Fluoxetine-nortriptyline

Fluoxetine
Type Antidepressant
Group SSRI
links
Medscape Fluoxetine
PubChem 3386
PubMed Fluoxetine
Kompas (Dutch) Fluoxetine
Wikipedia Fluoxetine
Nortriptyline
Type Antidepressant
Group TCA
links
Medscape Nortriptyline
PubChem 4543
PubMed Nortriptyline
Kompas (Dutch) Nortriptyline
Wikipedia Nortriptyline

Switch medication from fluoxetine to nortriptyline.

Nietinrijdenbord.png Stop fluoxetine
  • 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.
Eenrichtingbord.png Start nortriptyline

Caution is necessary for at least four weeks.

  • Day 2: start administration of nortriptyline in a low dosage of 25 mg/day.
  • Day 15: increase dosage of nortriptyline to 50 mg/day.
  • Day 29: gradually increase dosage of nortriptyline to 75 mg/day and more.
Infobord.png More information
  • Fluoxetine and norfluoxetine slow the metabolism of nortriptyline via CYP2D6.
  • Fluoxetine and its metababolite desmethyl-fluoxetine have a very long elimination time of about 1 week; phasing out fluoxetine is therefore not necessary.
  • Start low, go slow for nortriptyline.
  • Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
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