taking, titrating, and tapering Zoloft (sertraline)
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I Forgot Why I Cake Topamax
Taking & Titration Overview
One of the most important aspects of any medication is how to go about taking it. This includes:
- how much to take (the dosage or dose)
- when and how often to take it (dosing schedule or doses)
- how much to start with and how to increase the dose/dosage until you’re taking the target amount (titration or titration schedule).
Although we often disagree with them, we’ll always give you the manufacturer’s recommendations from Zoloft’s full US Prescribing Information. If, for some reason, that isn’t available, we’ll use information for patients leaflets, SPCs from overseas, or whatever official sources we can find. Most doctors will give you some idea of what it will be like, and this is what every pharmacist is trained and paid to tell you.1 As “often” doesn’t mean “always”, whatever is in the PI sheet works for us a lot of the time.
We usually advocate starting at a lower dosage than recommended. One of our core philosophies is increasing the dosages as slowly as one’s condition allows, and staying at the dosage that works instead of a target dosage2. More and more doctors are agreeing with us3. You and your doctor can always discuss increasing the dosage when you need to in advance.
And since you never really know how a drug might affect you, it’s best to start when you have some time off of work. Like Friday night / Saturday morning, or your equivalent. Better still would be to get someone to stay with you or at least check on you frequently, especially if you’re the primary caretaker of young children and similar critters.4
Zoloft (sertraline) Dosage and Doses
- Typically it’s one 25, 50, or 100mg tablet once a day, usually in the morning. Larger tablets are often split in half to save money.
- The Crazymeds’ suggestion: However many whole and half tablets of any size it takes to get the dosage that works for you, anywhere a range of 12.5 to 100mg a day, in increments of 12.5mg. So that’s 12.5, 25, 37.5 and so forth.
- Zoloft is rated safe up to 200mg a day, and many people take dosages above 100mg a day. The are probably ultra-rapid metabolizers.
Special Instructions/Best Way to Take Zoloft (sertraline)
- Unless you find it makes you sleepy, take Zoloft in the morning. Zoloft tends to wake people up.
- Taking it with food would probably help with any gastro-intestinal problems you might have.
- However, taking Zoloft with food slightly alters its pharmacokinetics. Not enough to affect how much you need to take, but possibly enough to affect how it makes you feel a few hours after you take it, so taking it before or with breakfast might make a difference.
- Just don’t mess around too much with when you take it. Like almost all SSRIs Zoloft has a half-life in the neighborhood of 24 hours, so taking it at the same time each day, give or take an hour, will make your life a lot easier.
- If you’re Chinese you can probably get away with taking no more than 25mg a day. At least that’s what they found in this single, small study. And while that is a frequent occurrence with crazy meds, don’t base your insurance plan selection on your ethnicity.
- The oral concentrate has some interesting instructions:
ZOLOFT Oral Concentrate contains 20 mg/mL of sertraline (as the hydrochloride) as the active ingredient and 12% alcohol. ZOLOFT Oral Concentrate must be diluted before use. Just before taking, use the dropper provided to remove the required amount of ZOLOFT Oral Concentrate and mix with 4 oz (1/2 cup) of water, ginger ale, lemon/lime soda, lemonade or orange juice ONLY. Do not mix ZOLOFT Oral Concentrate with anything other than the liquids listed. The dose should be taken immediately after mixing. Do not mix in advance. At times, a slight haze may appear after mixing; this is normal.--the Zoloft PI sheet
- Why only ginger ale, lemonade, OJ, and what I guess is 7-Up or Sprite (or generic equivalents)?5 Did the R&D guys grow up drinking Gin Bucks or something? Furthermore…
Note that caution should be exercised for patients with latex sensitivity, as the dropper dispenser contains dry natural rubber.--ibid
- OK, that’s easy enough to deal with. At least they warn you. Back to making mixed drinks with Zoloft…
ZOLOFT Oral Concentrate is contraindicated with ANTABUSE (disulfiram) due to the alcohol content of the concentrate.--ibid
- There’s nothing in the literature about it, but I’ve read a few reports and seen it myself, Zoloft makes some people drunker faster. So it seems extra weird to even supply Zoloft in a liquid form if it needs a solution with 12% alcohol to keep the sertraline stable.
Zoloft (sertraline) Titration (Dosage Increase)
Panic Disorder, Posttraumatic Stress Disorder and Social Anxiety Disorder (PTSD)–ZOLOFT 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 MDD, OCD, panic disorder, PTSD or social anxiety disorder, patients were dosed in a range of 50–200 mg/day in the clinical trials demonstrating the effectiveness of ZOLOFT 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. Given the 24 hour elimination half-life of ZOLOFT, dose changes should not occur at intervals of less than 1 week.--the Zoloft PI sheet
Everybody starts at 12.5–25mg and waits at least two weeks, if you can, before increasing by 12.5–25mg a day. And increase the dosage only if you need to.
Premenstrual Dysphoric Disorder (PMDD)–ZOLOFT treatment should be initiated with a dose of 50 mg/day, either daily throughout the menstrual cycle or limited to the luteal phase of the menstrual cycle, depending on physician assessment.
While a relationship between dose and effect has not been established for PMDD, patients were dosed in the range of 50–150 mg/day with dose increases at the onset of each new menstrual cycle. Patients not responding to a 50 mg/day dose may benefit from dose increases (at 50 mg increments/menstrual cycle) up to 150 mg/day when dosing daily throughout the menstrual cycle, or 100 mg/day when dosing during the luteal phase of the menstrual cycle. If a 100 mg/day dose has been established with luteal phase dosing, a 50 mg/day titration step for three days should be utilized at the beginning of each luteal phase dosing period.--ibid
Sure, why not. I have no freaking idea. Girls’ plumbing is complicated. Maybe starting at 25mg like everyone else will work. Try to find an OB/GYN who knows about psych meds or a head doctor who treats PMDD on a regular basis.
Pile of Pills
Vaccines Cause Immunity
Medicated For Your Protection
One thing PI sheets and doctors infrequently discuss, and don’t go into enough detail about, is how to discontinue a medication. With some meds it’s not too bad, but with others (most notably SNRIs like Effexor and Cymbalta) it can be a nightmare if not done carefully.
How to Stop Taking Zoloft (sertraline)
The usual way with SSRIs. Reduce your dosage by 12.5–25mg each week. If the discontinuation syndrome is too harsh you have two options, getting a prescription for the oral concentrate and reducing your dosage by whatever you can tolerate, or getting a prescription for 10mg fluoxetine capsules and take 20–30mg a day (if you’re at 25mg of Zoloft) for two weeks and lowering your dosage by 10mg a day each week.
Notes, Tips, Helpful Hints, etc. for Withdrawing Zoloft (sertraline)
As with every other SSRI/SNRI, if a really slow taper isn’t working for you, beg your doctor for liquid Prozac. It tastes like mint-flavored mouthwash / cheap schnapps and lets you control the dosage to the milliliter.
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- Zoloft full US Prescribing Information
- Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.
Don’t worry about actually buying one. Windows shop and share the designs you’d like to buy or find worthy of ridicule. What else are you doing now? Working? Sure you are.
1 And everyone has the time to do their jobs properly, when said time isn't being wasted by idiots asking for grocery store phone numbers** or they aren't playing Angry Farmers on the Faecesbooks.
2 Although not everyone has the luxury of stopping at a dosage when the symptoms abate and not increasing it unless the return. Sometimes you just have to keep going up until you reach that target dosage. E.g. you have a history of seizures that haven't yet responded to several medications.
3 Most notably Dr. Edward Faught, founder and Director of the Epilepsy Center, and vice chairman of the Department of Neurology, at the University of Alabama School of Medicine in Birmingham. His article on new antiepileptic drugs in Volume 7 issue 1 of Peer Review in Review stressed starting at low dosages, doing a slow titration, and stopping at the dosage where symptoms were under control. In Topiramate in the treatment of partial and generalized epilepsy, the one free, full-text article I could find (that's not about geriatric patients), he again stresses the low and slow approach to avoid or lessen most side effects, while still achieving seizure control in the same amount of time.
4 Assuming you have the luxury of a job, being able to cope with your symptoms not being dealt with for however many days you need to wait in order to do this, and/or someone who can and is willing to stay with you for a few days. Read enough of this site and you can tell what sort of fantasy world I live in.
5 Because there aren't many exclusively lemon sodas or exclusively lime sodas on the US market.
If you have any questions not answered here, please see the Crazymeds Zoloft discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.us)
|Last modified on Saturday, 12 July, 2014 at 18:04:50 by JerodPoore||Page Author Jerod Poore||Date created|
|“Zoloft (sertraline): a Synopsis for the Educated Consumer.” by Jerod Poore is copyright © Jerod Poore||Published online 2011/04/06|
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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas? I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion of anonymity. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.