Switch medication from dosulepine to hypericum.
Stop dosulepine
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Before day 1: gradually reduce dosage of dosulepine to a maximum of 75 mg/ day, when this dosage is > 75 mg/day.
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Day 1: reduce dosage of dosulepine to 50 mg/day.
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Day 8: reduce dosage of dosulepine to 25 mg/day.
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Day 15: stop administration of dosulepine.
Start hypericum
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Day 15-22: a wash-out period of one week is necessary.
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Day 23: start administration of hypericum in a dosage of 300 mg three times a day (900 mg/day).
Cave
- Occurrence of the serotonin syndrome is theoretically possible without wash-out period.
More information
- Hypericum induces enzymes of the CYP P-450 type and P-gp type.
- Hypericum might have MAO-inhibiting and/or COMT-inhibiting properties.
- Many studies reported that hypericin is the main source of pharmacological effects of hypericum. However the IC50 of hypericin to inhibit MAO A and MAO B is 100- to 1000-fold higher than accessible Cmax values of hypericin after oral administration of hypericum.[3]
- The T1/2 of hypericum is 19 - 37 hour.[1]
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