The effect of zopiclone co-administration on sertraline initial dosage optimization in pediatric major depressive disorder patients based on model-informed precision dosing

Objective The present study aims to explore the initial dosage optimization of sertraline in pediatric major depressive disorder (MDD) patients based on model-informed precision dosing (MIPD). Methods A total of 111 pediatric MDD patients treated with sertraline were included for analysis using MIPD. Sertraline concentration levels, physiological and biochemical indexes of pediatric MDD patients, combined drug information were included in the construction of model. Results Weight and zopiclone co-administration influenced sertraline clearance in pediatric MDD patients. With the same weight, the sertraline clearance rates were 0.453:1 in patients with, or without zopiclone, respectively. Furthermore, without zopiclone, for once-daily sertraline scheme, the dosages of 4.0, and 3.0 mg/kg/day were suggested for pediatric MDD patients with body weight of 30–38.5, and 38.5–80 kg, respectively; for twice-daily sertraline scheme, the dosage of 2.0 mg/kg/day was suggested for pediatric MDD patients with body weight of 30–80 kg. With zopiclone, for once-daily sertraline scheme, the dosage of 1.0 mg/kg/day was suggested for pediatric MDD patients with body weight of 30–80 kg; for twice-daily sertraline scheme, the dosage of 0.5 mg/kg/day was suggested for pediatric MDD patients with body weight of 30–80 kg. Conclusion This study first explored the initial dosage optimization of sertraline in pediatric MDD patients based on MIPD, and recommended the optimal sertraline initial dosage in pediatric MDD patients based on zopiclone co-administration.