Switch medication from amitriptyline to fluoxetine.[1][2]
Stop amitriptyline
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Day 1: Decrease with about 25% of the original dose per 3 days.
Start fluoxetine
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Day 6 and after: At approximately 50-25% of the original TCA dosering start fluoxetine at 100% of the target dose.
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After 3 weeks: If necessary, gradually increase dosage of fluoxetine.
More information
- Safe target dose fluoxetine = 20 mg
- Fluoxetine and norfluoxetine are inhibitors of CYP2D6 (strong) which metabolizes nortriptyline, (a metabolite of amitriptyline).
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↑ Switches are based on literature references on this page and expert opinions of the authors. The authors have used pharmacokinetic and receptor affinity properties to determine the switch schedules
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↑ Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.
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