Switch medication from vortioxetine to bupropion.
- Day 1: reduce dosage of vortioxetine to 5 mg/day.
- Day 8: stop administration of vortioxetine.
- Day 9: start administration of bupropion in a dosage of 150 mg/day.
- Bupropion is a strong inhibitor of CYP2D6, which metabolizes vortioxetine. Combination of vortioxetine and bupropion can lead to adverse effects of vortioxetine.
- Vortioxetine has a biological half-life of 66 hours. Reduction to the lowest effective dose of vortioxetine probably prevents adverse effects of vortioxetine due to lower blood levels of vortioxetine. After 1 week at 5 mg vortioxetine, interaction with bupropion will not be dangerous.  
- Katona et al. New generation multi-modal antidepressants: focus on vortioxetine for major depressive disorder. 2014 2014 Feb 19;10:349-54
- KNMP; Informatorium Medicamentorum 2015; Monografie "vortioxetine" (Dutch)
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