Switching antidepressant (vortioxetine to tricyclic antidepressants (TCAs)) in adults

Vortioxetine to tricyclic antidepressants (TCAs)

• is limited experience with this switch so extra caution is required to avoid serotonin syndrome

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 TCA can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability

Stop, washout and switch

• alternatively, stop vortioxetine; wait for a period before starting low dose TCA. Clinicians should decide the duration of the washout period on a case-by-case basis.

To clomipramine

• 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.

Taper, stop and switch

• gradually reduce the dose of vortioxetine and stop. Start low dose clomipramine the following day

Stop, washout and switch

• alternatively, stop vortioxetine; wait for a period before starting low dose clomipramine. Clinicians should decide the duration of the washout period on a case-by-case basis

Reference:

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