Switch medication from amitriptyline to fluoxetine.
- Before day 1: gradually reduce dosage of amitriptyline to a maximum of 50-100 mg/ day, when this dosage is > 100 mg/day.
- Day 1-3: reduce dosage of amitriptyline to 50 mg/day.
- Day 4-7: reduce dosage of amitriptyline to 25 mg/day.
- Day 8: stop administration of amitriptyline.
- Day 9: start administration of fluoxetine in a normal dosage of 20 mg/day.
- Day 16: if necessary, increase dosage of fluoxetine.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
- Fluoxetine and norfluoxetine are inhibitors of CYP2D6 (strong) and CYP3A4 (moderate), which metabolize amitriptyline.
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