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Moclobemide to fluoxetine switch — GPhC CRA MCQ

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HardCNS TherapeuticsMoclobemide to fluoxetine switchGPhC CRA

A patient has completed a gradual moclobemide taper and took the final dose at 08:00 today. The GP asks when fluoxetine can be started. Assuming no other serotonergic medicine or clinical complication, what is the recommended switch?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Wait 24 hours after the last moclobemide dose, then start fluoxetine cautiously

NHS SPS advises tapering and stopping moclobemide, then waiting 24 hours before starting an SSRI. Cross-tapering is not recommended because combined serotonergic and monoamine-oxidase inhibition can cause serotonin syndrome. The longer washout commonly associated with switching from fluoxetine applies in the opposite direction because fluoxetine and norfluoxetine persist for weeks.

Reference: NHS SPS, Moclobemide to other antidepressants—switching in adults: https://www.sps.nhs.uk/articles/moclobemide-to-other-antidepressants-switching-in-adults/