Switch medication from clomipramine to fluoxetine.[1]
[2]
Stop clomipramine
- Day 1: Decrease with about 25% of the original dose per 3 days.
Start fluoxetine
- Day 6 and after: At approximately 50-25% of the original TCA dosering start fluoxetine at 100% of the target dose.
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- Safe target dose fluoxetine = 20 mg
- Fluoxetine and norfluoxetine are inhibitors of CYP2D6 (strong) and CYP3A4 (moderate), which metabolize (desmethyl)clomipramine.
- ↑ 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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Stop clomipramine 
Start fluoxetine
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