Maximum Recommended Dose of Sertraline
The maximum recommended dose of sertraline is 200 mg per day for adults across all approved indications including major depressive disorder, obsessive-compulsive disorder, panic disorder, PTSD, social anxiety disorder, and PMDD. 1
Standard Dosing Algorithm
Initial Dosing
- Major Depressive Disorder 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 the menstrual cycle or limited to luteal phase) 1
Dose Titration
- Patients not responding to 50 mg daily may have their dose increased in 50 mg increments up to the maximum of 200 mg daily 2, 1
- Dose changes should not occur at intervals of less than 1 week due to sertraline's 24-hour elimination half-life 1
- The mean effective dose in clinical trials for completers was typically 70-186 mg/day depending on the indication 1
Special Population Considerations
Pediatric Dosing (OCD only)
- 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 in children should be considered when advancing doses to avoid excess dosing 1
Elderly Patients
- No dosage adjustment is required based solely on age 3, 4, 5
- The maximum dose remains 200 mg per day, including in patients with Alzheimer's disease and depression 3
- Consider starting at 25 mg for patients who are more sensitive to medication side effects or taking multiple medications 6
Renal Impairment
- No dose adjustment is necessary as sertraline pharmacokinetics are unaffected by renal impairment 1
Critical Safety Considerations
Monitoring Requirements
- Patients must be monitored closely for clinical worsening, suicidality, and unusual behavior changes, especially during the initial months of therapy or at times of dose changes 3, 6
Discontinuation Protocol
- Never discontinue sertraline abruptly; gradual tapering over 10-14 days is essential to limit withdrawal symptoms 2, 6
Drug Interactions
- Sertraline has minimal inhibitory effects on major cytochrome P450 enzymes, resulting in fewer drug-drug interactions compared to other SSRIs 3, 7
- When used with cholestyramine, space medications at least 4 hours apart to prevent binding and loss of efficacy 6
Common Pitfalls to Avoid
- Do not increase doses more frequently than weekly intervals - the 24-hour elimination half-life requires adequate time to reach steady state 1
- Do not exceed 200 mg/day - this is the established maximum across all indications with no evidence supporting higher doses 2, 3, 1
- For PMDD with luteal phase dosing, the maximum is 100 mg/day (lower than other indications), and requires a 50 mg titration step for 3 days at the beginning of each luteal phase if established at 100 mg 1