Switch medication from nortriptyline to fluoxetine.
- Before day 1: gradually reduce dosage of nortriptyline to a maximum of 50 mg/ day, when this dosage is > 50 mg/day.
- Day 1-3: reduce dosage of nortriptyline to 25 mg/day.
- Day 4-7: reduce dosage of nortriptyline to 10 mg/day.
- Day 8: stop administration of nortriptyline.
- Day 1: simultaneously start administration of fluoxetine in a normal dosage of 20 mg/day.
- Day 8: stop administration of nortriptyline and continue administration of fluoxetine.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
- Fluoxetine is a strong inhibitor of CYP2D6, which metabolizes nortriptyline.
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