Switch medication from mirtazapine to hypericum.[1]
[2]
Stop mirtazapine
- Before day 1: gradually reduce dosage of mirtazapine to a maximum of 30 mg/day, when this dosage is > 30 mg/day.
- Day 1: reduce dosage of mirtazapine to 15 mg/day.
- Day 8: stop administration of mirtazapine.
Start hypericum
- Day 8-14: a wash-out period of one week is necessary.
- Day 15: start administration of hypericum in a dosage of 300 mg three times a day (900 mg/day).
More information
- Occurrence of serotonin syndrome is theoretically possible, so caution is necessary.
- Hypericum slows the metabolism of mirtazapine via CYP3A4.
- This switch is currently being reviewed.
- ↑ 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 mirtazapine 
Start hypericum
More information