Switch medication from fluvoxamine to agomelatine.
- Before day 1: gradually reduce dosage of fluvoxamine to a maximum of 50 mg/day, when this dosage is > 50 mg/day.
- Day 1: reduce dosage of fluvoxamine further to 25 mg/day.
- Day 8: stop administration of fluvoxamine.
- Day 8-14: a wash-out period of one week is necessary.
- Day 15: start administration of agomelatine after this period in a dosage of 25 mg/day.
- Day 22: if necessary, the dosage of agomelatine can be increased to 50 mg/day.
- Fluvoxamine inhibits the metabolism of agomelatine via CYP1A2 (90%) and via CYP2C9/2C19 (10%).
- The reduction of the SSRI doses in 7-14 days could cause emotional instability, headache and flu-like symptoms. One could extend this period.
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