Switching antidepressant (SSRIs to monoamine oxidase inhibitors (MAOIs)) in adults
SSRIs 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 SSRI, you should gradually reduce the dose and stop
- a clinician will then need to wait for a period (see below), dependent on the antidepressant being switched from, 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 fluoxetine
- after stopping the SSRI, wait 7 to 14 days before starting the MAOI
From fluoxetine
- after stopping fluoxetine, wait 5 to 6 weeks before starting the MAOI
- fluoxetine may still cause medicine interactions 5 or 6 weeks after stopping, as fluoxetine and its active metabolite have a long half-life
Reference:
- NHS Specialist Pharmacy Service (February 2023). SSRIs to other antidepressants: switching in adults
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