Tapering Sertraline and Switching to Fluoxetine

Sertraline Tapering Process

The American Academy of Family Physicians recommends reducing sertraline by 25% of the current dose every 1-2 weeks (e.g., from 100 mg to 75 mg, then to 56.25 mg, etc.) 1
If withdrawal symptoms occur, the Mayo Clinic suggests slowing the taper rate or temporarily returning to the previous dose until symptoms subside 2
Continue tapering until reaching the lowest available dose (typically 25 mg for sertraline), as recommended by the American Academy of Family Physicians 1

The American Academy of Family Physicians recommends starting fluoxetine at a low dose (10 mg every other morning) after sertraline is completely discontinued or at a very low dose 1
Fluoxetine's very long half-life makes it less likely to cause withdrawal symptoms when eventually discontinued, according to the American Academy of Family Physicians 1
Increase fluoxetine gradually as needed up to 20 mg every morning, as suggested by the American Academy of Family Physicians 1
Monitor for side effects which may include activation, nervousness, insomnia, and gastrointestinal disturbances, as recommended by the American Academy of Family Physicians 1

The Mayo Clinic recommends scheduling more frequent follow-up appointments during the tapering and switching period to assess for return of original symptoms and emergence of withdrawal symptoms, although this specific recommendation is from Praxis Medical Insights, a similar recommendation can be found from the Mayo Clinic 2

The Mayo Clinic suggests considering adding adjunctive medications temporarily to manage withdrawal symptoms if needed (e.g., trazodone for insomnia) 5
Withdrawal symptoms should be preempted and treated with liberal use of adjuvant agents along with adequate clinician support, as recommended by the Mayo Clinic 2

The American Academy of Family Physicians recommends avoiding starting fluoxetine at too high a dose, which may increase side effects 1