Switch medication from doxepin to fluvoxamine.
- Before day 1: gradually reduce dosage of doxepin to a maximum of 100 mg/day.
- Day 1: reduce dosage of doxepin to 50 mg/day.
- Day 3: reduce dosage of doxepin to 25 mg/day.
- Day 8: stop administration of doxepin.
- Day 3: simultaneously start administration of fluvoxamine in a normal dosage of 50 mg/day.
- Day 8: stop administration of doxepin and continue administration of fluvoxamine in a dosage of 50-100 mg/day.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary..
- Fluvoxamine is an inhibitor of CYP1A2, CYP2C19 and CYP3A4 (moderate), which metabolize doxepin.
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