Switch medication from nortriptyline to bupropion.
Stop nortriptyline
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Before day 1: gradually reduce dosage of nortriptyline to a maximum of 50 mg/ day, when this dosage is > 50 mg/day.
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Day 1-3: reduce dosage of nortriptyline to 25 mg/day.
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Day 4-7: reduce dosage of nortriptyline to 10 mg/day.
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Day 8: stop administration of nortriptyline.
Start bupropion
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Day 1: simultaneously start administration of bupropion in a dosage of 150 mg/day and continue administration of nortriptyline according to the scheme above.
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Day 8: stop administration of nortriptyline and continue administration of bupropion.
More information
- Bupropion is a strong inhibitor of CYP2D6, which metabolizes nortriptyline.
- Caution with this switch is necessary.
- The concomitant use of bupropion and tricyclic antidepressants (TCAs) may potentiate the risk of seizures. These agents are all epileptogenic and may have additive effects on the seizure threshold.
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