Maximum Dose of Sertraline
The maximum recommended dose of sertraline is 200 mg per day for all FDA-approved indications including major depressive disorder, obsessive-compulsive disorder, panic disorder, PTSD, social anxiety disorder, and PMDD. 1
FDA-Approved Dosing Framework
Standard Adult Dosing
- Starting dose: 50 mg once daily for major depressive disorder and OCD 1
- Starting dose for anxiety disorders: 25 mg once daily for panic disorder, PTSD, and social anxiety disorder, increased to 50 mg after one week 1
- Maximum dose: 200 mg/day across all indications 1
- Dose titration interval: Changes should not occur more frequently than once weekly due to sertraline's 24-hour elimination half-life 1
Pediatric Dosing (OCD Only)
- Children ages 6-12: Start 25 mg daily, maximum 200 mg/day 1
- Adolescents ages 13-17: Start 50 mg daily, maximum 200 mg/day 1
- Body weight should be considered when advancing doses in children to avoid excess dosing 1
Special Clinical Applications
Premature Ejaculation (Off-Label)
- Daily dosing ranges from 25-200 mg/day have been studied 2
- Higher doses may increase efficacy but potentially increase risk of erectile dysfunction and decreased libido 2
- Both continuous daily dosing and situational dosing (50 mg taken 4-8 hours before intercourse) have shown effectiveness 2
Hepatic Pruritus (Off-Label)
- Recommended dose: 75-100 mg daily 2
- Sertraline is considered third-line treatment after rifampicin and cholestyramine 2
- Well tolerated in this indication based on small RCT data 2
Elderly Patients and Special Populations
- No dose adjustment needed based solely on age 1, 3, 4
- The maximum dose remains 200 mg/day even in patients with Alzheimer's disease 5
- Sertraline has minimal cytochrome P450 inhibition, reducing drug interaction concerns particularly important in elderly patients on multiple medications 5, 6
Critical Dosing Principles
Dose Escalation Strategy
- Patients not responding to 50 mg may benefit from increases up to 200 mg/day 1
- Dose increases should occur in 50 mg increments 1
- Allow at least one week between dose changes to reach steady-state concentrations 1
- The optimal therapeutic dose for most patients is 50 mg/day when balancing efficacy and tolerability 7
Common Pitfall: Premature Dose Escalation
- Many patients respond adequately to 50 mg/day; allow 2-4 weeks at each dose before escalating 7
- Steady-state plasma concentrations vary widely (up to 15-fold) between individuals at the same dose, so therapeutic drug monitoring is not routinely useful 6
Tolerability at Maximum Doses
- Common side effects include sweating, tremors, nervousness, insomnia or somnolence, dizziness, gastrointestinal disturbances, and sexual dysfunction 5
- The adverse effect profile is similar across age groups 3, 4
- Higher doses may theoretically increase side effect frequency, though studies have been too small to definitively establish dose-related adverse effects 2