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Switching antidepressant (SSRIs to mirtazapine) in adults

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SSRIs to mirtazapine

Cross-taper

  • cross-tapering can generally be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability

Additional caution when switching from fluoxetine

  • fluoxetine may still cause medicine interactions 5 or 6 weeks after stopping, as fluoxetine and its active metabolite have a long half-life

Additional caution when switching from fluvoxamine

  • start mirtazapine at a dose of 15mg daily.
    • this caution is required because fluvoxamine is a potent inhibitor of the liver enzyme CYP1A2 which is involved in the metabolism of mirtazapine
      • is therefore a risk of raised mirtazapine levels in the body when they are administered together

Reference:

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