Fluvoxamine Drug Profile

What is Fluvoxamine?

Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) antidepressant medication primarily used to treat obsessive-compulsive disorder and depression. It belongs to the class of medications that work by increasing serotonin levels in the brain. Fluvoxamine was one of the first SSRI medications developed and has been widely used since the 1980s.

Uses

Fluvoxamine is approved and commonly prescribed for several mental health conditions:

• Obsessive-Compulsive Disorder (OCD): The primary FDA-approved indication, helping reduce intrusive thoughts and compulsive behaviors
• Major Depressive Disorder: Treatment of depression symptoms including persistent sadness, loss of interest, and mood changes
• Social Anxiety Disorder: Reducing excessive fear and avoidance of social situations
• Panic Disorder: Prevention and treatment of panic attacks and associated anxiety
• Post-Traumatic Stress Disorder (PTSD): Off-label use for managing trauma-related symptoms

How it works

Fluvoxamine works by blocking the reuptake of serotonin in the brain, which increases the amount of this neurotransmitter available between nerve cells. Serotonin plays a crucial role in regulating mood, anxiety, and obsessive thoughts. By maintaining higher serotonin levels, fluvoxamine helps improve symptoms of depression, OCD, and anxiety disorders over time.

Side effects

Common side effects include:

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• Nausea and stomach upset
• Drowsiness or fatigue
• Headache
• Dizziness
• Dry mouth
• Constipation or diarrhea
• Sleep disturbances or insomnia
• Sexual dysfunction or decreased libido

Serious side effects requiring immediate medical attention:

• Suicidal thoughts or behaviors, especially in young adults
• Serotonin syndrome (fever, muscle rigidity, confusion, rapid heart rate)
• Severe allergic reactions with rash, swelling, or difficulty breathing
• Unusual bleeding or bruising
• Seizures or convulsions

Warnings and precautions

• Black Box Warning: Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults under 25, especially during the first few months of treatment
• Pregnancy considerations: Category C medication that should only be used when benefits outweigh risks; may cause withdrawal symptoms in newborns
• Liver function: Use with caution in patients with liver disease as fluvoxamine is extensively metabolized by the liver
• Discontinuation: Should be tapered gradually rather than stopped abruptly to avoid withdrawal symptoms
• Bipolar disorder: May trigger manic episodes in patients with undiagnosed bipolar disorder

Interactions

Fluvoxamine has numerous significant drug interactions due to its effects on liver enzymes:

• MAO inhibitors: Can cause dangerous serotonin syndrome; require 14-day washout period
• Warfarin: Fluvoxamine increases warfarin levels, raising bleeding risk
• Theophylline: Significantly increases theophylline levels, potentially causing toxicity
• Clozapine: Dramatically increases clozapine levels, requiring dose adjustments
• Benzodiazepines: Enhances effects of diazepam and alprazolam, increasing sedation
• Triptans: Increased risk of serotonin syndrome when combined with migraine medications
• NSAIDs and aspirin: May increase bleeding risk, especially gastrointestinal bleeding
• St. John’s Wort: Herbal supplement that increases serotonin syndrome risk

Check interactions with the GMJ Interaction Checker

Dosage

Typical adult dosing varies by condition and should always be determined by a healthcare provider:

• Obsessive-Compulsive Disorder: Starting dose 50mg daily at bedtime, may increase to 100-300mg daily as tolerated
• Depression: Initial dose 50mg daily, typically increased to 100-200mg daily in divided doses
• Maximum dose: Generally should not exceed 300mg daily for most patients

Doses are typically started low and gradually increased to minimize side effects. The medication should be taken with food to reduce stomach upset. Extended-release formulations may be taken once daily, while immediate-release forms are often divided into multiple daily doses.

Sources: FDA DailyMed drug labels (public domain), BNF, WHO Essential Medicines List. This article is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider before starting or stopping any medication.

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