Switch medication from fluvoxamine to hypericum.
- Before day 1: gradually reduce dosage of fluvoxamine to a maximum of 50 mg/day, when this dosage is > 50 mg/day.
- Day 1: reduce dosage of fluvoxamine to 25 mg/day.
- Day 8: stop administration of fluvoxamine.
- Day 8-14: a wash-out period of one week is necessary.
- Day 15: start administration of hypericum in a dosage of 300 mg three times a day (900 mg/day).
- Occurrence of the serotonin syndrome is possible without wash-out period  .
- Hypericum induces enzymes of the CYP P-450 type and P-gp type.
- Hypericum might have MAO-inhibiting and/or COMT-inhibiting properties.
- Many studies reported that hypericin is the main source of pharmacological effects of hypericum. However the IC50 of hypericin to inhibit MAO A and MAO B is 100- to 1000-fold higher than accessible Cmax values of hypericin after oral administration of hypericum.
- The T1/2 of hypericum is 19 - 37 hour.
- This switch is currently being reviewed.
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