Switch medication from fluoxetine to bupropion.
- 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.
- Day 2: start administration of bupropion in a low dosage of 150 mg/day.
- Day 30: if necessary gradually increase bupropion to 300 mg/day.
- Bupropion inhibits CYP2D6 which metabolizes fluoxetine.
- Fluoxetine and its metababolite desmethyl-fluoxetine have a very long elimination time of about 1 week; phasing out fluoxetine is therefore not necessary.
- Because of the normal half-life of 1 week of desmethylfluoxetine, there should be a low dosing of bupropion during 4 weeks.
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