Switching antidepressant (SSRIs to agomelatine) in adults

SSRIs to agomelatine

From all except fluvoxamine

Cross-taper

• cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability
  
  
• is limited experience with this switch so extra caution is required. Although interactions are not expected, agomelatine is not expected to mitigate discontinuation reactions from stopping the SSRI
  
  
• 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

From fluvoxamine

Taper, washout and switch

• gradually reduce the dose of fluvoxamine and stop; wait 4 days before starting agomelatine.
• cross-tapering is not appropriate with this switch because fluvoxamine is a potent inhibitor of the liver enzyme CYP1A2 which is involved in the metabolism of agomelatine. There is therefore a risk of raised agomelatine levels in the body when they are administered together

Reference:

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