Switch medication from fluoxetine to doxepin.
- Gradually reduce dosage of fluoxetine to a maximum of 20 mg/ day, when this dosage is > 20 mg/day.
- When a dosage of 20 mg/day is reached, stop administration.
Caution is necessary for at least four weeks.
- Day 1: start administration of doxepin in a low dosage of 25 mg/day.
- Day 14: increase dosage of doxepin to 50 mg/day.
- Day 28: increase dosage of doxepin to 75 mg/day.
- Fluoxetine and norfluoxetine slow the metabolism of doxepin via CYP2D6.
- Norfluoxetine has a halflife of at least 1 week: it takes therefore 1 month for elemination.
- Start low, go slow for doxepin.
- This switch is currently being reviewed.
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