Switch medication from amitriptyline to duloxetine.[1]
[2]
Stop amitriptyline
- Before day 1: gradually reduce dosage of amitriptyline to a maximum of 100 mg/day, when this dosage is > 100 mg/day.
- Day 1: reduce dosage of amitriptyline to 50 mg/day.
- Day 8: reduce dosage of amitriptyline to 25 mg/day.
- Day 15: stop administration of amitriptyline.
Start duloxetine
- Day 9-15: a wash-out period of one week is necessary.
- Day 16: start administration of duloxetine in a normal dosage of 60 mg/day.
More information
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
- Duloxetine is an inhibitor of CYP2D6, which metabolizes amitriptyline.
- ↑ 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 amitriptyline 
Start duloxetine
More information