Pharm
Fluvoxamine
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Fluvoxamine
, Luvox
Background
Gene
ric in 2001
Indications
Obsessive Compulsive Disorder
(OCD)
Mechanism
Selective Serotonin Reuptake Inhibitor
(
SSRI
)
Antiinflammatory effects
Binds Sigma-1 Receptor on immune cells
Decreases inflammatory
Cytokine
s
Decreases inflammatory gene expression on
Macrophage
s 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
SSRI
s
Children and teens have a higher rate of
Vomiting
with Fluvoxamine
Indigestion and
Diarrhea
are also reported
Less anxiety (more
Anxiolytic
) than other
SSRI
s
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
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
SSRI
s or
MAO inhibitor
s
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
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