Switch medication from bupropion to clomipramine.
- Before day 1: gradually reduce dosage of bupropion to a maximum of 300 mg/day, when this dosage is > 300 mg/day.
- Day 1: reduce dosage of bupropion to 150 mg/day.
- Day 8: stop administration of bupropion.
- Day 2: Start with normal dosage and increase with about 25% (up to 50%) every 3 days to target dose.
- Start administration of clomipramine in a low dosage of 25-50 mg/day.
- Bupropion slows the metabolism of clomipramine via CYP2D6.
- Caution is necessary at the start of administration of clomipramine.
- 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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