Sertraline Dosing: Weight-Based Calculation Not Standard Practice
Sertraline is not dosed by mg/kg in clinical practice; instead, use fixed dosing starting at 50 mg daily for adults and titrate based on response, or use age-based dosing for pediatric patients. 1, 2
Adult Dosing (Fixed Dose, Not Weight-Based)
- Start at 50 mg daily as the initial and often optimal therapeutic dose for most patients 1, 3
- Titrate if needed: Increase in 50 mg increments at weekly intervals up to a maximum of 200 mg daily for patients not responding adequately 1, 3
- No adjustment needed for renal insufficiency; consider dose reduction for hepatic insufficiency 2
Pediatric Dosing (Age-Based, Not Strictly Weight-Based)
While the evidence shows pediatric pharmacokinetic studies normalized doses by body weight for research purposes, clinical dosing in children follows age-based protocols similar to adults 4:
- Children (6-12 years): Start at 25 mg daily, titrate to 200 mg daily in 25 mg increments 4
- Adolescents (13-17 years): Start at 50 mg daily, titrate to 200 mg daily in 50 mg increments 4
- Pharmacokinetic parameters (AUC, Cmax, half-life) in pediatric patients are similar to adults when normalized for body weight 4
Key Clinical Considerations
Titration schedule matters for tolerability: Starting at 50 mg and increasing at 2-week intervals produces very low side effect incidence (no single side effect >10% frequency) 5
Common pitfalls to avoid:
- Do not abruptly discontinue—taper gradually over 10-14 days to prevent withdrawal symptoms (dizziness, fatigue, nausea, irritability) 2
- Monitor for suicidal ideation, especially in patients under 24 years during the first few months and after dose adjustments 2
- Early side effects (nausea, diarrhea, headaches, insomnia) typically appear in first few weeks but are generally well-tolerated 2
Duration of treatment: Continue for 4-12 months after remission for first depressive episode; consider longer treatment for recurrent depression given relapse risk increases to 50% after one episode, 70% after two, and 90% after three 2