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

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.

From clomipramine or imipramine

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

Reference:

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