Switch medication from fluoxetine to duloxetine.
- Before day 1: reduce dosage of fluoxetine with about 20 mg per week.
- Day 1: when a dosage of 20 mg/day is reached, stop fluoxetine.
No wash-out period is needed.
- Day 2: start duloxetine the next day in low dosage of 30 mg/day.
- Day 29: increase dosage of duloxetine to normal, 60 mg/day.
- Fluoxetine and its metababolite desmethyl-fluoxetine have a very long elimination time of about 1 week; phasing out fluoxetine is therefore not necessary.
- Desmethylfluoxetine has a halflife of at least 1 week: it takes therefore 1 month for elemination.
- Through CYP2D6 fluoxetine and duloxetine can mutually influence their metabolism.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
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