Fluvoxamine

Aka: Fluvoxamine, Luvox

1. Background
   1. Generic in 2001
2. Indications
   1. Obsessive Compulsive Disorder (OCD)
3. 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
4. Dosing
   1. Adults
      1. Start: 25 mg (half of 50 mg tablet) qhs for 3 days
      2. Next: 50 mg PO qhs for 7 days
      3. Next: 50 mg PO bid OR 100 qhs
      4. Titrate to 150 - 250 mg daily divided bid
   2. Children (Age 8 years or older)
      1. Start: 25 mg PO qhs
      2. Maximum: 200 mg divided bid
5. Pharmacokinetics
   1. Serum half life: 19 hours
6. 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
7. 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. Other interactions
      1. Seldane
      2. Hismanal
      3. Xanax
8. Precautions
   1. Relatively safe
   2. Avoid in Hepatic and Renal Insufficiency
   3. Avoid in pregnancy and Lactation
      1. Risk of primary persistent pulmonary Hypertension in Newborns
   4. No Overdose
9. References
   1. LoVecchio (2022) Crit Dec Emerg Med 36(2): 28