Table 1. Adult selective serotonin reuptake inhibitor dosing guidelines for obsessive-compulsive disorder.

Serotonin reuptake inhibitor	Startinga	Usual target	Usual maximum	Occasionalb
Clomipramine	25	100-250	250	_c
Escitalopram	10	20	40	60
Fluoxetine	20	40-60	80	120
Fluvoxamine	50	200	300	450
Paroxetine	20	40-60	60	100
Sertralined	50	200	200	400

Doses are presented as number of milligrams per day.

^aSome patients may need to start at half this dose or less to minimize undesired side effects such as nausea or to accommodate anxiety about taking medications.

^bThese doses are sometimes used for rapid metabolizers or for patients with no or mild side effects and inadequate therapeutic response after 8 weeks or more at the usual maximum dose.

^cCombined plasma levels of clomipramine plus desmethylclomipramine 12 hours after the dose should be kept below 500 ng/mL to minimize risk of seizures and cardiac conduction delay.

^dSertraline, alone among the selective serotonin reuptake inhibitors, is better absorbed with food.