Sertraline Titration in Elderly Patients

Introduction to Sertraline Titration

The American Academy of Family Physicians recommends starting sertraline at 25-50mg daily in elderly patients, as this is the recommended starting range for this population 1
The Journal of the American Geriatrics Society suggests increasing sertraline by 25-50mg increments at intervals of at least 1 week to allow adequate observation for adverse effects and therapeutic response 2

The American College of Cardiology notes that sertraline increases bleeding risk when combined with anticoagulants like apixaban, and recommends monitoring for signs of bleeding, such as bruising, petechiae, melena, hematuria, epistaxis, or any unexplained bleeding 3
The American Academy of Family Physicians recommends checking blood pressure (supine and standing) to assess for orthostatic hypotension, which is more common in elderly patients on multiple psychotropic medications 1, 2

The American Academy of Family Physicians reports that common side effects in elderly patients receiving sertraline 50-150mg/day include dry mouth, headache, diarrhea, and nausea, as well as insomnia or somnolence, dizziness, and sweating 1

The American Academy of Family Physicians recommends a practical approach to titration, starting with 25mg daily (or 50mg if the patient is robust and not frail), and increasing by 25-50mg every 1-2 weeks as needed and tolerated 1