When switching selective serotonin reuptake inhibitors (SSRIs), what is the best way to wean off of one before starting a new prescription (e.g., from sertraline [Zoloft] 200 mg to escitalopram [Lexapro])? — CATHERINE ROZARIO, MD, Little River, S.C.

There is no need to wean when switching from one SSRI to another drug in the same class. A patient taking sertraline 200 mg daily is taking the maximum daily dose of that drug. When switching, instruct the patient to stop the sertraline and start escitalopram 20 mg daily the following day. This is the maximum daily dose for escitalopram.

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Since there is no exact dose equivalent, caution the patient that he or she may experience some lightheadedness or mild nausea during the transition. These symptoms should resolve within a week or two. — Eileen F. Campbell, MSN, CRNP, Associate Program Director, Family Health Nurse Practitioner Program, University of Pennsylvania School of Nursing, Philadelphia (152-08)