Switch medication from fluvoxamine to clomipramine.[1]
[2]
Stop fluvoxamine
- Day 1: Decrease dose to 50%
- Day 8: Stop
Start clomipramine
- Day 1: start administration of clomipramine in a low dosage of 37.5 mg/day.
- Day 8: increase dosage of clomipramine to a dosage of 75 mg/day.
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- fluvoxamine slows the metabolism of clomipramine via CYP2C19 inhibition.
-
- Due to CYP inhibition a longer period of time is needed to reach steady state concentration. Please keep in mind when monitoring plasma levels
-
- Plasma monitoring for TCA's is advisable, because of plasma-reponse relations, genetic polymorphism and under or overdosing.[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.
- ↑ (dutch) monografie.org tricyclische-antidepressiva
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Stop fluvoxamine 
Start clomipramine
More information