Doxepine-hypericum

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 15-28: a wash-out period is necessary.
Day 29: start administration of hypericum in a dosage of 300 mg three times a day (900 mg/day).

Cave

Occurrence of the serotonin syndrome is 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]

↑ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 KNMP; Informatorium Medicamentorum 2023; Monografie "doxepine" (Dutch)
↑ 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.
↑ Wurglics M, Schubert-Zsilavecz M.Hypericum perforatum: a 'modern' herbal antidepressant: pharmacokinetics of active ingredients. Clin Pharmacokinet. 2006;45(5):449-68.

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[informatorium-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.

[Wurglics2006-4] Wurglics M, Schubert-Zsilavecz M.Hypericum perforatum: a 'modern' herbal antidepressant: pharmacokinetics of active ingredients. Clin Pharmacokinet. 2006;45(5):449-68.

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Psychiatrienet β

Doxepine-hypericum

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