Switch medication from fluvoxamine to duloxetine.
- 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 9: start duloxetine 30 mg/day.
- Day 18: increase administration of duloxetine to 60 mg/day.
- Fluvoxamine inhibits the metabolism of duloxetine through CYP1A2.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
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