Fluoxetine-amitriptyline
From Psychiatrienet
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Switch medication from fluoxetine to amitriptyline.[1] [2]
Stop fluoxetine - Before day 1: Gradually reduce dosage of fluoxetine to a maximum of 20 mg/ day, when this dosage is > 20 mg/day.
- Day 1: When a dosage of 20 mg/day is reached, stop administration.
Start amitriptylineCaution is necessary for at least four weeks.
- Day 1: start administration of amitriptyline in a low dosage of 25 mg/day.
- Day 14: increase dosage of amitriptyline to 50 mg/day.
- Day 28: gradually increase dosage of amitriptyline.
More information- Fluoxetine and norfluoxetine slow the metabolism of amitriptyline via CYP2D6.
- Start low, go slow for amitriptyline.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
- This switch is currently being reviewed.
- ↑ 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
- ↑ Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.
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