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