Switch medication from clomipramine to fluvoxamine.
- 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 9: start administration of fluvoxamine in a normal dosage of 50 mg/day.
- Day 16: increase dosage of fluvoxamine.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
- Fluvoxamine is an inhibitor of CYP1A2, CYP2C19 and CYP3A4 (moderate), which metabolize clomipramine.
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