Restarting Sertraline (Zoloft) After a Brief Discontinuation
Yes, you can restart sertraline at 100mg in a patient who has been off the medication for only a couple of weeks. 1
Rationale for Restarting at Previous Dose
- The FDA drug label for sertraline does not specifically require dose titration when restarting after a brief discontinuation period of just a couple of weeks 1
- For patients who have previously tolerated 100mg of sertraline, restarting at this same dose is appropriate when the discontinuation has been brief 1, 2
- The standard therapeutic dose of sertraline is 50-200mg daily, with 50mg being the usual starting dose for new patients, but not necessarily for those restarting therapy 2
Important Considerations When Restarting
- Monitor for any potential side effects in the first few days after restarting, particularly anxiety or agitation which can be initial adverse effects of SSRIs 3
- If the patient experiences significant side effects upon restarting at 100mg, you can temporarily reduce the dose and then gradually increase back to 100mg over 1-2 weeks 3
- Ensure the patient understands the importance of consistent medication adherence, as sertraline (particularly at shorter half-life than fluoxetine) can cause discontinuation symptoms when missed 3
Discontinuation Syndrome Awareness
- Sertraline has been associated with discontinuation syndrome, characterized by dizziness, fatigue, headaches, nausea, sensory disturbances, anxiety, and irritability 3
- The patient may have already experienced some of these symptoms during their two-week discontinuation period 4
- Restarting at their previous effective dose will quickly address any discontinuation symptoms they may be experiencing 3
Long-term Considerations
- After restarting treatment, periodically reassess the need for continued treatment and consider maintaining the patient on the lowest effective dose 1
- If the patient has had multiple episodes of stopping and restarting medication, consider discussing strategies for improving adherence 3
- For any future planned discontinuation, implement a gradual taper rather than abrupt cessation to minimize withdrawal symptoms 1, 4
Special Cautions
- If the patient has developed any new medical conditions or started any new medications during the brief discontinuation period, check for potential interactions before restarting 3
- Be particularly cautious with concomitant use of other serotonergic drugs, MAOIs, or medications that affect CYP450 enzymes 3
- If the patient has developed any liver impairment during the discontinuation period, consider a lower dose or less frequent dosing 1
By restarting at the previously effective and tolerated dose of 100mg, you can quickly reestablish therapeutic effect while minimizing the risk of prolonged discontinuation symptoms 1, 2.