Switch medication from doxepin to bupropion.
- Before day 1: gradually reduce dosage of doxepin to a maximum of 100 mg/ day, when this dosage is > 100 mg/day.
- Day 1-3: reduce dosage of doxepin to 50 mg/day.
- Day 4-7: reduce dosage of doxepin to 25 mg/day.
- Day 4: simultaneously start administration of bupropion in a dosage of 150 mg/day and continue administration of doxepin according to the scheme above.
- Day 8: stop administration of doxepin and continue administration of bupropion.
- Day 15: if necessary increase bupropion.
- Bupropion is a strong inhibitor of CYP2D6, which metabolizes doxepin.
- 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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