Switch medication from fluvoxamine to nortriptyline.
- 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 a maximum of 25 mg/day.
Caution is necessary.
- Day 1: simultaneously start administration of nortriptyline in a low dosage of 25 mg/day.
- Day 8: stop administration of fluvoxamine and continue administration of nortriptyline in a dosage of 50 mg/day.
- Fluvoxamine slows the metabolism of nortriptyline via CYP2D6.
- "Start low, go slow" is not required, but caution is necessary.
- This switch is currently being reviewed.
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