necessarily enhanced by doses higher than 100mg for most patients 6
- If side effects occur at 100mg, consider returning to a lower dose (50mg) which may still be effective 6
- Steady state plasma levels are typically reached after approximately 7 days of consistent dosing 3