What is the recommended tapering schedule for fluoxetine (selective serotonin reuptake inhibitor) when reducing the dose from 60mg to 40mg?

From the Research

When tapering fluoxetine from 60mg to 40mg, a hyperbolic and slow tapering schedule is recommended to minimize withdrawal symptoms, as suggested by the most recent and highest quality study 1.

Tapering Schedule

The tapering schedule should be individualized, but a general approach can be applied.

• Reduce the dose by small increments, such as 5-10mg, every 2-4 weeks.
• Monitor the patient for potential discontinuation symptoms, such as dizziness, headache, nausea, or mood changes.
• If symptoms occur, slow the tapering schedule.

Pharmacological Properties

Fluoxetine has a long half-life (2-3 days for the parent drug and 7-9 days for its active metabolite norfluoxetine), which creates a natural tapering effect and reduces the risk of discontinuation symptoms 2.

Clinical Considerations

Some patients may tolerate a direct reduction from 60mg to 40mg without an intermediate step due to this pharmacological property. Always consult with the prescribing healthcare provider before making any medication changes, as individual factors may require personalized adjustments to this general tapering approach.

Key Points

• Hyperbolic and slow tapering schedule recommended 1
• Monitor for discontinuation symptoms and adjust tapering schedule as needed
• Fluoxetine's long half-life reduces the risk of discontinuation symptoms 2
• Individualized tapering schedule may be necessary based on patient factors