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Fluvoxamine
Aka: Fluvoxamine, Luvox
- Background
- Generic in 2001
- Indications
- Obsessive Compulsive Disorder (OCD)
- 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
- Dosing
- Adults
- Start: 25 mg (half of 50 mg tablet) qhs for 3 days
- Next: 50 mg PO qhs for 7 days
- Next: 50 mg PO bid OR 100 qhs
- Titrate to 150 - 250 mg daily divided bid
- Children (Age 8 years or older)
- Start: 25 mg PO qhs
- Maximum: 200 mg divided bid
- Pharmacokinetics
- Serum half life: 19 hours
- Adverse Effects
- Sedating
- Other neurologic adverse effects include Headache
- Highest Nausea and Vomiting frequency among SSRIs
- Children and teens have a higher rate of Vomiting with Fluvoxamine
- Indigestion and Diarrhea are also reported
- 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
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Drug Interactions
- Substrate: CYP2D6 Substrate
- Inhibitor: CYP1A2, CYP2C19
- Other less potent inhibition at CYP2C9, CYP2D6, CYP3A4
- 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
- Other interactions
- Seldane
- Hismanal
- Xanax
- Precautions
- Relatively safe
- Avoid in Hepatic and Renal Insufficiency
- Avoid in pregnancy and Lactation
- Risk of primary persistent pulmonary Hypertension in Newborns
- No Overdose
- References
- LoVecchio (2022) Crit Dec Emerg Med 36(2): 28