Switch medication from citalopram to nortriptyline.
- Before day 1: gradually reduce dosage of citalopram to a maximum of 20 mg/day, when this dosage is > 20 mg/day.
- Day 1: reduce dosage of citalopram to a maximum of 10 mg/day.
- Day 8: stop administration of citalopram
- Day 9: start administration of nortriptyline in a normal dosage of 25-50 mg/day.
- Therapeutic Drug Monitoring of nortriptyline is useful, especially during the build up phase. Blood sampling is possible when reaching a steady state: administration of the same dose after one week.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
- ↑ 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
- ↑ Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.
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