SSRIs to vortioxetine
- is limited experience with this switch so extra caution is required to avoid serotonin syndrome
From all except fluoxetine
Direct switch
- a direct switch, i.e. stopping one medicine and then starting the new medicine the following day, is usually possible
Taper, washout and switch
- alternatively, gradually reduce the dose of the SSRI and stop; wait for a period before starting vortioxetine
- clinicians should decide the duration of the washout period on a case-by-case basis
Additional caution when switching from paroxetine
- if switching from paroxetine, caution is required because paroxetine is a potent inhibitor of the liver enzyme CYP2D6 which is involved in the metabolism of vortioxetine.
- there is therefore a risk of raised vortioxetine levels in the body when they are administered together
From fluoxetine
Taper, washout and switch
- gradually reduce the dose of fluoxetine to 20mg daily and stop; wait 4 to 7 days before starting low dose vortioxetine
- fluoxetine may still cause medicine interactions 5 or 6 weeks after stopping, as fluoxetine and its active metabolite have a long half-life
- if switching from fluoxetine, caution is required as it is a potent inhibitor of the liver enzyme CYP2D6 which is involved in the metabolism of vortioxetine
- there is therefore there is a risk of raised vortioxetine levels in the body when switching
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