Switching antidepressant (tricyclic antidepressants (TCA) to serotonin and noradrenaline reuptake inhibitors (SNRIs) (e.g. duloxetine or venlafaxine)) in adults

Switching antidepressant (tricyclic antidepressants (TCA) to serotonin and noradrenaline reuptake inhibitors (SNRIs))

From all except clomipramine

Cross-taper

• cross-tapering starting with a low dose SNRI can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability

From clomipramine

Taper, stop and switch

• if switching from clomipramine, gradually reduce the dose of clomipramine and stop. Start low dose SNRI the following day
  
  
• cross-tapering is not recommended and should only be undertaken if specialist advice is in place, this is because clomipramine is a potent serotonin reuptake inhibitor so there is a high risk of serotonin syndrome.

Reference:

• NHS Specialist Pharmacy Service (February 2023). Tricyclics to other antidepressants: switching in adults