What are the potential consequences of an accidental double dose (100 mg) of sertraline (Zoloft) in a healthy adult?

Accidental Double Dose of Sertraline (100mg): What to Expect

An accidental double dose of sertraline (100mg total instead of 50mg) is unlikely to cause serious harm in a healthy adult, though you may experience increased side effects that are typically mild and self-limiting. 1

Expected Outcomes

Most Likely Scenario

• You will probably experience no symptoms or only mild side effects that resolve within 24-48 hours 2
• In a prospective study of sertraline overdoses, 10 out of 17 patients who took sertraline alone (at much higher doses than 100mg) had no symptoms at all 2
• The therapeutic dose range for sertraline extends from 25mg to 200mg daily, so 100mg falls within the normal treatment range 3

Possible Side Effects to Monitor

If symptoms do occur, watch for these common manifestations (listed in order of likelihood):

Mild symptoms (most common in overdose situations):

• Tremor 2
• Lethargy or drowsiness 3, 2
• Nausea 3, 2
• Dizziness 3
• Agitation or restlessness 3, 2
• Vomiting 2
• Headache 3

Less common but possible:

• Tachycardia (rapid heart rate) 1
• Confusion 2
• Dry mouth 3, 2

What You Should Do

Immediate Actions

• Do not panic - the safety margin for sertraline is favorable compared to older antidepressants 3, 4
• Do not induce vomiting 1
• Stay hydrated and rest 5
• Rise slowly from sitting or lying positions to minimize dizziness 5

When to Seek Medical Attention

Call your doctor or poison control if you experience:

• Severe agitation or confusion 1
• Rapid or irregular heartbeat 1
• Seizures 1
• Severe tremors or muscle rigidity 3
• Mental status changes beyond mild drowsiness 3

Seek emergency care immediately if you develop signs of serotonin syndrome (rare but serious):

• High fever with confusion 3
• Severe muscle rigidity 3
• Severe agitation with tremors and rapid heart rate 3
• Unconsciousness 3

Important Context

Why This Is Generally Safe

• Sertraline has a 32-hour elimination half-life, meaning it takes over a day for half the drug to leave your system 6, 7
• The largest documented survival from sertraline overdose was 13.5 grams (135 times your 100mg dose) 1
• In overdose studies, patients who took sertraline alone had no significant morbidity 2
• Mean length of ED stay for overdose patients was only 3.9 hours, indicating mild clinical course 2

Critical Caveat

Do not take this as permission to double dose intentionally. While a single accidental double dose is unlikely to cause harm, repeated higher doses increase the risk of:

• Behavioral activation/agitation 3
• Serotonin syndrome (especially if taking other serotonergic medications) 3
• Seizures 3

Next Steps

• Resume your normal 50mg dose tomorrow - do not skip the next dose to "make up" for the double dose 3
• Contact your prescribing physician to report the incident, especially if you experienced any symptoms 3
• Consider using a pill organizer to prevent future dosing errors