Switch medication from imipramine to citalopram.
- Before day 1: gradually reduce dosage of imipramine to a maximum of 75 mg/ day, when this dosage is > 75 mg/day.
- Day 1-3: reduce dosage of imipramine to 50 mg/day.
- Day 4-7: reduce dosage of imipramine to 25 mg/day.
- Day 8: stop administration of imipramine.
- Day 1: simultaneously start administration of citalopram in a normal dosage of 20 mg/day.
- Citalopram is a weak inhibitor of CYP2D6, which metabolizes imipramine.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
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