Switching antidepressant (tricyclic antidepressants (TCA) to vortioxetine) in adults

Switching antidepressant (tricyclic antidepressants (TCA) to vortioxetine)

There is limited experience with this switch so extra caution is required to avoid serotonin syndrome.

From all except clomipramine

Cross-taper

Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability. It should include:

• halving the dose of the TCA
• then adding vortioxetine
• then slowly reducing and stopping the TCA

Taper, washout and switch

• alternatively, gradually reduce the dose of the TCA and stop; wait for a period before starting vortioxetine.
• clinicians should decide the duration of the washout period on a case-by-case basis

From clomipramine

• 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

Taper, stop and switch

• if switching from clomipramine, gradually reduce the dose of clomipramine and stop
• start low dose vortioxetine the following day

Taper, washout and switch

• alternatively, gradually reduce the dose of clomipramine and stop; wait for a period before starting vortioxetine. Clinicians should decide the duration of the washout period on a case-by-case basis.

Reference:

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