Switch medication from fluoxetine to vortioxetine.
- Before day 1: gradually reduce dosage of escitalopram to a maximum of 10 mg/day, when this dosage is > 10 mg/day.
- Day 1: when a dosage of 10 mg/day is reached, stop administration
- A wash-out period is not necessary, but care is needed.
- Day 1: start administration of vortioxetine in a dosage of 10 mg/day.
- Fluoxetine is a strong inhibitor of CYP2D6, which metabolizes vortioxetine.
- Occurrence of serotonin syndrome is theoretically possible, so caution is necessary.
- Patients could be directly switched from a SSRI or a SNRI to vortioxetine 10 mg/day. One week after initiation with vortioxetine, the dosage could be increased from 10 mg/day to 20 mg/day.
- Montgomery SA et al. A randomised, double-blind study in adults with major depressive disorder with an inadequate response to a single course of selective serotonin reuptake inhibitor or serotonin-noradrenaline reuptake inhibitor treatment switched to vortioxetine or agomelatine. Hum Psychopharmacol. 2014 Sep;29(5):470-82.
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