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Switch medication from fluvoxamine to amitriptyline.[1] [2]
Stop fluvoxamine - Before day 1: gradually reduce dosage of fluvoxamine to a maximum of 50 mg/day, when this dosage is > 50 mg/day.
- Day 1: reduce dosage of fluvoxamine further to 25 mg/day.
- Day 8: stop administration of fluvoxamine.
- Before day 1: gradually reduce dosage of fluvoxamine to a maximum of 100 mg/day when the dosage is > 100 mg/day.
- Day 1: reduce dosage of fluvoxamine to a maximum of 50 mg/day.
- Day 8: stop administration of fluvoxamine
Start amitriptyline- Day 1: simultaneously start administration of amitriptyline in a low dosage of 25 mg/day.
- Day 8: continue administration of amitriptyline in a dosage of 50 mg/day.
- Start low, go slow!
More information- Fluvoxamine is an inhibitor of CYP1A2, CYP2C19 and CYP3A4 (moderate), which metabolize amitriptyline.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
- 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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