Switch medication from fluoxetine to escitalopram.[1]
[2]
Stop fluoxetine
- Before day 1: reduce dosage of fluoxetine with about 20 mg per week.
- Day 1: when a dosage of 20 mg/day is reached, stop fluoxetine.
Start escitalopram
- No wash-out period is needed.
- Day 2: start escitalopram the next day in low dosage of 5 mg/day.
- Day 15 increase dosage of escitalopram to normal, i.e. 10 mg/day.
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- Fluoxetine has a very long elimination time; phasing out fluoxetine is therefore not necessary.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
- Fluoxetine inhibits CYP2C19, CYP2D6 and CYP3A4, which metabolize escitalopram.
- This switch is currently being reviewed.
- ↑ Switches are based on literature references on this page and expert opinions of the authors. The authors have used pharmacokinetic and receptor affinity properties to determine the switch schedules
- ↑ Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.
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Stop fluoxetine 
Start escitalopram
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