Switch medication from fluoxetine to paroxetine.
- 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 paroxetine the next day in low dosage of 10 mg/day.
- Day 15: increase dosage of paroxetine to 20 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.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
- Fluoxetine and norfluoxetine inhibit de metabolism of paroxetine via CYP2D6.
- Paroxetine inhibits the metabolism of fluoxetine via CYP2D6.
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