Switch medication from maprotiline to fluoxetine.
- Before day 1: gradually reduce dosage of maprotiline to a maximum of 75 mg/day.
- Day 1: reduce dosage of maprotiline to 50 mg/day.
- Day 7: reduce dosage of maprotiline to 25 mg/day.
- Day 14: stop dosage of maprotiline.
- Day 7: simultaneously start administration of fluoxetine in a normal dosage of 20 mg/day.
- Day 14: stop administration of maprotiline and continue administration of fluoxetine.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
- Fluoxetine is a strong inhibitor of CYP2D6, which metabolizes maprotiline.
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