Switch medication from hypericum to clomipramine.[1]
[2]
Stop hypericum
- Administration of hypericum can be stopped abruptly.
Start clomipramine
- Day 1-7: a wash-out period of one week is necessary.
- Day 8: start administration of clomipramine in a dosage of 50 mg/day.
- If necessary, increase dosage of clomipramine to 75 mg/day.
- Start low, go slow.
More information
- Occurrence of the serotonin syndrome is theoretically possible.
- Hypericum slows the metabolism of clomipramine via CYP3A4. This effect may persist up to two weeks after stopping hypericum, so caution is necessary.
- ↑ 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 hypericum 
Start clomipramine
More information