Sertraline Dose Equivalent to Fluoxetine 40 mg
A sertraline dose of approximately 100 mg is equivalent to fluoxetine 40 mg. 1
Dose Equivalence Rationale
- According to evidence-based recommendations from randomized controlled trials, fluoxetine 40 mg/day is equivalent to sertraline 98.5 mg/day 1
- This equivalence is based on systematic analysis of flexible-dose trials comparing standard drugs with other active antidepressants in the treatment of unipolar depression 1
- For practical purposes in clinical settings, this would typically be rounded to sertraline 100 mg daily 2
Dosing Considerations for Sertraline
- Sertraline is typically initiated at 50 mg/day, which is considered the usually effective therapeutic dose for most patients 2
- For patients who don't respond adequately within 2-4 weeks, the dose can be increased in 50 mg increments at weekly intervals up to a maximum of 200 mg/day 2
- Sertraline is generally administered as a single daily dose and may be taken at any time of day 2, 3
- Sertraline has a half-life of approximately 32 hours, allowing for once-daily dosing with steady state reached after about 7 days 3
Comparative Efficacy and Safety
- Sertraline has been shown to increase ejaculatory latency at doses ranging from 25 to 200 mg daily or situationally at 50 mg (4-8 hours before intercourse) 4
- Higher doses of sertraline may increase efficacy but could potentially be associated with increased frequency of erectile dysfunction and decreased libido 4
- Unlike some other SSRIs, sertraline has a relatively favorable drug interaction profile due to less effect on CYP450 isoenzymes 4
- Sertraline has a recommended therapeutic plasma concentration range of 10-50 ng/mL 4
Common Side Effects and Monitoring
- Common side effects include nausea, dry mouth, drowsiness, reduced libido, headache, insomnia, and dizziness 4
- A discontinuation syndrome can occur with abrupt cessation, characterized by dizziness, fatigue, headaches, nausea, insomnia, sensory disturbances, and anxiety 4
- Unlike fluoxetine which has a very long half-life, sertraline has a shorter half-life requiring more gradual discontinuation to avoid withdrawal symptoms 4
- Monitoring for suicidal thinking and behavior is recommended, especially in the first months of treatment and following dosage adjustments 4
Clinical Pearls
- There is limited evidence for a dose-response relationship with sertraline in depression treatment; continued treatment with 50 mg may yield comparable response rates to dose escalation to 150 mg 5
- When switching from fluoxetine 40 mg to sertraline, consider the long half-life of fluoxetine and its active metabolite (1-3 days and 7-15 days respectively), which may require a washout period 4
- Sertraline may be administered without dose adjustment in elderly patients, unlike some other antidepressants 2, 3
- Avoid concomitant use with MAOIs due to risk of serotonin syndrome 4