Switching antidepressant - SNRI (e.g. duloxetine or venlafaxine) to monoamine oxidase inhibitors (MAOIs) in adults
SNRIs to monoamine oxidase inhibitors (MAOIs)
Specialist advice is indicated because MAOI is always a complex switch.
Taper, washout and switch with specialist advice
- for any SNRI, you should gradually reduce the dose and then stop. You will need to wait a period, dependent on the antidepressant being switched from (see below), before starting MAOI
- specialist will advise the duration of the washout period on a case-by-case basis taking into consideration the MAOI being started.
Cross-tapering is not recommended due to the high risk of serotonin syndrome.
From duloxetine
- after stopping duloxetine, wait 5 to 14 days before starting the MAOI.
From venlafaxine
- after stopping venlafaxine, wait 7 to 14 days before starting the MAOI.
Reference:
- NHS Specialist Pharmacy Service (February 2023). SNRIs to other antidepressants: switching in adults
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