Type Antidepressant
Group SSRI
Medscape paroxetine
PubChem 43815
PubMed paroxetine
Kompas (Dutch) paroxetine
Wikipedia paroxetine
Type Antidepressant
Group TCA
Medscape Nortriptyline
PubChem 4543
PubMed Nortriptyline
Kompas (Dutch) Nortriptyline
Wikipedia Nortriptyline

Switch medication from paroxetine to nortriptyline.[1][2]

Nietinrijdenbord.png Stop paroxetine
  • Day 1: Decrease with about 25% of original dose every 3-4 days
Eenrichtingbord.png Start nortriptyline

Caution is necessary.

  • Day 1: start administration of nortriptyline in a low dosage of 25 mg/day.
  • Day Stop paroxetine: increase administration of nortriptyline to a dosage of 50 mg/day.
Infobord.png More information
  • Paroxetine slows the metabolism of nortriptyline via CYP2D6.
  • Due to CYP inhibition a longer period of time is needed to reach steady state concentration. Please keep in mind when monitoring plasma levels
  • Plasma monitoring for TCA's is advisable, because of plasma-reponse relations, genetic polymorphism and under or overdosing.[3]
  1. Switches are based on literature references on this page and expert opinions of the authors. The authors have used pharmacokinetic and receptor affinity properties to determine the switch schedules
  2. Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.
  3. (dutch) tricyclische-antidepressiva
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