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SSRI Antidepressant Pregnancy: C

Sertraline (Elderly)

Brand names: Lustral, Zoloft

Adult dose

Dose: 50 mg once daily initially; increase to 100–200 mg if needed after 4 weeks
Route: oral
Frequency: once daily
Max: 200 mg/day
Preferred SSRI in elderly due to minimal drug interactions (low CYP450 inhibition), low anticholinergic burden, and good safety profile; take morning or evening

Paediatric dose

Route: oral
Frequency: once daily
Max: 200 mg/day
Concentration: 50 mg/mL oral solution mg/ml
OCD ≥6 years: 25 mg/day initially, titrate to max 200 mg; depression ≥12 years: 50 mg/day

Dose adjustments

Renal

No dose adjustment required

Hepatic

Reduce dose in hepatic impairment — use lower doses and monitor

Clinical pearls

  • Preferred SSRI in elderly for depression — minimal CYP2D6 inhibition vs. fluoxetine/paroxetine
  • Hyponatraemia risk: check sodium 2–4 weeks after starting in elderly, especially in those on diuretics
  • PROSPECT trial: effective and well-tolerated in elderly depressed patients with cardiovascular disease

Contraindications

  • Concurrent MAOIs (serotonin syndrome — washout 14 days)
  • Pimozide (serotonin syndrome/QT prolongation)

Side effects

  • Nausea (reduce with food)
  • Diarrhoea
  • Insomnia
  • Sexual dysfunction
  • Hyponatraemia (SIADH — monitor in elderly)
  • GI bleeding (with NSAIDs)
  • Falls risk

Interactions

  • MAOIs (absolute CI — 14-day washout)
  • Pimozide (CI)
  • Warfarin (increased INR)
  • NSAIDs (GI bleeding)
  • Anticoagulants (bleeding)
  • QT-prolonging drugs

Monitoring

  • Sodium (2–4 weeks after starting)
  • Mood assessment
  • Suicidal ideation (especially <25 years, first 4 weeks)
  • Weight

Reference: BNFc; BNF 86; NICE NG222; PROSPECT trial. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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