Switch medication from amitriptyline to bupropion.
- Before day 1: if the dosage of this tricyclic antidepressant (TCA) is > 100 mg/day, gradually reduce by 50 mg per 3-4 days to a maximum of 100 mg/ day.
- Day 1-3: administer 75 mg/day.
- Day 4-6: administer 50 mg/day.
- Day 7-9: administer 25 mg/day.
- Day 10: stop administration.
- Day 7: start administration of bupropion in a dosage of 150 mg/day.
- Bupropion is a strong inhibitor of CYP2D6, which metabolizes amitriptyline.
- The interaction by CYP2D6-inhibition is not relevant because of low dosages during the switch.
- The concomitant use of bupropion and tricyclic antidepressants (TCAs) may potentiate the risk of seizures. These agents are all epileptogenic and may have additive effects on the seizure threshold.
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