Switch medication from sertraline to tranylcypromine.
Stop sertraline
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Before day 1: Gradually reduce dosage of sertraline to a maximum of 50 mg/ day, when this dosage is > 50 mg/day.
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Day 1: Reduce dosage of sertraline to a dosage of 25 mg/ day
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Day 8: Stop administration of sertraline
Start tranylcypromine
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Day 9-23: a wash-out period of 2 weeks is necessary.
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Day 24: start tranylcypromine the next day in a low dosage of 20 mg/day for one week.
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Day 31: after this week the dosage of tranylcypromine can be increased gradually.
Cave
- Occurrence of the serotonin syndrome is possible without wash-out period.
- The reduction of the SSRI doses in 7-14 days could cause emotional instability, headache and flu-like symptoms. One could extend this period.
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