What are the doses of Sertraline (Selective Serotonin Reuptake Inhibitor - SSRI)?

From the Guidelines

Sertraline dosing for premature ejaculation should start at 25-50 mg/day, with the option to increase up to 200 mg/day if needed, or 50 mg 4-8 hours before intercourse for situational dosing, as this range has been shown to increase ejaculatory latency with acceptable side effects 1. When considering sertraline for the treatment of premature ejaculation, it's essential to weigh the benefits against potential side effects, which can include nausea, dry mouth, drowsiness, and reduced libido, similar to its use in depression but potentially at lower frequencies due to lower doses used for PE 1. Key points to consider in sertraline dosing include:

• Starting dose: 25-50 mg/day for daily dosing or 50 mg for situational dosing 4-8 hours before intercourse.
• Maximum dose: Up to 200 mg/day for daily dosing, with higher doses potentially increasing efficacy but also possibly side effects like erectile dysfunction and decreased libido.
• Administration: Can be taken with or without food, and patients should be advised to take it at the same time each day for consistency.
• Duration of therapy: Likely needed on a continuing basis, as premature ejaculation tends to return upon discontinuation of the medication 1.
• Side effects: Generally similar to those seen in depression treatment, including gastrointestinal issues, sexual dysfunction, and sleep disturbances, but may be less frequent at the lower doses used for premature ejaculation 1. Given the information from the most recent and highest quality study available 1, the recommended dosing strategy for sertraline in the treatment of premature ejaculation prioritizes both efficacy and the minimization of side effects, aiming to improve patient quality of life by addressing the condition effectively while considering potential impacts on morbidity and mortality associated with untreated premature ejaculation or excessive medication side effects.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Initial Treatment Dosage for Adults Major Depressive Disorder and Obsessive-Compulsive Disorder Sertraline treatment should be administered at a dose of 50 mg once daily. Panic Disorder, Posttraumatic Stress Disorder and Social Anxiety Disorder Sertraline treatment should be initiated with a dose of 25 mg once daily After one week, the dose should be increased to 50 mg once daily. While a relationship between dose and effect has not been established for major depressive disorder, OCD, panic disorder, PTSD or social anxiety disorder, patients were dosed in a range of 50 to 200 mg/day in the clinical trials demonstrating the effectiveness of sertraline for the treatment of these indications Consequently, a dose of 50 mg, administered once daily, is recommended as the initial therapeutic dose. Patients not responding to a 50 mg dose may benefit from dose increases up to a maximum of 200 mg/day.

The recommended initial dose of sertraline is:

• 50 mg once daily for Major Depressive Disorder and Obsessive-Compulsive Disorder
• 25 mg once daily for Panic Disorder, Posttraumatic Stress Disorder, and Social Anxiety Disorder, increased to 50 mg once daily after one week The maximum dose is 200 mg/day. 2

From the Research

Sertraline Doses

• The starting dose of sertraline is 50 mg/day, which is the usually effective therapeutic dose and the optimal dose when considering both efficacy and tolerability for most patients 3.
• For patients who do not show an adequate therapeutic response within 24 weeks, the dose of sertraline can be increased in 50 mg/day increments at no less than weekly intervals to a maximum of 200 mg/day 3.
• Sertraline is generally given as a single daily dose and may be administered at any time of the day 3.
• In contrast to other selective serotonin reuptake inhibitors, there is no need for altered dose recommendations in the elderly 3.

Dose-Response Relationship

• The dose-efficacy curve for SSRIs, including sertraline, shows a gradual increase up to doses between 20 mg and 40 mg fluoxetine equivalents, and a flat to decreasing trend through the higher licensed doses up to 80 mg fluoxetine equivalents 4.
• Dropouts due to adverse effects increase steeply through the examined range, indicating optimal acceptability for SSRIs in the lower licensed range between 20 mg and 40 mg fluoxetine equivalents 4.

Clinical Applications

• Sertraline has been shown to be effective in the treatment of depression, anxiety disorders, eating disorders, premenstrual dysphoric disorder (PMDD), and possibly substance abuse treatment 5, 6, 7.
• Sertraline offers several advantages over older antidepressants, including improved patient tolerability, low risk of lethality in overdose, and no dependence potential 5.