Switching antidepressant (SSRIs to vortioxetine) in adults

SSRIs to vortioxetine

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

From all except fluoxetine

Direct switch

• a direct switch, i.e. stopping one medicine and then starting the new medicine the following day, is usually possible

Taper, washout and switch

• alternatively, gradually reduce the dose of the SSRI and stop; wait for a period before starting vortioxetine
• clinicians should decide the duration of the washout period on a case-by-case basis

Additional caution when switching from paroxetine

• if switching from paroxetine, caution is required because paroxetine is a potent inhibitor of the liver enzyme CYP2D6 which is involved in the metabolism of vortioxetine.
  • there is therefore a risk of raised vortioxetine levels in the body when they are administered together

From fluoxetine

Taper, washout and switch

• gradually reduce the dose of fluoxetine to 20mg daily and stop; wait 4 to 7 days before starting low dose vortioxetine
  
  
• fluoxetine may still cause medicine interactions 5 or 6 weeks after stopping, as fluoxetine and its active metabolite have a long half-life
  
  
• if switching from fluoxetine, caution is required as it is a potent inhibitor of the liver enzyme CYP2D6 which is involved in the metabolism of vortioxetine
  • there is therefore there is a risk of raised vortioxetine levels in the body when switching

Reference:

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