Providing time-saving prescribing guidelines for primary care

Switching Antidepressants

Posted in Depression.

Print

To 
From
Sertraline Citalopram Mirtazapine Escitalopram Duloxetine Venlafaxine Fluoxetine Paroxetine MAOI’s i.e Phenelzine Moclobemide Trazodone Tricyclics Stopping
Licensed dose range ( refer to SPC 50mg daily, Dose increments 50mg/ week. Max 200mg daily 20mg daily, max 40mg daily.
Elderly, max 20mg daily		 15-30mg
daily. Up to 45mg daily		 10-20mg daily ( Elderly-half dose) (Cymbalta) 60mg daily. Max 120mg daily. 75mg daily (in 2 divided does) up to 300mg daily. Higher doses
-  specialist supervision		 20mg daily. Max 60mg daily 20mg daily. Max 50mg daily          
Sertraline - (Anxiety & Depression)   Taper and stop then start Citalopram 10mg/ day Cross Taper cautiously Taper and stop then start escitalopram Abrupt switch possible. Start at 60mg/day Cross taper cautiously. Start venlafaxine at 37.5mg/day. Up slowly Taper and stop then start fluoxetine at 10mg/ day Taper and stop then start paroxetine at 10mg/ day Taper and stop then wait for 1 week Taper and stop then wait for 1 week Cross taper cautiously starting with low dose trazodone Cross taper cautiously with very low dose of tricyclic *2 Reduce over 4 weeks
Citalopram (Depression) Taper and stop then start sertraline at 25mg / day   Cross Taper cautiously Cross Taper cautiously Abrupt switch possible. Start at 60mg/day Cross taper cautiously. Start venlafaxine at
37.5mg/day. Up slowly		 Taper and stop then start fluoxetine at 10mg/ day Taper and stop then start paroxetine at 10mg/ day Taper and stop then wait for 1 week Taper and stop then wait for 1 week Cross taper cautiously starting with low dose trazodone Cross taper cautiously *2 Reduce over 4 weeks
Mirtazapine (Sleep) Cross taper cautiously Cross Taper cautiously   Cross Taper cautiously Cross Taper cautiously, start at 30mg/day. Up slowly. Cross Taper cautiously Cross Taper cautiously Cross Taper cautiously Taper and stop then wait for 2 week Taper and stop then wait for 1 week Cross taper cautiously Cross taper cautiously with very low dose of tricyclic Reduce over 4 weeks
Escitalopram Taper and stop then start sertraline at 25mg/ day Cross Taper cautiously Cross Taper cautiously   Abrupt switch possible. Start at 60mg/day Cross taper cautiously. Start venlafaxine at 37.5mg/day.
Up slowly		 Taper and stop then start fluoxetine at 10mg/ day Taper and stop then start paroxetine at 10mg/ day Taper and stop then wait for 1 week Taper and stop then wait for 1 week Cross taper cautiously starting with low dose trazodone Cross taper cautiously *2 Reduce over 4 weeks
Duloxetine Taper and stop then start sertraline at 25mg/ day Cross Taper cautiously. Start
citalopram 10mg/day		 Cross Taper cautiously Cross Taper cautiously   Taper and stop then start venlafaxine Taper and stop then start fluoxetine Taper and stop then start paroxetine Taper and stop then wait at least 5 days. Taper and stop then wait at least 5 days. Cross taper cautiously starting with low dose trazodone Cross taper cautiously with very low dose of tricyclic *2 Reduce over 4 weeks
Venlafaxine Taper and stop then start sertraline at 25mg/ day Cross Taper cautiously. Start citalopram 10mg/day Cross Taper cautiously Cross Taper cautiously Taper and stop, start 30mg/ day. Up slowly   Taper and stop then start fluoxetine at 10mg/day Cross taper cautiously. Start paroxetine 10mg/day Taper and stop then wait at least 1 week Taper and stop then wait at least 1 week Cross taper cautiously Cross taper cautiously with very low dose of tricyclic *2 Reduce over 4 weeks or longer if necessary
To
From		 Sertraline Citalopram Mirtazapine Escitalopram Duloxetine Venlafaxine Fluoxetine Paroxetine MAOI’s i.e Phenelzine Moclobemide Trazodone Tricyclics Stopping
Fluoxetine *3 Taper and stop fluoxetine.4-7 days. Start sertraline at 25mg/day and up slowly. Stop fluoxetine. Wait 4-7 days. Start citalopram at 10mg/day and up slowly. Cross taper cautiously. Start mirtazapine at 15mg/day Stop fluoxetine. Wait 4-7 days. Start Escitalopram and up slowly. Abrupt switch possible. Start at 60mg/day Taper and stop. Start venlafaxine at 37.5mg/day. Up slowly.   Taper and stop fluoxetine. Wait 4-7 days. Start paroxetine 10mg/day and up slowly. Taper and stop then wait at least 5-6 weeks Taper and stop then wait at least 5 weeks Cross taper cautiously starting with low dose trazodone Taper and stop fluoxetine. Wait 4-7 days. Start tricyclic at very low dose and up slowly *2 At 20mg/day just stop. At higher doses reduce over 2 weeks
Paroxetine Cross Taper cautiously. Start Sertraline 25mg/day Taper and stop then start Citalopram 10mg/ day Cross Taper cautiously Taper and stop then start escitalopram Abrupt switch possible. Start at 60mg/day Cross taper cautiously. Start venlafaxine at 37.5mg/day.
Up slowly		 Taper and stop then start fluoxetine at 10mg/ day   Taper and stop then wait for 2 weeks Taper and stop then wait for 1 week Cross taper cautiously starting with low dose trazodone Cross taper cautiously with very low dose of tricyclic *2 Higher risk of withdrawal symptoms. Reduce over 4 weeks or longer
if necessary *4
MAOI’s i.e Phenelzine Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks *1 Reduce over 4 weeks
Moclobemide Taper then stop then wait 24 hours Taper then stop then wait 24 hours Taper then stop then wait 24 hours Taper then stop then wait 24 hours Taper then stop then wait 24 hours Taper then stop then wait 24 hours Taper then stop then wait 24 hours Taper then stop then wait 24 hours Taper then stop then wait 24 hours   Taper then stop then wait 24 hours Taper then stop then wait 24 hours Reduce over 4 weeks
Reboxetine Cross taper cautiously Cross taper cautiously Cross taper cautiously Cross taper cautiously Cross taper cautiously Cross taper cautiously Cross taper cautiously Cross taper cautiously Taper then stop then wait at least 1 week Taper then stop then wait at least 1 week Cross taper cautiously Cross taper cautiously Reduce over 4 weeks
Trazodone Taper and stop then start sertraline at 25mg/ day Cross Taper cautiously. Start
citalopram 10mg/day		 Cross Taper cautiously Cross Taper cautiously Cross Taper cautiously. Start at
30mg/day. Up slowly		 Cross taper cautiously. Start
venlafaxine at 37.5mg/day.		 Taper and stop then start fluoxetine at 10mg/ day Taper and stop then start paroxetine at 10mg/ day Taper and stop then wait at least 1 week Taper and stop then wait at least 1 week   Cross taper cautiously with very low dose of Tricyclic Reduce over 4 weeks
Tranyl- cypromine Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks Taper and stop then wait 2 weeks *1 Reduce over 4 weeks
Tricyclics Halve dose and add sertraline then slow withdrawal *2 Halve dose and add citalopram then slow withdrawal *2 Cross Taper cautiously, start at 30mg / day. Up  slowly *2 Halve dose and add Escitalopram then slow withdrawal *2 Cross Taper cautiously, start at 30mg / day. Up  slowly *2 Cross Taper cautiously starting with venlafaxine 37.5mg/day
*2		 Halve dose and add  fluoxetine then slow withdrawal *2 Halve dose and add paroxetine then slow withdrawal *2 Taper and stop then wait for 2 week *1 Taper and stop then wait at 1 week Halve dose and add trazodone then slow withdrawal Cross taper cautiously Reduce over 4 weeks

 cross taper - lower the dose of one medication while simultaneously increasing the dose of another medication as per suggested dosage reduction

fluoxetine paroxetine venlafaxine Sertraline Citalopram Escitalopram Duloxetine phenelzine mirtazapine reboxetine moclobemide trazodone Cymbalta

AskShilpa
18-19 Western Rd
Hove, East Sussex
BN3 1AE

01273 772020
contact@askshilpa.com

facebook twitter linkedin instagram

What We Do

If you are involved in the prescribing process, then this website has been created for you!

This website will enable you to prescribe the correct dose for the appropriate condition at the right time.

Company

© 2023 AskShilpa.com | WellBN Ltd

Press enter to search
Impressum

Wir bieten unseren Kunden mit nützlichen Informationen und Ratschläge, die sie benötigen, fundierte Entscheidungen zu treffen, ihre Ziele zu erreichen. Ob es sich um die Verwaltung von Kundeninvestitionen oder einen umfassenden Plan für sie zu schaffen und ihre Familie sind unsere zertifizierten Planern gewidmet mit einem außergewöhnlichen Service zu bieten.

Deshalb, im Laufe der Jahre konnten wir einen Ruf als einer der besten unabhängigen Beratern zu bauen. Wir verstehen die Bedeutung der Kunden auf dem richtigen Weg zum Erfolg bringen, und wir sind bereit, mit ihnen der Planung in allen Bereichen zu arbeiten.

Terms and Conditions

  1. Introduction

These Website Standard Terms and Conditions written on this webpage shall manage your use of this website. These Terms will be applied fully and affect to your use of this Website. By using this Website, you agreed to accept all terms and conditions written in here. You must not use this Website if you disagree with any of these Website Standard Terms and Conditions.

Minors or people below 18 years old are not allowed to use this Website.

  1. Intellectual Property Rights

Other than the content you own, under these Terms, Buckle LLC and/or its licensors own all the intellectual property rights and materials contained in this Website.

You are granted limited license only for purposes of viewing the material contained on this Website.

  1. Restrictions

You are specifically restricted from all of the following

  • publishing any Website material in any other media;
  • selling, sublicensing and/or otherwise commercializing any Website material;
  • publicly performing and/or showing any Website material;
  • using this Website in any way that is or may be damaging to this Website;
  • using this Website in any way that impacts user access to this Website;
  • using this Website contrary to applicable laws and regulations, or in any way may cause harm to the Website, or to any person or business entity;
  • engaging in any data mining, data harvesting, data extracting or any other similar activity in relation to this Website;
  • using this Website to engage in any advertising or marketing.

Certain areas of this Website are restricted from being access by you and Buckle LLC may further restrict access by you to any areas of this Website, at any time, in absolute discretion. Any user ID and password you may have for this Website are confidential and you must maintain confidentiality as well.

  1. Your Content

In these Website Standard Terms and Conditions, “Your Content” shall mean any audio, video text, images or other material you choose to display on this Website. By displaying Your Content, you grant Buckle LLC a non-exclusive, worldwide irrevocable, sub licensable license to use, reproduce, adapt, publish, translate and distribute it in any and all media.

Your Content must be your own and must not be invading any third-party’s rights. Buckle LLC reserves the right to remove any of Your Content from this Website at any time without notice.

  1. No warranties

This Website is provided “as is,” with all faults, and Buckle LLC express no representations or warranties, of any kind related to this Website or the materials contained on this Website. Also, nothing contained on this Website shall be interpreted as advising you.

  1. Limitation of liability

In no event shall Buckle LLC, nor any of its officers, directors and employees, shall be held liable for anything arising out of or in any way connected with your use of this website whether such liability is under contract. Buckle LLC, including its officers, directors and employees shall not be held liable for any indirect, consequential or special liability arising out of or in any way related to your use of this Website.

  1. Indemnification

You hereby indemnify to the fullest extent Buckle LLC from and against any and/or all liabilities, costs, demands, causes of action, damages and expenses arising in any way related to your breach of any of the provisions of these Terms.

  1. Severability

If any provision of these Terms is found to be invalid under any applicable law, such provisions shall be deleted without affecting the remaining provisions herein.

  1. Variation of Terms

Buckle LLC is permitted to revise these Terms at any time as it sees fit, and by using this Website you are expected to review these Terms on a regular basis.

  1. Assignment

The Buckle LLC is allowed to assign, transfer, and subcontract its rights and/or obligations under these Terms without any notification. However, you are not allowed to assign, transfer, or subcontract any of your rights and/or obligations under these Terms.

  1. Entire Agreement

These Terms constitute the entire agreement between Buckle LLC and you in relation to your use of this Website, and supersede all prior agreements and understandings.

  1. Governing Law & Jurisdiction

These Terms will be governed by and interpreted in accordance with the laws of the State of New York, and you submit to the non-exclusive jurisdiction of the state and federal courts located in New York for the resolution of any disputes.

Press enter to search

If you are involved in the prescribing process, then AskShilpa has been created for you!

01273 772020
contact@askshilpa.com
18-19 Western Rd, Hove BN3 1AE

Shilpa's Words

We love askshilpa.com

Get Connected

facebook twitter linkedin instagram