Switch medication from fluoxetine to amitriptyline.
- Before day 1: reduce dosage of fluoxetine with about 20 mg per week.
- Day 1: when a dosage of 20 mg/day is reached, stop fluoxetine.
Caution is necessary for at least four weeks.
- Day 2: start administration of amitriptyline in a low dosage of 25 mg/day.
- Day 15: increase dosage of amitriptyline to 50 mg/day.
- Day 29: gradually increase dosage of amitriptyline.
- Fluoxetine and norfluoxetine slow the metabolism of amitriptyline via CYP2D6.
- Start low, go slow for amitriptyline.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
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