Switch medication from escitalopram to fluvoxamine.
- Before day 1: gradually reduce dosage of escitalopram to a maximum of 10 mg/day, when this dosage is >10 mg/day.
- Day 1: reduce dosage of escitalopram to a maximum of 5 mg/day.
- Day 8: stop administration of escitalopram.
- No wash-out period is needed.
- Day 9: start fluvoxamine in normal dosage of 50 mg/day.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
- Fluvoxamine slows the metabolism of escitalopram by inhibition of CYP2C19 and CYP3A4
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