Switching antidepressant - SNRI (e.g. duloxetine or venlafaxine) to tricyclic antidepressants (TCAs) in adults

SNRIs to tricyclic antidepressants (TCAs)

Switching to dosulepin requires specialist advice and should not be done in primary care due to the increased cardiac risk and toxicity in overdose (1).

To all except clomipramine

Cross-taper

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

To clomipramine

Taper, stop and switch

• gradually reduce the dose of the SNRI and stop. Start low dose clomipramine 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). SNRIs to other antidepressants: switching in adults