Duloxetine-vortioxetine

Before day 1: gradually reduce dosage of duloxetine to a maximum of 60 mg/day, when this dosage is > 60 mg/day.
Day 1-7: reduce dosage of duloxetine from 60 mg/day to 30 mg/day
Day 8-14: reduce dosage of duloxetine to 30 mg/day to 0 mg/day
Day 15: stop administration of duloxetine.

Start vortioxetine

A wash-out period is not necessary, but care is needed.
Day 15: Start administration of vortioxetine in a dosage of 10 mg/day.

More information

Duloxetine is a strong inhibitor of CYP2D6, which metabolizes vortioxetine.
Occurrence of serotonin syndrome is theoretically possible, so caution is necessary.
Patients could be directly switched from a SSRI or a SNRI to vortioxetine 10 mg/day. One week after initiation with vortioxetine, the dosage could be increased from 10 mg/day to 20 mg/day.^[3]

↑ 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.
↑ Montgomery SA et al. A randomised, double-blind study in adults with major depressive disorder with an inadequate response to a single course of selective serotonin reuptake inhibitor or serotonin-noradrenaline reuptake inhibitor treatment switched to vortioxetine or agomelatine. Hum Psychopharmacol. 2014 Sep;29(5):470-82.

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[1] 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

[2] Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.

[3] Montgomery SA et al. A randomised, double-blind study in adults with major depressive disorder with an inadequate response to a single course of selective serotonin reuptake inhibitor or serotonin-noradrenaline reuptake inhibitor treatment switched to vortioxetine or agomelatine. Hum Psychopharmacol. 2014 Sep;29(5):470-82.

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Duloxetine-vortioxetine

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