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Fluoxetine to MAOI switch — GPhC CRA MCQ

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HardCNS TherapeuticsFluoxetine to MAOI switchGPhC CRA

A patient is switching from fluoxetine 40mg daily to phenelzine after specialist psychiatric review. The pharmacy receives a prescription for phenelzine dated three days after fluoxetine was stopped. What is the most appropriate action?

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

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Correct answer: A — Query the prescription because a longer washout is needed after fluoxetine

Fluoxetine and its active metabolite have long half-lives, so a prolonged washout is required before starting an MAOI. Starting phenelzine too soon risks serotonin syndrome and serious toxicity. The pharmacist should query the prescription with the specialist or prescriber. Cross-tapering SSRIs with MAOIs is unsafe.

Reference: https://www.pharmacyregulation.org/students-and-trainees/pharmacist-education-and-training/registration-assessment