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Difference between revisions of "Fluvoxamine-doxepine"

 
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| from = fluvoxamine  
 
| from = fluvoxamine  
 
| to = doxepin  
 
| to = doxepin  
| stop =  
+
| stop = {{StopSSRI,SNRI}}
* '''Before day 1:''' gradually reduce dosage of fluvoxamine to a maximum of 50 mg/ day when this dosage is > 50 mg/day.
 
* '''Day 1:''' reduce dosage of fluvoxamine to a maximum of 25 mg/day.
 
 
| start =  
 
| start =  
Caution is necessary
+
* '''Day 1:''' start administration of doxepine in a low dosage of 25mg/day.  
* '''Day 1:''' simultaneously start administration of doxepin in a low dosage of 25 mg/day.  
+
* '''Day 8:''' increase dosage of doxepine to a dosage of 75 mg/day.
* '''Day 8:''' stop administration of fluvoxamine and continue administration of doxepin only. If necessary, increase dosage of doxepin.
 
 
| info =  
 
| info =  
* Fluvoxamine slows the metabolism of doxepin via CYP2D6, and possibly via CYP1A2 too.
+
* fluvoxamine slows the metabolism of doxepine via CYP2C19 inhibition.  
* "Start low, go slow" is not required, but caution is necessary.}}
+
* {{SSCYPinh}}
 +
* {{TCAplasmalevelmonitoring}}
 +
}}

Latest revision as of 14:40, 30 June 2023

Fluvoxamine
Type Antidepressant
Group SSRI
links
Medscape Fluvoxamine
PubChem 5324346
PubMed Fluvoxamine
Kompas (Dutch) Fluvoxamine
Wikipedia Fluvoxamine
Doxepin
Type antidepressant
Group TCA
links
ATC-code N06AA12
Medscape Doxepin
PubChem 3158
PubMed Doxepin
Drugs.com doxepin
Kompas (Dutch) Doxepin
Wikipedia Doxepin

Switch medication from fluvoxamine to doxepin.[2] [3]

Nietinrijdenbord.png Stop fluvoxamine
  • Day 1: Decrease dose to 50%
  • Day 8: Stop
Eenrichtingbord.png Start doxepin
  • Day 1: start administration of doxepine in a low dosage of 25mg/day.
  • Day 8: increase dosage of doxepine to a dosage of 75 mg/day.
Infobord.png More information
  • fluvoxamine slows the metabolism of doxepine via CYP2C19 inhibition.
  • Due to CYP inhibition a longer period of time is needed to reach steady state concentration. Please keep in mind when monitoring plasma levels
  • Plasma monitoring for TCA's is advisable, because of plasma-reponse relations, genetic polymorphism and under or overdosing.[4]
  1. 1.0 1.1 1.2 1.3 1.4 KNMP; Informatorium Medicamentorum 2023; Monografie "doxepine" (Dutch)
  2. 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
  3. Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.
  4. (dutch) monografie.org tricyclische-antidepressiva
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