Fluoxetine-clomipramine
From Psychiatrienet
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Switch medication from fluoxetine to clomipramine[1][2]
Stop fluoxetine - Day 1: Stop fluoxetine
Start clomipramine- Day 5: start administration of clomipramine in a low dosage of 37.5 mg/day.
- Day 15: increase dosage of clomipramine to 75 mg/day.
- Day 20 and after: gradually increase dosage of clomipramine if necessary.
More information- Plasma monitoring for TCA's is advisable, because of plasma-reponse relations, genetic polymorphism and under or overdosing.[3]
- Fluoxetine and norfluoxetine slow the metabolism of clomipramine via CYP2D6.
- Fluoxetine and its metababolite desmethyl-fluoxetine have a very long elimination time of about 1 week; phasing out fluoxetine is therefore not necessary.
- Start low, go slow for clomipramine.
- ↑ 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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