Should sertraline (selective serotonin reuptake inhibitor) be taken in the morning or at night?

Timing of Sertraline Administration: Morning vs. Night

Sertraline can be administered either in the morning or evening, as its bioavailability and elimination are not influenced by the time of administration. 1, 2

Pharmacokinetic Considerations

• Sertraline has a 24-26 hour elimination half-life, making it suitable for once-daily administration at any time of day 1, 3
• The bioavailability and elimination of sertraline are not affected by whether it is taken in the morning or evening 2
• Sertraline can be taken with or without food, offering flexibility in administration 2

Administration Recommendations

• For adults with depression, the FDA recommends a starting dose of 50 mg once daily, which can be administered at any time of day 1
• For panic disorder, PTSD, and social anxiety disorder, treatment should be initiated with 25 mg once daily for one week, then increased to 50 mg once daily 1
• The American Academy of Family Physicians notes that sertraline can be taken either in the morning or evening 4

Side Effect Considerations for Timing

• Common side effects that may influence timing of administration include:

  • Insomnia or somnolence 4, 5
  • Dizziness 4, 5
  • Gastrointestinal disturbances (nausea, diarrhea) 3, 6

• If sertraline causes insomnia, morning administration may be preferable 4

• If sertraline causes somnolence/sedation, evening administration may be more appropriate 4

Special Populations

• For pediatric patients with OCD, sertraline should be administered once daily, either in the morning or evening 1
• For elderly patients, no specific time of day is recommended over another, and no dosage adjustments are needed based solely on age 7, 5

Clinical Considerations

• For patients with specific side effects:
  • Patients experiencing sleep disturbances may benefit from adjusting the timing of administration (morning for those with sedation, evening for those with insomnia) 4
  • For patients taking multiple medications, sertraline has less effect on the metabolism of other medications compared to other SSRIs, regardless of administration time 4

Monitoring

• Patients should be monitored closely for clinical worsening, suicidality, and unusual behavior changes, especially during the initial few months of treatment or at times of dose changes 8
• Side effects are usually mild and transient, decreasing in frequency with continued treatment 3

The timing of sertraline administration should be based primarily on the patient's side effect profile, particularly whether they experience insomnia or sedation, as the medication's effectiveness is not affected by the time of day it is taken.