II. Background

  1. Generic in 2001

III. Indications

IV. 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

V. 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

VI. Pharmacokinetics

  1. Serum half life: 19 hours

VII. 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

VIII. 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

IX. 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

X. References

  1. LoVecchio (2022) Crit Dec Emerg Med 36(2): 28

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Related Studies

Cost: Medications

fluvoxamine (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
FLUVOXAMINE ER 100 MG CAPSULE Generic $6.52 each
FLUVOXAMINE ER 150 MG CAPSULE Generic $7.43 each
FLUVOXAMINE MALEATE 100 MG TAB Generic $0.25 each
FLUVOXAMINE MALEATE 25 MG TAB Generic $0.17 each
FLUVOXAMINE MALEATE 50 MG TAB Generic $0.21 each

Ontology: Fluvoxamine (C0085228)

Definition (NCI_NCI-GLOSS) A drug used to treat obsessive-compulsive disorder. It is a type of antidepressant agent and selective serotonin reuptake inhibitor (SSRI).
Definition (NCI) A 2-aminoethyl oxime ether of aralkylketones, with antidepressant, antiobsessive-compulsive, and anxiolytic properties. Fluvoxamine, chemically unrelated to other selective serotonin reuptake inhibitors, selectively blocks serotonin reuptake by inhibiting the serotonin reuptake pump at the presynaptic neuronal membrane. This increases serotonin levels within the synaptic cleft, prolongs serotonergic transmission and decreased serotonin turnover, thereby leading to antidepressant, anxiolytic and antiobsessive-compulsive effects. Fluvoxamine shows no significant affinity for histaminergic, alpha or beta adrenergic, muscarinic, or dopaminergic receptors in vitro.
Definition (MSH) A selective serotonin reuptake inhibitor that is used in the treatment of DEPRESSION and a variety of ANXIETY DISORDERS.
Definition (CSP) selective serotonin reuptake inhibitor effective in treatment of depression, obsessive compulsive disorders, anxiety, panic disorders, and alcohol amnestic disorders.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D016666
SnomedCT 372905008, 96213009
LNC LP14994-5, MTHU002297
English Fluvoxamine, 1-Pentanone, 5-methoxy-1-(4-(trifluoromethyl)phenyl)-, O-(2-aminoethyl)oxime, (E)-, Fluvoxamine [Chemical/Ingredient], fluvoxaMINE, fluvoxamine, FLUVOXAMINE, Fluvoxamine (product), Fluvoxamine (substance), Fluoxamine
Swedish Fluvoxamin
Czech fluvoxamin
Finnish Fluvoksamiini
Russian FLUVOKSAMIN, ФЛУВОКСАМИН
Japanese フルボキサミン
Polish Fluwoksamina
Spanish fluvoxamina (producto), fluvoxamina (sustancia), fluvoxamina, Fluvoxamina
French Fluvoxamine
German Fluvoxamin
Italian Fluvoxamina
Portuguese Fluvoxamina

Ontology: Luvox (C0086307)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D016666
English luvox, Luvox, Faverin, Dumirox, Fevarin, Floxyfral, Solvay Brand of Fluvoxamine Maleate