Switch medication from amitriptyline to fluvoxamine.
- Before day 1: gradually reduce dosage of amitriptyline to a maximum of 50 mg/day.
- Day 1: reduce dosage of amitriptyline to 25 mg/day.
- Day 8: stop dosage of amitriptyline.
- Day 8: start administration of fluvoxamine in a normal dosage of 50 mg/day.
- Day 15: increase dosage of fluvoxamine.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
- Fluvoxamine is an inhibitor of CYP1A2, CYP2C19 and CYP3A4 (moderate), which metabolize amitriptyline.
- This switch is currently being reviewed.
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