Switch medication from paroxetine to imipramine.
- Before day 1: gradually reduce dosage of paroxetine to a maximum of 20 mg/day when this dosage is > 20 mg/day.
- Day 1: reduce dosage of paroxetine to a maximum of 10 mg/day.
- Day 8: stop administration of paroxetine.
- Day 9: start administration of imipramine in a low dosage of 25 mg/day.
- Day 16: increase administration of imipramine to a dosage of 75 mg/day.
- Paroxetine slows the metabolism of imipramine via CYP1A2 and CYP2D6.
- Occurrence of the serotonin syndrome is not likely, but theoretically possible, so caution is necessary.
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