Switch medication from fluoxetine to trazodone.
- 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.
- Day 2-22: A wash-out period is needed.
- Day 23: Start trazodone in a dosage of 100-150 mg/day.
- After day 29: If necessary, increase gradually the dosage of trazodone to a maximum of 400 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.
- Fluoxetine slows the metabolism of trazodone via CYP2D6, so caution is necessary for at least four weeks.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
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