II. Indications
III. Mechanism
- Selective Serotonin Reuptake Inhibitor (SSRI)
- Antiinflammatory effects
- Binds Sigma-1 Receptor on immune cells
- Decreases inflammatory Cytokines
- Decreases inflammatory gene expression on Macrophages and vascular endothelial cells
IV. Background
- Generic in 2001
VI. Dosing: Immediate Release
- Adults
- Start: 25 mg (half of 50 mg tablet) at bedtime for 3 days
- Next: 50 mg orally at bedtime for 7 days
- Next: 50 mg orally twice daily OR 100 mg orally at bedtime
- Titrate to 150 - 250 mg daily divided orally twice daily
- Children (Age 8 years or older)
- Start: 25 mg orally at bedtime
- Maximum: 200 mg divided orally twice daily
VII. Dosing: Controlled Release (CR)
- Adults
- Start 100 mg orally daily at bedtime
- Increase by 50 mg/day each week as tolerated and to effect
- Maximum: 300 mg/day
- Children (Age 8 years or older)
- Start 25 mg orally at bedtime
- Increase by 25 mg/day each week as tolerated and to effect
- Typical effective dose 50 to 200 mg divided twice daily
- Maximum: 200 mg/day (300 mg/day if over age 11 years)
VIII. Pharmacokinetics: Immediate Release
- Serum half life: 19 hours
IX. Adverse Effects
- Sedating
- Other neurologic adverse effects include Headache
- Highest Nausea and Vomiting frequency among SSRIs
- Less anxiety (more Anxiolytic) than other SSRIs
- Behavioral activation is more common in children and teens
- Less Sexual Dysfunction than Prozac, Zoloft, Paxil
- Sexual Dysfunction in 10-15% of cases
- Similar to Celexa and Effexor
- See Antidepressant Induced Sexual Dysfunction
X. Drug Interactions
- Substrate: CYP2D6 Substrate
- Inhibitor: CYP1A2, CYP2C19
-
Methylxanthine interactions
- Avoid with Theophylline (risk of toxicity)
- Increases Caffeine half life
- Raises Tricyclic Antidepressant levels
- Risk of Serotonin Syndrome when combined with SSRIs or MAO Inhibitors
- Avoid use of other serotinergic agents for at least 2 weeks of using Fluvoxamine
- Raises Warfarin (Coumadin) and associated INR levels
- Increases antiplatelet and Anticoagulation activity of other agents
- Contrainidicated with other agents
- Drugs no longer on U.S. market: Terfenadine (Seldane), Astemizole (Hismanal), Cisapride
- Benzodiazepines (esp. Xanax); May use with caution
- Thioridazine
- Alosetron
- Tizanidine
- Tryptophan
XI. Precautions
- Avoid in Hepatic and Renal Insufficiency
- Avoid in pregnancy and Lactation
- Risk of primary persistent pulmonary Hypertension in Newborns
- No significant Overdose complications
XII. Resources
XIII. References
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 38-9
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- LoVecchio (2022) Crit Dec Emerg Med 36(2): 28
Images: Related links to external sites (from Bing)
Related Studies
| fluvoxamine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| FLUVOXAMINE ER 100 MG CAPSULE | Generic | $6.24 each |
| FLUVOXAMINE ER 150 MG CAPSULE | Generic | $6.01 each |
| FLUVOXAMINE MALEATE 100 MG TAB | Generic | $0.32 each |
| FLUVOXAMINE MALEATE 25 MG TAB | Generic | $0.24 each |
| FLUVOXAMINE MALEATE 50 MG TAB | Generic | $0.25 each |