Pharmacokinetics of acute sertraline overdose: an observational retrospective study

Background Sertraline, a selective serotonin reuptake inhibitor is commonly prescribed for adolescent patients with depression, either as monotherapy or in combination with other treatments. Therapeutic doses typically range from 50 to 300 mg/day, whereas overdose cases generally exceed 450 mg, as observed in this study. This study aimed to characterise the pharmacokinetic profiles of sertraline in acute overdose settings and evaluate the impact of gastric lavage on drug clearance. Methods This observational case retrospective study analysed the clinical manifestations, severity, treatment interventions, and outcomes of sertraline overdose cases. Results The dataset comprised 16 cases of sertraline overdose. Gastric lavage was administered between 0.67 h and 12 h post-ingestion, with blood sampling commencing after lavage completion. The median ingested dose was 925 mg (range: 450–1,400 mg). Apparent elimination half-lives, estimated from two-point concentration measurements obtained 1–22 h and 27–146 h post-ingestion, ranged from 13.27 to 52.78 h (median: 24.12 h). These estimates represent post-decontamination kinetics and may not reflect true elimination half-lives due to unknown peak concentration timing. No life-threatening toxicity or severe organ dysfunction was observed. Conclusion This study characterized post-gastric lavage sertraline concentrations in 16 adolescent intentional overdose cases. Apparent half-life estimates overlapped with therapeutic ranges, but methodological constraints, including unknown Tmax and two-point sampling, preclude definitive conclusions regarding overdose pharmacokinetics. Gastric lavage appeared well-tolerated and may reduce drug exposure, though its impact on clinical outcomes requires further study. These preliminary observations require validation in prospective studies with serial sampling.