Switch medication from tranylcypromine to amitriptyline.
- Gradually decrease the dosage of tranylcypromine with 10-20 mg/week.
- When a dosage of 10 mg/day is reached, stop administration.
- Day 1-14: a wash-out period of two weeks is necessary.
- Day 15: start amitriptyline after this period in a low dosage of 25-50 mg/day.
- Occurrence of the serotonin syndrome is possible without a wash-out period.
- The wash-out period is necessary for the MAO enzymes to restore their function.
- This switch is currently being reviewed.
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