Switch medication from clomipramine to bupropion.
- Before day 1: gradually reduce dosage of clomipramine to a maximum of 75 mg/ day, when this dosage is > 75 mg/day.
- Day 1-3: reduce dosage of clomipramine to 50 mg/day.
- Day 4-7: reduce dosage of clomipramine to 25 mg/day.
- Day 8: stop administration of clomipramine.
- Day 1: simultaneously start administration of bupropion in a dosage of 150 mg/day and continue administration of clomipramine according to the scheme above.
- Day 8: continue administration of bupropion.
- Bupropion is an inhibitor of CYP2D6, which metabolizes clomipramine.
- The concomitant use of bupropion and tricyclic antidepressants (TCAs) may potentiate the risk of seizures. These agents are all epileptogenic and may have additive effects on the seizure threshold.
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