Recommended Starting Dosage of Zoloft (Sertraline)
The recommended starting dosage of Zoloft (sertraline) for adults with major depressive disorder and obsessive-compulsive disorder is 50 mg once daily. 1
Dosing Guidelines by Condition
Major Depressive Disorder and Obsessive-Compulsive Disorder (Adults)
- Initial dose should be 50 mg administered once daily 1
- This starting dose is considered the usually effective therapeutic dose and optimal when considering both efficacy and tolerability for most patients 2
Panic Disorder, PTSD, and Social Anxiety Disorder (Adults)
- Initial dose should be 25 mg once daily for the first week 1
- After one week, increase to 50 mg once daily 1
- This gradual titration helps minimize initial side effects while establishing therapeutic effect 3
Premenstrual Dysphoric Disorder (Adults)
- Initial dose should be 50 mg once daily, either throughout the menstrual cycle or limited to the luteal phase 1
Pediatric Patients with OCD
- Children ages 6-12: Start with 25 mg once daily 1
- Adolescents ages 13-17: Start with 50 mg once daily 1
- Lower starting doses in children account for their generally lower body weights compared to adults 1
Dose Adjustments and Titration
- Patients not responding to initial doses may benefit from dose increases up to a maximum of 200 mg/day 1
- Dose changes should not occur at intervals of less than 1 week due to sertraline's 24-hour elimination half-life 1
- Sertraline has a relatively long elimination half-life (approximately 26 hours), making it suitable for once-daily administration 3
Administration Considerations
- Sertraline can be administered at any time of day 2
- No dosage adjustment is needed for elderly patients 2
- Sertraline has fewer drug interactions than some other antidepressants 4
Pharmacokinetic Considerations
- Sertraline reaches steady state after about 7 days of consistent dosing 5
- Therapeutic plasma concentration range is 10-50 ng/mL 4
- Mean plasma concentrations are approximately 12±17 ng/mL at 50 mg daily and 19±18 ng/mL at 100 mg daily 4
Common Side Effects to Monitor
- Gastrointestinal disturbances (nausea, diarrhea/loose stools) 3
- Sexual dysfunction (primarily ejaculatory disturbance in males) 3
- Insomnia or somnolence 4
- Dizziness and nervousness 4
- These side effects are usually mild and transient, decreasing in frequency with continued treatment 3
Clinical Pearls
- Unlike some other SSRIs, sertraline does not require altered dosing recommendations for elderly patients 2
- Sertraline has minimal anticholinergic activity and is essentially devoid of cardiovascular effects, making it suitable for elderly patients or those with underlying cardiovascular disorders 3
- Sertraline has demonstrated efficacy in multiple conditions beyond depression, including OCD, panic disorder, PTSD, and social anxiety disorder 6, 7