Sertraline dosage

Ng, C.H., Norman, T. R., Ho, B. et al. (2006a). A comparison study of sertraline dosages, plasma levels, efficacy and adverse reactions in Chinese versus Caucasian populations. Int. 

Stevens-Johnson syndrome has been reported in a 96-year-old woman who had taken sertraline (dosage not stated) for 3 weeks (12). The lesions involved the skin, oral mucosa, and conjunctiva. The eruption disappeared within 7 days of sertraline withdrawal. 

An isolated report descrihes a woman with schizoaflective disorder successfully treated for 3 years with haloperidol and carhamazepine who was given sertraline 50 mg daily for depression. When she failed to respond, the sertraline dosage was progressively increased to 300 mg daily but her sertraline plasma levels remained low (about 17 to 25% of those predicted). Another patient on carbamazepine similarly failed to respond to the addition of sertraline and had low sertraline levels. In an analysis of plasma sertraline levels the concentration to daily dose ratio of sertraline was significantly lower in patients who had taken sertraline with carbamazepine compared with those who had taken sertraline without carbamazepine, suggesting that carbamazepine lowered sertraline levels. 

The clearance of sertindole is increased by tobacco smoking (probably because of the induction of cytochrome P450 isoenzymes) but no sertraline dosage alteration is thought necessary. ... 

A recent study compared the differences in dosage and steady state plasma concentrations of sertraline, in Chinese versus Caucasian depressed outpatients. 

Chinese depressed patients appeared to require lower dosages, with consequently lower plasma concentrations of sertraline compared to Caucasian patients to achieve clinical efficacy (Ng et al, 2006). Again, this finding has supported the fact that Asian patients, especially Chinese, need lower doses of antidepressant drugs than their Western counterparts. 

Reduce the initial dosage of paroxetine in patients with severe renal impairment. Use sertraline and escitalopram with caution in patients with severe renal impairment. 

In general, the SSRIs have a more tolerable side effect profile than the tricyclic antidepressants with their anticholinergic effects. Review of the rate that subjects in the controlled studies discontinued a SSRI because of adverse effects provides some perspective on how well tolerated the medications are, although the specifics may vary according to dosage and design (e.g., forced titration) and are not directly comparable. The rate of discontinuation was reported to be 12% (4/48) for fluoxetine (Emslie et ah, 1997), 9.7% for paroxetine (Keller et ah, 2001), 13% (12/92) for sertraline (March et ah, 1998), and 33% (19/57) (Riddle et ah, 2001) and 7.9% (5/63) for fluvoxamine (Walkup et ah, 2001). 

Sertraline is manufactured by Pfizer under the name Zoloft, in three dosages 25,50, and 100 mg. Zoloft is prescribed for depression, obsessive-compulsive disorder, panic disorder, social anxiety disorder, and post-traumatic stress disorder. Sertraline is also used to treat obsessive-compulsive disorder in children. 

Greist J, Chouinard G, DuBoff E, et al. Double-blind parallel comparison of three dosages of sertraline and placebo in outpatients with obsessive-compulsive disorder. Arch Gen Psychiatry 1995 52 289-295. 

Both fluvoxamine and sertraline are approved for the treatment of OCD in children and adolescents. Fluvoxamine was proven effective in a 10-week, double-blind, placebo-controlled trial in patients 8 to 17 years of age with OCD ( 149). Dosages in this study were adjusted to a total daily fluvoxamine dose of approximately 100 mg per day over the first 2 weeks using a balanced, twice-daily dosing schedule. After that, the dose was adjusted within a range of 50 to 200 mg per day based on clinical assessment of efficacy and tolerability. Fluvoxamine was superior to placebo on the Children s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) at weeks 1 to 6 and week 10. However, the effect was mainly in the 8- to 11-year-old versus the 12- to 17-year-old age group. The significance of this age difference is not known. 

Sertraline hydrochloride has an average half-life of about 26 hours, and mean peak plasma concentrations occur at 4.5-8.4 hours. The dosage is 50-200 mg/day orally. Its major metabolite, /V-desmethylsertraline, is less active than sertraline. Adverse effects are as for the SSRIs in general. 

The dosage of sertraline used in this case was high and the combined use of dexamfetamine may also have been relevant. 

Childhood depression occurs commonly and can present with nonspecific symptoms. The dosage range, titration, and adverse effects of fluoxetine, imipramine, and sertraline are similar in children and adults. 

Recommended initial doses and dosage ranges are shown in Table 67-3. The usual initial adult dose of most TCAs is 50 mg at bedtime, and the dose may be increased by 25 to 50 mg every third day. The recommended initial dose for the SSRIs is fluoxetine, 10 to 20 mg paroxetine, 20 mg sertraline, 50 mg citalopram, 20 mg and esci-talopram 10 mg. 

Dosing and Administration. SSRIs should be initiated at doses similar to those used for the treatment of depression and administered as a single daily dose with or without food (except for fluvoxamine). If the patient suffers from comorbid panic disorder, the SSRI dose should be started at one-fourth or one-half of the normal antidepressant dose. Patients should receive the starting dose for 2 to 4 weeks before it is increased slowly (i.e., paroxetine 10 mg/day and sertraline 50 mg/day) in weekly intervals as necessary to obtain a response. Safety for paroxetine in SAD was demonstrated in doses up to 60 mg/day, but additional therapeutic benefits above 20 mg/day were not shown. The maximum dosage of sertraline used in patients with SAD was 200 mg/day. ... 

The starting dose for fluvoxamine is 50 mg/day, which is then increased as tolerated and needed up to 300 mg/day divided into twice-daily doses. If citalopram is used, the initial dose is 20 mg/day, and it may be increased to 40 mg/day after 2 weeks. The starting dose for escitalopram is 10 mg/day, and it can be increased to a maximum of 20 mg/day. The dosage should be tapered slowly (i.e., decreasing sertraline by 50 mg/month or paroxetine by 10 mg/month) to decrease... 

The initial dose of sertraline is 25 mg given once daily, with an increase to 50 mg/day after 1 week. The dose can be increased in weekly intervals by 50 mg/day up to a maximum dosage of... 

Clomipramine, fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram are extensively metabolized in the Liver, and patients with significant liver disease should be prescribed these drugs cautiously and in lower doses than those used in healthy subjects. The pharmacokinetics of fluoxetine and fluvoxamine were similar in patients with renal faUme and in healthy subjects however, the manufacturer recommends starting with a lower dose in patients with renal impairment. The pharmacokinetics of sertraline are not altered in patients with significant renal dysfunction, and dosage adjustment is not necessary in these patients. Increased plasma concentrations of paroxetine occur in subjects with renal impairment. The initial dose of paroxetine should be reduced in patients with severe renal impairment, and upward titration should occm more slowly. No dosage adjustment is necessary for patients with mild to moderate renal impairment receiving citalopram. 

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