Recommended Starting Dose of Sertraline
The recommended starting dose of sertraline for adults is 50 mg once daily for most indications, with the exception of panic disorder, PTSD, and social anxiety disorder which should start at 25 mg once daily for the first week before increasing to 50 mg. 1
Initial Dosing Guidelines
- For major depressive disorder and obsessive-compulsive disorder in adults, start with 50 mg once daily 1
- For panic disorder, posttraumatic stress disorder, and social anxiety disorder, start with 25 mg once daily for one week, then increase to 50 mg once daily 1
- For premenstrual dysphoric disorder, start with 50 mg once daily (either throughout the menstrual cycle or limited to the luteal phase) 1
- For pediatric patients with OCD, start with 25 mg once daily in children ages 6-12 and 50 mg once daily in adolescents ages 13-17 1, 2
Dosage Adjustments and Maximum Doses
- Sertraline can be administered at any time of day, either morning or evening 1, 3
- Dose changes should not occur at intervals of less than 1 week due to sertraline's 24-hour elimination half-life 1
- If needed, the dose may be increased in 50 mg increments up to a maximum of 200 mg daily 1, 2
- The starting dose of 50 mg is generally the effective therapeutic dose and optimal dose when considering both efficacy and tolerability for most patients 3
Special Populations
- No dosage adjustment is required for elderly patients based solely on age 1, 4
- Sertraline is well tolerated in elderly patients and lacks the marked anticholinergic effects of tricyclic antidepressants 4
- The pharmacokinetics of sertraline in elderly patients and those with renal impairment are similar to those in young healthy volunteers 5
Common Side Effects and Monitoring
- Common side effects include dry mouth, headache, diarrhea, nausea, insomnia, somnolence, and dizziness 4
- Sertraline has less effect on the metabolism of other medications compared to other SSRIs 2
- Monitor patients closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of treatment or at times of dose changes 2
- When discontinuing sertraline, it should be slowly tapered to avoid withdrawal effects 2
Clinical Pearls
- Sertraline follows first-order kinetics with a plasma elimination half-life of 24-26 hours 6
- Steady state is reached after approximately 7 days of consistent dosing 5
- Sertraline is highly protein-bound and has a large volume of distribution 6
- The 50 mg starting dose is generally well tolerated and effective for most patients, making dose adjustments often unnecessary 3, 7