Switch medication from fluvoxamine to mirtazapine.
- 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 administration of mirtazapine in a low dosage of 15 mg/day for one week.
- Day 16: gradually increase dosage of mirtazapine to target dose.
- Caution with this switch is necessary, because fluvoxamine slows the metabolism of mirtazapine via CYP1A2, CYP2C9, CYP2D6 and CYP3A4. The inhibiting effect of fluvoxamine can continue up to two weeks after stopping administration.
- 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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