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

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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:

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