switching antidepressant (tricyclic antidepressants (TCA) to monoamine oxidase inhibitors (MAOIs)) in adults
Last edited 03/2023 and last reviewed 03/2023
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.
- after stopping clomipramine or imipramine, wait 21 days before starting low dose MAOI.
Reference:
- NHS Specialist Pharmacy Service (February 2023). Tricyclics to other antidepressants: switching in adults
summary advice - switching from tricyclic antidepressants (TCAs) to another antidepressant