Switch medication from fluoxetine to escitalopram.
- 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.
- 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.
- Fluoxetine and its metababolite desmethyl-fluoxetine have a very long elimination time of about 1 week; 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.
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