What are the treatment steps for a sertraline (Selective Serotonin Reuptake Inhibitor (SSRI)) overdose after accidentally taking an extra 75mg dose?

Management of Accidental Double Dose of Sertraline (150mg Total)

For an accidental ingestion of an extra 75mg sertraline dose (150mg total), home observation is appropriate with monitoring for symptoms of serotonin syndrome over the next 24-48 hours, as this dose falls well below the threshold requiring emergency department evaluation. 1, 2

Immediate Assessment and Triage

You can safely observe at home if the following conditions are met:

• The ingestion was unintentional (not suicidal intent) 2
• The total dose is less than five times the initial adult therapeutic dose (250mg for sertraline) 2
• The patient is currently asymptomatic or has only mild effects (mild vomiting, light drowsiness, dilated pupils, or sweating) 2
• No other serotonergic medications or substances were co-ingested 3, 2

Emergency department referral is NOT necessary for this 150mg total dose, as it represents less than the 250mg threshold established for home observation in unintentional overdoses 2.

Home Monitoring Protocol

Monitor for serotonin syndrome symptoms over the next 24-48 hours, which is the critical window for symptom development 1, 4:

Mental Status Changes to Watch For:

• Confusion, agitation, or anxiety 4, 3
• Hallucinations or delirium 3
• Unusual restlessness 5

Neuromuscular Symptoms:

• Tremors or shaking 4, 3
• Muscle twitching (myoclonus) 4, 5
• Increased reflexes (hyperreflexia) 4, 5
• Muscle rigidity or stiffness 4, 3
• Incoordination 3

Autonomic Symptoms:

• Rapid heartbeat (tachycardia) 4, 3
• Elevated blood pressure 3
• Fever or feeling overheated 4, 5
• Heavy sweating (diaphoresis) 3, 2
• Flushing 3
• Nausea, vomiting, or diarrhea 3

What NOT to Do

• Do not induce vomiting 2
• Do not take activated charcoal at home - there is no evidence of clinical benefit for this dose, and the risk of SSRI-induced loss of consciousness, though small, makes home administration inadvisable 2
• Do not take any additional serotonergic medications (triptans for migraine, tramadol, St. John's Wort, tryptophan supplements, other antidepressants) as this significantly increases serotonin syndrome risk 1, 3

When to Seek Emergency Care

Call 911 or go to the emergency department immediately if:

• Any symptoms beyond mild effects develop (anything more than slight drowsiness, mild nausea, or sweating) 2
• Fever above 104°F (40°C) develops 2
• Seizures occur 3, 2
• Severe confusion or inability to stay awake 3
• Muscle rigidity or uncontrollable muscle movements 4, 3

Follow-Up Considerations

• Contact your poison control center (1-800-222-1222) for additional guidance and potential follow-up calls during the observation period 2
• Resume your normal sertraline dose tomorrow - do not skip doses or make changes without consulting your prescriber 3
• Inform your prescriber about this incident at your next appointment to discuss medication storage and administration strategies 3

Important Context

Sertraline is relatively safe in overdose when taken alone, with minimal significant morbidity reported in isolated ingestions at doses much higher than 150mg 1, 6. Deaths have only been reported following very large ingestions of thousands of milligrams 1. Studies of sertraline overdoses up to 8,000mg have shown that isolated ingestions typically result in minor, short-duration symptoms 6. The most serious complications occur when sertraline is combined with other serotonergic agents or substances 3, 7.