Switching antidepressant (tricyclic antidepressants (TCA) to monoamine oxidase inhibitors (MAOIs)) in adults

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Switching antidepressant (tricyclic antidepressants (TCA) to monoamine oxidase inhibitors (MAOIs))

Switching to an MAOI is always a complex switch and you should follow specialist advice.

Taper, washout and switch with specialist advice

for any TCA, you should gradually reduce the dose and stop

you will then need to wait for a period, dependent on the antidepressant being switched from (see below), before starting the MAOI

the 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 all except clomipramine and imipramine

after stopping the TCA, wait 7 to 21 days before starting low dose MAOI.

after stopping clomipramine or imipramine, wait 21 days before starting low dose MAOI.

NHS Specialist Pharmacy Service (February 2023). 

Tricyclics to other antidepressants: switching in adults

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Switching antidepressant (tricyclic antidepressants (TCA) to monoamine oxidase inhibitors (MAOIs)) in adults

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