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Text
PSYCHIATRIENET
To see the consequences of a switch between antipsychotics click in the crosstable below: the switch is made "from" (vertical) "to" (horizontal). During switching: don't reduce anticholinergics; consider adding oxazepam. Read: General considerations concerning switching antipsychotics . Rest AP = Chlorprothixene, Flupentixol,Loxapine
PSYCHIATRIENET
Before day 1: Gradually reduce dosage of sertraline to a maximum of 50 mg/ day, when this dosage is > 50 mg/day. Day 1: Start administration of bupropion in a normal dosage of 150 mg/day for one week. Day 8: Continue administration of just bupropion. The editors of psychiatrienet.nl take the greatest care to provide up-to-date andaccurate
PSYCHIATRIENET
Week 1-3: approx. 75% of initial dose. Week 4-6: approx. 50% of initial dose. Week 7-9: approx. 25% of initial dose. Week 10: stop. Start Aripiprazole. Day 1: Start drug at target dose. More information. During this switch you could monitor ECG, especially in patients prone to QT-conduction problems. There is a possibility of QTinterval
PSYCHIATRIENET
Switch medication from citalopram to duloxetine . Before day 1: gradually reduce dosage of citalopram to a maximum of 20 mg/day, when this dosage is > 20 mg/day. Day 1: reduce dosage of citalopram to a maximum of 10 mg/day. Day 8: start administration of duloxetine in a dosage of 30 mg/day. Day 15: increase dosage of duloxetine 60 mg/day.PSYCHIATRIENET
Gradually reduce dosage of sertraline to a maximum of 50 mg/ day, when this dosage is > 50 mg/day. Start mirtazapine. Day 1: reduce sertraline to a dosage of 25 mg/day and start administration of mirtazapine in a normal dosage of 15-30 mg/day for one week. Day 8: stop administration of sertraline and continue administration of justmirtazapine.
PSYCHIATRIENET
Stop mirtazapine. Before day 1: gradually reduce the dosage of mirtazapine to a maximum of 30 mg/day. Day 1: reduce dosage of mirtazapine to 15 mg/day. Day 8: stop administration of mirtazapine. Start trazodone. Day 9: Start administration of trazodone in a dosage of 100-150 mg/day. If necessary, increase dosage of trazodone.PSYCHIATRIENET
A wash-out period is not necessary. Day 8: start administration of mirtazapine in a normal dosage of 15 mg/day. Day 15: increase dosage of mirtazapine to 30 mg/day. The content of trazodone in the tablet, for example 100 mg or 150 mg, determines which exact doses are given. The editors of psychiatrienet.nl take the greatest care to provide upPSYCHIATRIENET
Switch medication from sertraline to fluoxetine . Gradually reduce dosage of sertraline to a maximum of 50 mg/ day, when this dosage is > 50 mg/day. When a dosage of 50 mg/day is reached, stop administration. No wash-out period is needed. Start fluoxetine the next day in normal dosage of 20 mg/day. Occurrence of the serotonin syndrome is notPSYCHIATRIENET
Switch medication from paroxetine to mirtazapine . Stop paroxetine. Day -7: reduce dosage of paroxetine to 20 mg/day, if this dosage is > 20 mg/day. Day 0: dosage of paroxetine is 20 mg/day. Day 1: reduce dosage of paroxetine to 10 mg/day. Day 8: reduce dosage of paroxetine to 5 mg/day. Day 15: stop administration of paroxetine. Startmirtazapine.
PSYCHIATRIENET
Vortioxetine. Wikipedia. Vortioxetine. Switch medication from sertraline to vortioxetine . Stop sertraline. Before day 1: gradually reduce dosage of sertraline to a maximum of 15 mg/day, when this dosage is > 50 mg/day. Day 1: when a dosage of 50 mg/day is reached, stop administration. Start vortioxetine. A wash-out period is notnecessary.
PSYCHIATRIENET
To see the consequences of a switch between antipsychotics click in the crosstable below: the switch is made "from" (vertical) "to" (horizontal). During switching: don't reduce anticholinergics; consider adding oxazepam. Read: General considerations concerning switching antipsychotics . Rest AP = Chlorprothixene, Flupentixol,Loxapine
PSYCHIATRIENET
Before day 1: Gradually reduce dosage of sertraline to a maximum of 50 mg/ day, when this dosage is > 50 mg/day. Day 1: Start administration of bupropion in a normal dosage of 150 mg/day for one week. Day 8: Continue administration of just bupropion. The editors of psychiatrienet.nl take the greatest care to provide up-to-date andaccurate
PSYCHIATRIENET
Week 1-3: approx. 75% of initial dose. Week 4-6: approx. 50% of initial dose. Week 7-9: approx. 25% of initial dose. Week 10: stop. Start Aripiprazole. Day 1: Start drug at target dose. More information. During this switch you could monitor ECG, especially in patients prone to QT-conduction problems. There is a possibility of QTinterval
PSYCHIATRIENET
Switch medication from citalopram to duloxetine . Before day 1: gradually reduce dosage of citalopram to a maximum of 20 mg/day, when this dosage is > 20 mg/day. Day 1: reduce dosage of citalopram to a maximum of 10 mg/day. Day 8: start administration of duloxetine in a dosage of 30 mg/day. Day 15: increase dosage of duloxetine 60 mg/day.PSYCHIATRIENET
Gradually reduce dosage of sertraline to a maximum of 50 mg/ day, when this dosage is > 50 mg/day. Start mirtazapine. Day 1: reduce sertraline to a dosage of 25 mg/day and start administration of mirtazapine in a normal dosage of 15-30 mg/day for one week. Day 8: stop administration of sertraline and continue administration of justmirtazapine.
PSYCHIATRIENET
Stop mirtazapine. Before day 1: gradually reduce the dosage of mirtazapine to a maximum of 30 mg/day. Day 1: reduce dosage of mirtazapine to 15 mg/day. Day 8: stop administration of mirtazapine. Start trazodone. Day 9: Start administration of trazodone in a dosage of 100-150 mg/day. If necessary, increase dosage of trazodone.PSYCHIATRIENET
A wash-out period is not necessary. Day 8: start administration of mirtazapine in a normal dosage of 15 mg/day. Day 15: increase dosage of mirtazapine to 30 mg/day. The content of trazodone in the tablet, for example 100 mg or 150 mg, determines which exact doses are given. The editors of psychiatrienet.nl take the greatest care to provide upPSYCHIATRIENET
Switch medication from sertraline to fluoxetine . Gradually reduce dosage of sertraline to a maximum of 50 mg/ day, when this dosage is > 50 mg/day. When a dosage of 50 mg/day is reached, stop administration. No wash-out period is needed. Start fluoxetine the next day in normal dosage of 20 mg/day. Occurrence of the serotonin syndrome is notPSYCHIATRIENET
Switch medication from paroxetine to mirtazapine . Stop paroxetine. Day -7: reduce dosage of paroxetine to 20 mg/day, if this dosage is > 20 mg/day. Day 0: dosage of paroxetine is 20 mg/day. Day 1: reduce dosage of paroxetine to 10 mg/day. Day 8: reduce dosage of paroxetine to 5 mg/day. Day 15: stop administration of paroxetine. Startmirtazapine.
PSYCHIATRIENET
Vortioxetine. Wikipedia. Vortioxetine. Switch medication from sertraline to vortioxetine . Stop sertraline. Before day 1: gradually reduce dosage of sertraline to a maximum of 15 mg/day, when this dosage is > 50 mg/day. Day 1: when a dosage of 50 mg/day is reached, stop administration. Start vortioxetine. A wash-out period is notnecessary.
PSYCHIATRIENET
Gradually reduce dosage of sertraline to a maximum of 50 mg/ day, when this dosage is > 50 mg/day. Start mirtazapine. Day 1: reduce sertraline to a dosage of 25 mg/day and start administration of mirtazapine in a normal dosage of 15-30 mg/day for one week. Day 8: stop administration of sertraline and continue administration of justmirtazapine.
PSYCHIATRIENET
Switch medication from Aripiprazole to Amisulpride . Stop Aripiprazole. Day 1-21: Continue drug at usual dose. Day 22: Stop drug. Start Amisulpride. Day 1-4: approx. 25% of target dose. Day 5-8: approx. 50% of target dose. Day 9-12: approx. 75% of target dose. Day13: target dose.
PSYCHIATRIENET
Start fluoxetine. A wash-out period is not necessary, but care is needed. Day 8: start administration of fluoxetine in a normal dosage of 20 mg/day. More information. Occurrence of serotonin syndrome is theoretically possible, so caution is necessary. Fluoxetine is a strong inhibitor of CYP2D6, which metabolizes trazodone.PSYCHIATRIENET
Switch medication from fluoxetine to sertraline . Gradually reduce dosage of fluoxetine to a maximum of 20 mg/ day, when this dosage is > 20 mg/day. When a dosage of 20 mg/day is reached, stop administration. No wash-out period is needed. Day 1: start sertraline the next day in low dosage of 25 mg/day. Day 14: increase dosage of sertraline toPSYCHIATRIENET
Trazodone. Switch medication from sertraline to trazodone . Stop sertraline. Before day 1: gradually reduce dosage of sertraline to a maximum of 50 mg/ day, when this dosage is > 50 mg/day. Day 1: reduce dosage of sertraline to 25 mg/day. Day 8: stop administration of sertraline. Start trazodone. Day 9: start trazodone in dosage of100-150 mg/day.
PSYCHIATRIENET
Stop fluoxetine. Gradually reduce dosage of fluoxetine to a maximum of 20 mg/ day, when this dosage is > 20 mg/day. When a dosage of 20 mg/day is reached, stop administration. Start duloxetine. No wash-out period is needed. Day 1: start duloxetine the next day in low dosage of 30 mg/day. Day 28: increase dosage of duloxetine to normal, 60mg/day.
PSYCHIATRIENET
Switch medication from sertraline to escitalopram . Gradually reduce dosage of sertraline to a maximum of 50 mg/ day, when this dosage is > 50 mg/day. When a dosage of 50 mg/day is reached, stop administration. No wash-out period is needed. Start escitalopram the next day in normal dosage of 10 mg/day. Occurrence of the serotonin syndrome isPSYCHIATRIENET
The editors of psychiatrienet.nl take the greatest care to provide up-to-date and accurate information on this site. Nevertheless, mistakes and omissions cannot be entirely excluded. No rights devolve from the information provided. The editors and other providers of information to this site accept no responsibility for the content ofthis site
PSYCHIATRIENET
Switch medication from clomipramine to mirtazapine . Before day 1: gradually reduce dosage of clomipramine to a maximum of 25-50 mg/day. Day 1: reduce dosage of clomipramine to 25 mg/day. Day 3: reduce dosage of clomipramine to 10 mg/day. Day 1: simultaneously start administration of mirtazapine in a normal dosage of 30 mg/day.PSYCHIATRIENET
The editors of psychiatrienet.nl take the greatest care to provide up-to-date and accurate information on this site. Nevertheless, mistakes and omissions cannot be entirely excluded.PSYCHIATRIENET
Switching Antipsychotics (part of www.switchwiki.eu; an app ('switchtabellen') is available) To see the consequences of a switch between antipsychotics click in the crosstable below: the switch is made "from" (vertical) "to" (horizontal).PSYCHIATRIENET
The editors of psychiatrienet.nl take the greatest care to provide up-to-date and accurate information on this site. Nevertheless, mistakes and omissions cannot be entirely excluded.PSYCHIATRIENET
During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. ↑ Vieta E at al, Efficacy and safety of quetiapine in combination with lithium or divalproex for maintenance of patients with bipolar IPSYCHIATRIENET
Flupenthixol LA-Paliperidone LA. There are 2 switch possibities: . Number 1 (the general approach): Day 1: Switch to oral risperidone (or oral paliperidone): see this switch in the main cross table. Day 1-29: Maintain on oral risperidone (or oral paliperidone) and examine the effects. Day 30: stop oral risperidone (or oral paliperidone) and administer paliperidone-LA: see this switch in thePSYCHIATRIENET
Switching Antipsychotics (part of www.switchwiki.eu; an app ('switchtabellen') is available) To see the consequences of a switch between antipsychotics click in the crosstable below: the switch is made "from" (vertical) "to" (horizontal).PSYCHIATRIENET
The editors of psychiatrienet.nl take the greatest care to provide up-to-date and accurate information on this site. Nevertheless, mistakes and omissions cannot be entirely excluded.PSYCHIATRIENET
During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. ↑ Vieta E at al, Efficacy and safety of quetiapine in combination with lithium or divalproex for maintenance of patients with bipolar IPSYCHIATRIENET
Flupenthixol LA-Paliperidone LA. There are 2 switch possibities: . Number 1 (the general approach): Day 1: Switch to oral risperidone (or oral paliperidone): see this switch in the main cross table. Day 1-29: Maintain on oral risperidone (or oral paliperidone) and examine the effects. Day 30: stop oral risperidone (or oral paliperidone) and administer paliperidone-LA: see this switch in thePSYCHIATRIENET
Combining Moodstabilizers (part of www.switchwiki.eu; an app ('switchtabellen') is available) To see the consequences of combining mood stabilizers click in the cross table below: the combination is made "from" (vertical) "to" (horizontal).PSYCHIATRIENET
The editors of psychiatrienet.nl take the greatest care to provide up-to-date and accurate information on this site. Nevertheless, mistakes and omissions cannot be entirely excluded.PSYCHIATRIENET
Day 9: start trazodone in dosage of 100-150 mg/day. Day 14: If necessary, increase the dosage of trazodone every 3-4 days with 50 mg to a maximum of 400 mg/day.PSYCHIATRIENET
During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. ↑ Vieta E at al, Efficacy and safety of quetiapine in combination with lithium or divalproex for maintenance of patients with bipolar IPSYCHIATRIENET
↑The UK Drug and Therapeutics Bulletin; 1999;37:49-52 ↑ Editor: please note that not all dosages are available in pharmacy. So now and then you should be creative. ↑ Rosenbaum JF et al. Selective serotonin reuptake inhibitor discontinuation syndrome: a randomized clinical trial. Biol Psychiatry. 1998 Jul 15;44(2):77-87 ↑ Haddad PM. Antidepressant discontinuation syndromes.* DSM-5
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