Maximum Dose of Sertraline
The maximum dose of sertraline is 200 mg per day for all standard indications including depression, OCD, panic disorder, PTSD, and social anxiety disorder. 1
Standard Dosing Framework
Initial Dosing
- Depression and OCD: Start at 50 mg once daily 1
- Panic disorder, PTSD, and social anxiety disorder: Start at 25 mg once daily for one week, then increase to 50 mg once daily 1
- PMDD: Start at 50 mg daily (either throughout cycle or luteal phase only), with maximum of 150 mg/day for continuous dosing or 100 mg/day for luteal phase dosing 1
Dose Titration
- Patients not responding to 50 mg may benefit from dose increases up to the maximum of 200 mg/day 1
- Dose changes should occur at intervals of no less than 1 week due to sertraline's 24-hour elimination half-life 1
- Increases should be made in 50 mg increments 2
Special Populations
Elderly Patients
- The maximum dose remains 200 mg/day even in elderly patients, including those with Alzheimer's disease 3, 4
- No dosage adjustments are warranted for elderly patients based solely on age 5
- Sertraline has minimal cytochrome P450 inhibition, reducing drug interaction concerns particularly important in elderly patients on multiple medications 3
Pediatric Patients (OCD)
- Children ages 6-12: Start at 25 mg once daily, maximum 200 mg/day 1
- Adolescents ages 13-17: Start at 50 mg once daily, maximum 200 mg/day 1
- Lower body weights should be considered when advancing doses to avoid excess dosing 1
Special Clinical Applications Beyond Standard Indications
Off-Label Uses with Different Dosing
- Hepatic pruritus (cholestatic itch): 75-100 mg daily as third-line treatment 6, 3
- Premature ejaculation: 25-200 mg daily (or 50 mg situationally 4-8 hours before intercourse), though higher doses may increase erectile dysfunction and decreased libido 3, 7
- Uremic pruritus: Start at 25 mg daily, titrate by 25 mg monthly up to maximum 200 mg daily 8
Important Clinical Considerations
Common Side Effects at Higher Doses
- Sweating, tremors, nervousness, insomnia or somnolence, dizziness 3, 4
- Gastrointestinal disturbances (nausea, diarrhea, dyspepsia) 9
- Sexual dysfunction 7
- Higher doses may theoretically increase side effect frequency 3
Critical Safety Points
- Avoid concomitant use with MAOIs due to serotonin syndrome risk 7
- Monitor for suicidal thinking and behavior, especially in first months and following dose adjustments 7
- Unlike fluoxetine's very long half-life, sertraline requires more gradual discontinuation to avoid withdrawal syndrome (dizziness, fatigue, headaches, nausea, insomnia, sensory disturbances, anxiety) 7