Took zoloft three hours late - worried

[Hivenburs]

I took my zoloft three hours late today (at 11am instead of 8 am).. I take it at 8 and at 4 usually.. Im concerned I will have a relapse of some sort now.. And was it ok to take it at 11 when I take more zoloft at 4?

[MyNameIsTerry]

Why do you take two doses per day? How much per dose do you take that way?

[Hivenburs]

125mg in the morning and 150mg at 4.. My doctor said it would evenly distribute the medication throughout the day...

[NoPoet]

The half life of this medication is somewhere in the region of a day, so you probably wouldn't experience withdrawal effects for a couple of days of missed doses. Citalopram has a similar half life and I had to miss doses for between 3-5 days before I started feeling it. Is your dose broken up through the day because your doctor wanted to reduce the impact of side effects?

[MyNameIsTerry]

The med is manufactured to distribute itself already and since its half life is 23-26 hours (32 hours for women) missing a dose is usually less of an issue. But your doctor is treating it like a very short half life med like Venlafaxine (in standard form) instead.

What will happen is that rather than be receiving a 275mg dose, you will get an overlap between the two doses that never makes it that high. But in the flipside it does mean that the levels in your blood plasma may not dip as low too. I would have to look at the distribution time to check that but this is my gut feel.

It's an interesting way of doing it. I've seen it once before with a different SSRI. Is this a psychiatrist or GP?

Missing a dose by a few hours will just mean the current levels dip a bit further. This is not a problem as if you were taking it once daily, this is a norm anyway and the same would occur if taking it late then. Pushing it back also means it is closer to the next dose which may cause a greater overlap but that's not an issue either if you are taking doses that are classed as safe in a 24 hour period. That is perhaps a question for the doctor given the specialised dosage you are on.

[Hivenburs]

Its a psychiatrist who prescribed it to me.. He said his idea was that he would spread it out throughout the whole day so it works all day and night for me.. Since I took the morning zoloft three hours late, could that mean that my overall zoloft levels will be lower for the next few days?

---------- Post added at 19:11 ---------- Previous post was at 19:10 ----------

Also he does the same spreading out method wuth tegretol.. Three times a day I take that

[MyNameIsTerry]

I'm glad it's a psychiatrist. I would be concerned if it were a GP but a psychiatrist has much more training & knowledge to devise something specialised like this.

Usually the max dose per day is 200mg BUT this will decline to 50% of it's total by it's half life. Your psychiatrist has taken a view to implement a lower overall dose but create a dosing schedule that aims to keep the levels in your blood plasma higher than normal because you basically "topping up" when it could be falling to a level below what you are topping up to.

In men there has been study of the peak plasma levels. From what I tell it shows as 4.5-8.4 hours from taking the dose. So, some overlap of the first tabs peak will be seen but not of the second since it takes that 4.5 hours potentially to reach peak again. This means that the total dose at the same time is highly unlikely to be 285mg but it does mean that the two peaks you would experience each day are a bit closer together. This means that the hours that follow up to the end of each half life from taking each tablet will overlap a bit more than normal but below the peak levels you would have earlier so does it matter that much? Probably not.

Also, by taking it late you would have seen a very slight further reduction of the tablet from the night before and the one earlier in the day. Basically, it's going to sort itself out very quickly and unless you have felt anything different, it's no big deal.

If it was absolutely vital to take them the same times per day, your psychiatrist would have warned you of this. With Venlafaxine, they would do since because of the standard preps very short half life you can go cold turkey in around 24 hours. That can't happen with your med as it takes about a weak to leave your system fully.