What are the proper dosage and administration instructions for a patient starting Zoloft (sertraline)?

Zoloft (Sertraline) Dosing and Administration

For adults starting Zoloft, begin with 50 mg once daily for major depressive disorder and obsessive-compulsive disorder, or 25 mg once daily for panic disorder, PTSD, and social anxiety disorder (increasing to 50 mg after one week). 1

Initial Dosing by Indication

Major Depressive Disorder and OCD

• Start at 50 mg once daily 1
• This starting dose is the optimal therapeutic dose for most patients when considering both efficacy and tolerability 2
• May be taken in the morning or evening 1

Panic Disorder, PTSD, and Social Anxiety Disorder

• Start at 25 mg once daily for the first week 1
• Increase to 50 mg once daily after one week 1
• This lower starting dose helps minimize initial side effects in these anxiety-related conditions 1

Premenstrual Dysphoric Disorder (PMDD)

• Start at 50 mg daily 1
• Can be dosed either continuously throughout the menstrual cycle or limited to the luteal phase 1
• If using luteal phase dosing and established at 100 mg/day, use a 50 mg/day titration step for 3 days at the beginning of each luteal phase period 1

Pediatric Dosing (Ages 6-17, OCD Only)

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

Dose Titration and Maximum Doses

When to Increase Dose

• Wait at least 1 week between dose changes due to sertraline's 24-hour elimination half-life 1
• Patients not responding to 50 mg may benefit from dose increases 1
• Increase in 50 mg increments 1

Maximum Doses

• Adults: 200 mg/day maximum for depression, OCD, panic disorder, PTSD, and social anxiety disorder 1
• PMDD: 150 mg/day maximum when dosing daily throughout cycle, or 100 mg/day when dosing during luteal phase only 1
• Pediatric patients: 200 mg/day maximum 1

Maintenance Treatment

• Continue for several months or longer after achieving response in major depressive disorder 1
• Sertraline maintains antidepressant efficacy for up to 44 weeks following initial 8-week treatment 1
• Periodically reassess patients to determine ongoing need for maintenance treatment 1

Administration Details

• Once-daily dosing is appropriate due to the 22-36 hour elimination half-life 3
• Can be taken morning or evening - timing does not affect efficacy 1
• No food restrictions - may be taken with or without food 1

Common Pitfalls to Avoid

• Do not increase doses more frequently than weekly intervals - steady-state concentrations require time to establish given the 24-hour half-life 1
• Do not start at higher than recommended doses - 50 mg is as effective as higher doses with fewer side effects and discontinuations 4
• Do not abruptly discontinue - taper gradually over 10-14 days minimum to avoid withdrawal symptoms including irritability, dizziness, sensory disturbances, and anxiety 5
• In elderly patients, no dose adjustment is typically needed unlike some other SSRIs, though caution is warranted 2

Expected Side Effects

• Most common: Gastrointestinal effects (nausea, diarrhea/loose stools) - usually mild and transient 6, 7
• Male sexual dysfunction (primarily ejaculatory disturbance) - typically decreases with continued treatment 6
• Side effects increase with higher doses but remain generally well-tolerated 4