Switch medication from fluvoxamine to maprotiline.
- 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 1: simultaneously start administration of maprotiline in a low dosage of 25-75 mg/day.
- Day 8: stop administration of fluvoxamine and continue administration of maprotiline. If necessary, increase dosage of maprotiline.
- Fluvoxamine slows the metabolism of maprotiline via CYP1A2 and CYP2D6.
- "Start low, go slow" is not required, but caution is necessary.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
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