Pharm

Fluvoxamine

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Fluvoxamine, Luvox

  • See Also
  1. Selective Serotonin Reuptake Inhibitor (SSRI)
  • Indications
  1. Obsessive Compulsive Disorder (OCD)
  • Mechanism
  1. Selective Serotonin Reuptake Inhibitor (SSRI)
  2. Antiinflammatory effects
    1. Binds Sigma-1 Receptor on immune cells
    2. Decreases inflammatory Cytokines
    3. Decreases inflammatory gene expression on Macrophages and vascular endothelial cells
  • Background
  1. Generic in 2001
  • Safety
  1. Pregnancy Category C
  2. Avoid in Lactation
  3. Indications to decrease dose
    1. Liver disease
  • Dosing
  • Immediate Release
  1. Adults
    1. Start: 25 mg (half of 50 mg tablet) at bedtime for 3 days
    2. Next: 50 mg orally at bedtime for 7 days
    3. Next: 50 mg orally twice daily OR 100 mg orally at bedtime
    4. Titrate to 150 - 250 mg daily divided orally twice daily
  2. Children (Age 8 years or older)
    1. Start: 25 mg orally at bedtime
    2. Maximum: 200 mg divided orally twice daily
  • Dosing
  • Controlled Release (CR)
  1. Adults
    1. Start 100 mg orally daily at bedtime
    2. Increase by 50 mg/day each week as tolerated and to effect
    3. Maximum: 300 mg/day
  2. Children (Age 8 years or older)
    1. Start 25 mg orally at bedtime
    2. Increase by 25 mg/day each week as tolerated and to effect
    3. Typical effective dose 50 to 200 mg divided twice daily
    4. Maximum: 200 mg/day (300 mg/day if over age 11 years)
  • Pharmacokinetics
  • Immediate Release
  1. Serum half life: 19 hours
  • Adverse Effects
  1. Sedating
    1. Other neurologic adverse effects include Headache
  2. Highest Nausea and Vomiting frequency among SSRIs
    1. Children and teens have a higher rate of Vomiting with Fluvoxamine
    2. Indigestion and Diarrhea are also reported
  3. Less anxiety (more Anxiolytic) than other SSRIs
  4. Behavioral activation is more common in children and teens
  5. Less Sexual Dysfunction than Prozac, Zoloft, Paxil
    1. Sexual Dysfunction in 10-15% of cases
    2. Similar to Celexa and Effexor
    3. See Antidepressant Induced Sexual Dysfunction
  • Drug Interactions
  1. Substrate: CYP2D6 Substrate
  2. Inhibitor: CYP1A2, CYP2C19
    1. Other less potent inhibition at CYP2C9, CYP2D6, CYP3A4
  3. Methylxanthine interactions
    1. Avoid with Theophylline (risk of toxicity)
    2. Increases Caffeine half life
  4. Raises Tricyclic Antidepressant levels
  5. Risk of Serotonin Syndrome when combined with SSRIs or MAO Inhibitors
    1. Avoid use of other serotinergic agents for at least 2 weeks of using Fluvoxamine
  6. Raises Warfarin (Coumadin) and associated INR levels
  7. Increases antiplatelet and Anticoagulation activity of other agents
  8. Contrainidicated with other agents
    1. Drugs no longer on U.S. market: Terfenadine (Seldane), Astemizole (Hismanal), Cisapride
    2. Benzodiazepines (esp. Xanax); May use with caution
    3. Thioridazine
    4. Alosetron
    5. Tizanidine
    6. Tryptophan
  • Precautions
  1. Avoid in Hepatic and Renal Insufficiency
  2. Avoid in pregnancy and Lactation
    1. Risk of primary persistent pulmonary Hypertension in Newborns
  3. No significant Overdose complications
  • Resources
  1. Fluvoxamine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=8f0ff905-5eb3-4ad0-ad31-fe35b924211f
  • References
  1. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 38-9
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  3. LoVecchio (2022) Crit Dec Emerg Med 36(2): 28