A case with occurring adverse effects when cross-over titration from fluvoxamine to paroxetine associated with increasing the plasma fluvoxamine level in major depressive disorder

Selective serotonin reuptake inhibitors (SSRIs) are first line drugs for treating not only depressive disorder but also anxiety disorder. Fluvoxamine, a SSRI, is mainly metabolized by cytochrome P450 (CYP) 2D6 and 1A2. However, paroxetine, an another SSRI is potent inhibitor for CYP 2D6. We report a case with depression whose plasma fluvoxamine level rapidly increased after the addition of paroxetine while switching from fluvoxamine to paroxetine. The case indicates that emerging adverse effects via the pharmacokinetic interaction of these drugs when switching patients from fluvoxamine to paroxetine can occur.