Protocol for Cross-Tapering Venlafaxine and Sertraline

Introduction to Cross-Tapering

The American College of Physicians recommends a gradual taper of venlafaxine by 25% of the current dose every 1-2 weeks while simultaneously introducing sertraline at a low dose after venlafaxine has been reduced by at least 50% 1

A taper slower than 10% per week might be better tolerated, particularly for patients who have been taking venlafaxine for longer durations, as recommended by the Centers for Disease Control and Prevention 2
The Mayo Clinic recommends beginning with the current dose of venlafaxine and reducing by 25% increments 3, 4
Monitor for withdrawal symptoms which may include drug craving, anxiety, insomnia, abdominal pain, vomiting, diarrhea, diaphoresis, tremor, and tachycardia, as advised by the Centers for Disease Control and Prevention 2

The American College of Physicians recommends beginning introducing sertraline when venlafaxine has been reduced to approximately 50% of the original dose 1
Start sertraline at a low dose and gradually increase as venlafaxine is further reduced, as recommended by the American College of Physicians 1

The Mayo Clinic advises considering adding adjunctive medications temporarily to manage withdrawal symptoms if needed 4
Never abruptly discontinue venlafaxine due to risk of withdrawal syndrome, as recommended by the Mayo Clinic 3, 4
For patients with cardiac disease, monitor more closely as venlafaxine has been associated with cardiac conduction abnormalities, as advised by the Mayo Clinic 4

Tapering too quickly can precipitate withdrawal symptoms, as warned by the Centers for Disease Control and Prevention 2
Failing to monitor for potential drug interactions between the two medications during the overlap period can lead to adverse effects, as cautioned by the American College of Physicians 1