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

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Switching antidepressant (tricyclic antidepressants (TCA) to vortioxetine)

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

From all except clomipramine

Cross-taper

Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability. It should include:

  • halving the dose of the TCA
  • then adding vortioxetine
  • then slowly reducing and stopping the TCA

Taper, washout and switch

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

From 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

  • if switching from clomipramine, gradually reduce the dose of clomipramine and stop
  • start low dose vortioxetine the following day

Taper, washout and switch

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

Reference:

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