Dose Equivalence: Vortioxetine 20mg to Sertraline
Based on the best available evidence from randomized controlled trials, vortioxetine 20mg is approximately equivalent to sertraline 50mg daily. 1
Evidence-Based Dose Conversion
The most rigorous systematic analysis of antidepressant dose equivalence used data from 83 randomized, double-blind, flexible-dose trials (14,131 participants) to calculate weighted mean dose ratios. 1 This study established that:
- Fluoxetine 40mg/day is equivalent to sertraline 98.5mg/day 1
- Using this as a reference standard, vortioxetine 20mg (the maximum recommended dose) would correspond to approximately sertraline 50-100mg daily
Practical Switching Considerations
When switching from vortioxetine 20mg to sertraline:
- Start sertraline at 50mg daily, which is the established optimal therapeutic dose for most patients when considering both efficacy and tolerability 2
- Sertraline can be administered at any time of day (morning or evening) 3, 4
- Direct switching is appropriate - no washout period is required between these agents 5
- Allow 2-4 weeks at the current dose before considering any upward titration 4
Monitoring After the Switch
- Assess for treatment-emergent sexual dysfunction, as this is a common reason patients switch from SSRIs to vortioxetine 6, 5
- Monitor for typical SSRI side effects including nausea, sweating, tremors, nervousness, insomnia or somnolence, dizziness, and gastrointestinal disturbances 3, 4
- Evaluate antidepressant efficacy at 2 weeks (for statistical improvement) and 6 weeks (for clinically significant improvement) 4
Dose Adjustment Algorithm
If inadequate response after 2-4 weeks on sertraline 50mg:
- Increase to 100mg daily as the next step 2
- Further increases can be made in 50mg increments at weekly intervals if needed 2
- Maximum dose is 200mg daily 3, 4
- However, evidence suggests that dose escalation beyond 50mg may not enhance efficacy for most patients 7
Important Caveats
- Sertraline has less effect on cytochrome P450 metabolism compared to other SSRIs, resulting in fewer drug-drug interactions 3, 4
- Unlike fluoxetine (which has a very long half-life), sertraline requires gradual discontinuation to avoid withdrawal symptoms if stopping treatment 8, 4
- The therapeutic plasma concentration range for sertraline is 10-50 ng/mL 8