Switch medication from duloxetine to dosulepine.
- Before day 1: gradually reduce dosage of duloxetine to a maximum of 60 mg/ day, when this dosage is > 60 mg/day.
- Day 1: reduce dosage of duloxetine to a maximum of 30 mg/day.
- Day 8: stop administration of duloxetine.
- Day 9: start administration of dosulepine in a low dosage of 25 mg/day.
- Day 16: and increase the dosage of dosulepine to 50-75 mg/day.
- Duloxetine slows the metabolism of dosulepine by CYP2D6.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
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