fluvoxamine

N06AB08

Forms & Strengths

Adult Dosing

Obsessive-Compulsive Disorder (OCD): Initial 50 mg orally once daily at bedtime; titrate by 50 mg every 4-7 days; max 300 mg/day (doses >100 mg/day should be divided twice daily)
Social Anxiety Disorder (ER formulation): Initial 100 mg once daily; titrate by 100 mg at intervals of at least 1 week; max 300 mg/day

Pediatric Dosing

OCD (Pediatric 8-17 years): Initial 25 mg once daily at bedtime; titrate by 25 mg every 4-7 days as tolerated; max 200 mg/day (children) or 300 mg/day (adolescents); doses >50 mg/day should be divided twice daily

Indications

Mechanism of Action

Selective serotonin reuptake inhibitor (SSRI); potent inhibitor of serotonin reuptake at the neuronal membrane, enhancing serotonergic neurotransmission
Sigma-1 receptor agonist (high affinity), which may contribute to anxiolytic and neuroprotective properties

Contraindications

Concurrent use of monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing them
Concurrent use of pimozide, tizanidine, or alosetron
Hypersensitivity to fluvoxamine or any excipients

Adverse Reactions

Nausea, vomiting, diarrhea, dry mouth, dyspepsia, anorexia
Somnolence, insomnia, dizziness, nervousness, tremor, headache
Asthenia, sweating, palpitations
Sexual dysfunction (ejaculatory delay, decreased libido)
Rare: Serotonin syndrome, suicidal thoughts/behaviors (in young adults), hyponatremia, SIADH, QT prolongation

Drug Interactions

Strong inhibitor of CYP1A2 and CYP2C19; moderate inhibitor of CYP2C9, CYP3A4, and CYP2D6; significant potential to increase levels of substrates such as clozapine, tizanidine, warfarin, and theophylline
MAOIs and other serotonergic agents (e.g., triptans, tramadol, linezolid): increased risk of serotonin syndrome
CYP1A2 inducers (e.g., tobacco smoke): may decrease fluvoxamine plasma concentrations
Drugs that prolong QT interval: potential additive risk of arrhythmias

Curated Content: Needs Vetting Before Put to Clinical Use