Switch medication from doxepin to hypericum.[2]
[3]
Stop doxepin
- Before day 0: gradually reduce dosage of doxepin to a maximum of 100 mg/day, when this dosage is > 100 mg/day.
- Day 1: reduce dosage of doxepin to 50 mg/day.
- Day 8: reduce dosage of doxepin to 25 mg/day.
- Day 15: stop administration of doxepin.
Start hypericum
- Day 15-22: a wash-out period of one week is necessary.
- Day 23: start administration of hypericum in a dosage of 300 mg three times a day (900 mg/day).
Cave
- Occurrence of the serotonin syndrome is theoretically possible without wash-out period.
More information
- Hypericum induces enzymes of the CYP P-450 type and P-gp type.
- Hypericum might have MAO-inhibiting and/or COMT-inhibiting properties.
- Many studies reported that hypericin is the main source of pharmacological effects of hypericum. However the IC50 of hypericin to inhibit MAO A and MAO B is 100- to 1000-fold higher than accessible Cmax values of hypericin after oral administration of hypericum.[4]
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Stop doxepin 
Start hypericum
Cave
More information