What is the recommended dose range of sertraline (selective serotonin reuptake inhibitor) for adults with depression or anxiety disorders, including considerations for elderly patients or those with impaired renal function?

Sertraline Dose Range

For adults with depression, OCD, panic disorder, PTSD, and social anxiety disorder, sertraline should be initiated at 50 mg once daily (25 mg for panic disorder, PTSD, and social anxiety disorder for the first week), with a therapeutic range of 50-200 mg/day, administered as a single daily dose. 1

Standard Adult Dosing by Indication

Depression and OCD

• Start at 50 mg once daily 1
• Therapeutic range: 50-200 mg/day 1
• The 50 mg starting dose is typically the effective therapeutic dose for most patients 1, 2

Panic Disorder, PTSD, and Social Anxiety Disorder

• Start at 25 mg once daily for one week, then increase to 50 mg once daily 1
• Therapeutic range: 50-200 mg/day 1
• For panic disorder specifically, effective doses range from 50-175 mg/day 3

Premenstrual Dysphoric Disorder (PMDD)

• Start at 50 mg/day (either daily throughout cycle or luteal phase only) 1
• Therapeutic range: 50-150 mg/day for continuous dosing or 50-100 mg/day for luteal phase dosing 1
• Use 50 mg increments per menstrual cycle for dose increases 1

Dose Titration Guidelines

• Dose adjustments should occur at intervals of no less than 1 week due to sertraline's 24-hour elimination half-life 1
• Patients not responding to 50 mg may benefit from increases up to a maximum of 200 mg/day 1
• Steady-state plasma concentrations are reached after approximately 7 days 4

Pediatric Dosing (Ages 6-17 for OCD)

• Children ages 6-12: Start at 25 mg once daily 1
• Adolescents ages 13-17: Start at 50 mg once daily 1
• Maximum dose: 200 mg/day 1
• Consider lower body weights when advancing doses to avoid excess dosing 1

Elderly Patients

No dosage reduction is required for elderly patients based on age alone. 1, 5, 2

• The standard adult dose of 50-200 mg/day is appropriate 5
• Sertraline pharmacokinetics in elderly patients are similar to younger adults 4
• This represents a significant advantage over other SSRIs that require dose adjustments in the elderly 5, 2
• Sertraline is well-tolerated in patients ≥60 years with major depressive disorder 5

Renal Impairment

No dosage adjustment is necessary for patients with renal impairment. 4

• Sertraline kinetics in patients with renal impairment are similar to healthy volunteers 4
• This differs from medications like amantadine and rimantadine, which require significant dose reductions in renal dysfunction 6

Therapeutic Drug Monitoring

• The therapeutic plasma concentration range for sertraline plus norsertraline (active metabolite) is not firmly established in the guideline evidence 6
• At 50 mg/day: geometric mean levels of 12±17 ng/mL sertraline and 30±24 ng/mL norsertraline 6
• At 100 mg/day: 19±18 ng/mL sertraline and 45±35 ng/mL norsertraline 6
• At 200 mg/day: 29±18 ng/mL sertraline and 87±43 ng/mL norsertraline 6

Administration Considerations

• Administer once daily, either morning or evening 1
• Unlike some SSRIs, sertraline appears neither stimulating nor sedating, though slight alerting effects may occur 4
• No potentiation of alcohol effects has been documented 4

Common Pitfalls to Avoid

• Do not increase doses more frequently than weekly intervals - sertraline requires 7 days to reach steady state 1, 4
• Do not assume elderly patients need lower doses - this is a common misconception; standard adult dosing applies 1, 2
• Do not overlook the lower starting dose (25 mg) for anxiety disorders - panic disorder, PTSD, and social anxiety disorder require initial titration 1