Switch medication from fluvoxamine to amitriptyline.
- Before day 1: gradually reduce dosage of fluvoxamine to a maximum of 50 mg/day, when this dosage is > 50 mg/day.
- Day 1: reduce dosage of fluvoxamine further to 25 mg/day.
- Day 8: stop administration of fluvoxamine.
- Day 1: simultaneously start administration of amitriptyline in a low dosage of 25 mg/day.
- Day 8: continue administration of amitriptyline in a dosage of 50 mg/day.
- Start low, go slow!
- Fluvoxamine is an inhibitor of CYP1A2, CYP2C19 and CYP3A4 (moderate), which metabolize amitriptyline.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
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