Switch medication from clomipramine to citalopram.
- Before day 1: gradually reduce dosage of clomipramine to a maximum of 50 mg/day.
- Day 1: reduce dosage of clomipramine to 25 mg/day.
- Day 3: reduce dosage of clomipramine to 10 mg/day.
- Day 1: simultaneously start administration of citalopram/escitalopram in a normal dosage of 20 mg/day, resp. 10 mg/day.
- Day 8: stop administration of clomipramine and continue administration of citalopram/escitalopram.
- Occurrence of serotonin syndrome is theoretically possible, so caution is necessary.
- Citalopram/escitalopram are very weak inhibitors of CYP2D6, which metabolizes clomipramine.
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