Maximum Dose of Zoloft (Sertraline)
Standard Adult Dosing
The maximum daily dose of sertraline for adults is 200 mg/day across all approved indications. 1, 2, 3
- The therapeutic range is 50-200 mg/day, with the starting dose of 50 mg/day being the usually effective therapeutic dose for most patients 1, 3
- Dose increases should be made in 50 mg/day increments at intervals of no less than one week, based on inadequate therapeutic response after 2-4 weeks at the current dose 1, 3
- Sertraline can be administered at any time of day (morning or evening) as a single daily dose 1, 3
Elderly Patients (≥60 Years)
No age-based dose reduction is required for elderly patients—the maximum dose remains 200 mg/day. 1, 4, 5
- Elderly patients can use the same dosing as younger adults (50-200 mg/day) without adjustment solely based on age 4, 5
- Sertraline plasma clearance is approximately 40% lower in elderly patients, and steady-state is achieved after 2-3 weeks rather than 1-2 weeks 2
- For elderly patients with Alzheimer's disease and depression, start at 25-50 mg per day, with a maximum of 200 mg per day 1
- Sertraline is preferred in elderly patients due to lack of anticholinergic effects and minimal cytochrome P450 interactions 1, 4, 5
Hepatic Impairment
In patients with hepatic disease, a reduced dose or less frequent dosing is recommended, though no specific maximum is defined. 1, 2
- Patients with chronic mild liver impairment (Child-Pugh 5-8) have approximately 3-fold greater sertraline exposure compared to those without hepatic impairment 2
- Start at lower doses (25 mg) and titrate more slowly in hepatic impairment 1
- The effects in moderate and severe hepatic impairment have not been studied 2
Adolescents (12 Years and Older)
The maximum dose for adolescents aged 13-17 years is 200 mg/day, starting at 50 mg/day. 2
- For children aged 6-12 years, start at 25 mg/day with a maximum of 200 mg/day 2
- Titrate in weekly increments of 25 mg/day (children) or 50 mg/day (adolescents) based on clinical response 2
- Pediatric patients metabolize sertraline with slightly greater efficiency than adults, but lower doses may be advisable given lower body weights 2
- Close monitoring of weight and growth is recommended if long-term treatment is continued in pediatric patients 2
Renal Impairment
No dose adjustment is needed for patients with renal impairment—maximum dose remains 200 mg/day. 1, 2
- Sertraline is extensively metabolized, and excretion of unchanged drug in urine is a minor route of elimination 2
Critical Safety Considerations
- At low doses, some patients may require twice-daily dosing due to sertraline's shorter half-life (22-36 hours) compared to other SSRIs 1, 6
- Never stop sertraline abruptly—taper gradually over a minimum of 2-4 weeks to avoid discontinuation syndrome (dizziness, fatigue, myalgias, headaches, nausea, insomnia, sensory disturbances) 1
- Sertraline is contraindicated with MAOIs due to risk of serotonin syndrome 1
- Monitor closely for suicidal thinking and behavior, especially in the first months of treatment and following dose adjustments, particularly in patients under 24 years of age 1, 2