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

Last edited 03/2023 and last reviewed 03/2023

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-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

• 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

• 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

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

• 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.

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