What is the next dose and maximum recommended dose of sertraline (selective serotonin reuptake inhibitor) for an adult or adolescent patient currently taking 50 mg daily?

Sertraline Dose Escalation from 50 mg

For a patient currently on sertraline 50 mg daily who requires dose escalation, increase to 100 mg daily (50 mg increment), with a maximum dose of 200 mg daily. 1

Next Dose Increase

• Increase sertraline by 50 mg increments to 100 mg daily if the patient is not responding adequately to the current 50 mg dose 2, 1
• Wait at least 1 week between dose changes, as sertraline has a 24-hour elimination half-life and requires this interval to reach steady-state concentrations 1
• The 50 mg starting dose is the usually effective therapeutic dose for most patients with depression and OCD, so assess response adequately before escalating 1, 3

Maximum Recommended Dose

• The maximum dose is 200 mg daily for all approved indications including major depressive disorder, OCD, panic disorder, PTSD, and social anxiety disorder 2, 1
• Clinical trials demonstrating sertraline's effectiveness used a dosing range of 50-200 mg/day 1
• For premenstrual dysphoric disorder specifically, the maximum is 150 mg/day when dosing throughout the menstrual cycle, or 100 mg/day when dosing only during the luteal phase 1

Dose Escalation Strategy

• Continue 50 mg increments at weekly intervals or longer until reaching therapeutic response or the 200 mg maximum 2, 1
• The dose-response relationship has not been definitively established, but patients not responding to 50 mg may benefit from higher doses up to 200 mg/day 1
• Sertraline can be administered at any time of day as a single daily dose 1, 3

Critical Monitoring During Dose Increases

• Monitor closely for behavioral activation and agitation with each dose increase, particularly in younger patients and those with underlying anxiety disorders 4
• Watch for suicidality especially in patients under age 24, particularly during the first months of treatment and following any dosage adjustments 4
• Assess for serotonin syndrome symptoms within 24-48 hours after dose increases, especially if the patient is taking other serotonergic medications 4

Common Pitfalls to Avoid

• Do not increase doses more frequently than weekly intervals, as steady-state concentrations require time to establish given sertraline's 22-36 hour elimination half-life 1, 5
• Never discontinue sertraline abruptly if dose reduction becomes necessary; gradual tapering over 10-14 days helps limit withdrawal symptoms 2
• Avoid combining with MAOIs or multiple serotonergic drugs without extreme caution due to significantly increased serotonin syndrome risk 4