Sertraline

Source: UK SPC (eMC) for Lustral 100mg film coated tablets, §4.2 (https://www.medicines.org.uk/emc/product/2835/smpc). INITIAL TREATMENT — Depression and OCD: sertraline treatment should be started at a dose of 50 mg/day. Panic disorder, PTSD and social anxiety disorder: therapy should be initiated at 25 mg/day; after one week the dose should be increased to 50 mg once daily (this regimen has been shown to reduce the frequency of early treatment-emergent side effects characteristic of panic disorder). TITRATION (all of depression, OCD, panic disorder, social anxiety disorder and PTSD): patients not responding to a 50 mg dose may benefit from dose increases; dose changes should be made in steps of 50 mg at intervals of at least one week, up to a maximum of 200 mg/day. Changes in dose should not be made more frequently than once per week given the 24-hour elimination half-life. Onset of therapeutic effect may be seen within 7 days, but longer periods are usually necessary, especially in OCD. MAINTENANCE: dosage during long-term therapy should be kept at the lowest effective level. Patients with depression should be treated for a sufficient period of at least 6 months to ensure they are free from symptoms; in prevention of recurrence of major depressive episodes the recommended dose is in most cases the same as that used during the current episode. Continued treatment in panic disorder and OCD should be evaluated regularly, as relapse prevention has not been shown for these disorders. ELDERLY: should be dosed carefully, as elderly may be more at risk for hyponatraemia. HEPATIC IMPAIRMENT: use should be approached with caution; a lower or less frequent dose should be used; sertraline should not be used in cases of severe hepatic impairment as no clinical data are available. PAEDIATRIC (fixed mg doses, not per-kg, so not expressed as a structured paedDose): children and adolescents with obsessive compulsive disorder — age 13-17 years initially 50 mg once daily; age 6-12 years initially 25 mg once daily, which may be increased to 50 mg once daily after one week; subsequent doses may be increased in 50 mg increments over a period of some weeks as needed, maximum dosage 200 mg daily, with dose changes not occurring at intervals of less than one week. The generally lower body weights of children compared to adults should be taken into consideration when increasing the dose from 50 mg. Efficacy is not shown in paediatric major depressive disorder, and no data is available for children under 6 years of age. Verify any under-18 use against a children's formulary. WITHDRAWAL: abrupt discontinuation should be avoided; when stopping treatment the dose should be gradually reduced over a period of at least one to two weeks to reduce the risk of withdrawal reactions; if intolerable symptoms occur following a decrease in dose or upon discontinuation, resuming the previously prescribed dose may be considered, then decreasing at a more gradual rate. Note: §4.5 was not retrieved in this bundle — the interactions listed below come from §4.3 of the UK SPC and from the US label; verify the full §4.5.