Switch medication from duloxetine to doxepin.[2]
[3]
Stop duloxetine
- Before day 1: gradually reduce dosage of duloxetine to a maximum of 60 mg/ day, when this dosage is > 60 mg/day.
- Day 1: reduce dosage of duloxetine to a maximum of 30 mg/day.
- Day 8: stop administration of duloxetine.
Start doxepin
- Day 8:start administration of doxepin in a low dosage of 25 mg/day.
- Day 15: increase the dosage of doxepin to 50 mg/day.
More information
- Duloxetine slows the metabolism of doxepin by CYP2D6.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
- This switch is currently being reviewed.
- ↑ 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.
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Stop duloxetine 
Start doxepin
More information