Switch medication from doxepin to paroxetine.
- Before day 1: gradually reduce dosage of doxepin to a maximum of 100 mg/day, when this dosage is > 100 mg/day.
- Day 1: reduce dosage of doxepin to 50 mg/day.
- Day 8: reduce dosage of doxepin to 25 mg/day.
- Day 15: stop administration of doxepin.
- Day 16 start administration of paroxetine in a normal dosage of 20 mg/day.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
- Paroxetine is a strong inhibitor of CYP2D6, which metabolizes doxepin.
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