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Fluvoxamine

Brands and Forms

  • Luvox
    • tablet: 25mg, 50mg scored, 100mg scored.
    • extended-release capsule: 100mg, 150mg.
  • Fevarin
  • Faverin
  • Dumyrox
  • Favoxil
  • Movox

Uses of Fluvoxamine

Fluvoxamine is commonly used for treating Depressive Disorders (including Major Depressive Disorder, Dysthymia, and Premenstrual Dysphoric Disorder) and Anxiety Disorders (including Panic Disorder, Generalized Anxiety Disorder, Social Phobia, PTSD, and Obsessive-Compulsive Disorder).

It can also be used for treating Bulimia Nervosa, Binge-Eating Disorder, Hypochondriasis, Body Dysmorphic Disorder, Trichotillomania, Depression in Bipolar Disorder, and impulsive behaviors associated with Borderline Personality Disorder and Dementia.

How Fluvoxamine Works

Fluvoxamine is an SSRI antidepressant. It blocks serotonin reuptake at the serotonin transporter, and thus boosts serotonin actions in the central nervous system. Fluvoxamine also desensitizes serotonin 1a autoreceptors.

Cautions when Using Fluvoxamine

Fluvoxamine can induce Manic or Mixed Episodes and Rapid Cycling in people with Bipolar Disorder.

Children and adolescents who use antidepressants like Fluvoxamine may develop self-injurious or suicidal behaviors (for more information, see here).

Use with caution in people with a known seizure disorder, and in those who are taking anticoagulant (blood thinning) medication.

Long-term use of SSRI antidepressants like Fluvoxamine has been associated with increased risk of osteoporosis and bone fractures in individuals over age 50.

Dangerous heart arrhythmias could occur if Fluvoxamine is combined with Thioridazine or Pimozide.

Fluvoxamine should not be used during or within 14 days following the administration of an MAOI, because a hypertensive crisis may result.

Dosing of Fluvoxamine

The usual therapeutic range of Fluvoxamine is 100-200mg/day; doses of up to 300mg/day may be required for Obsessive-Compulsive Disorder or for other kinds of conditions that are difficult to treat.

When using the immediate-release tablet, intial dose is 25-50mg/day, which can be raised within the first week or two to 100mg/day. Thereafter, it is recommended to wait 4 weeks for therapeutic effects to take place before deciding to increase the dose. Dose increases are usually done in 50mg increments at 2-week intervals to allow time for therapeutic effects to appear.

Because Fluoxetine can be sedating, doses of the immediate-release tablet of 100mg/day or less should be given at bedtime. Higher doses can be given twice a day, with the larger dose at bedtime, but can also be given as a single dose at bedtime.

The extended-release capsule is started at 100mg/day, given once daily at bedtime, and can be increased in 50mg increments every week or two.

When wanting to stop this medication, the dose should be decreased gradually over a period of 6-8 weeks. A sudden cessation of the medication can result in an SSRI discontinuation syndrome.

Onset of action

Therapeutic effects are not expected before 2-4 weeks at a dose of 100mg/day. If no significant effects are seen after 6-8 weeks of use, including at least 2 weeks at a dose above 100mg/day, then the medication may not work at all.

Kidney impairment

No dose adjustment needed.

Liver impairment

Lower dose by about half, or give less frequently.

Side-effects of Fluvoxamine

Below is a list of most of the reported side-effects of Fluvoxamine. Most of these side-effects occur in only a minority of individuals, and many also resolve with time while the medication is continued.

Cardiovascular: postural hypotension; vasodilation.

Central Nervous System: dizziness; virtigo; headache; somnolence; weakness; insomnia; confusion; incoordination; paresthesia; fever; tremor; decreased libido (see below on managing sexual side-effects); akathisia and other extrapyramidal symptoms (rare); seizures (very rare); serotonin syndrome (very rare).

Dermatologic: excessive sweating; itchiness; flushing; rash; hair loss (rare).

Endocrine/Metabolic: weight loss; elevated prolactin (very rare); SIADH (very rare).

Eyes, Ears, Nose and Throat: blurred vision; nasal congestion; sneezing; sore throat.

Gastrointestinal: nausea; dry mouth; diarrhea; dyspepsia; vomiting; abdominal pain; flatulence; appetite loss; GI hemorrhage (rare, due to the blood-thinning effects of the medication).

Genitourinary: ejaculation disorder (see below on managing sexual side-effects); impotence; abnormal orgasm; excessive urination.

Hematologic: increases bleeding time (thins the blood); easy bruising; thrombocytopenia; thrombosis.

Muskuloskeletal: joint and muscle pain; risk of osteoporosis and bone fractures with long-term use.

Psychiatric: anxiety; agitation; apathy; worsening depression; suicidal thoughts (overall, Fluvoxamine use helps to lower risk of suicide); self-injurious behaviors among children and adolescents; can induce Manic or Mixed Episodes and Rapid Cycling in people with Bipolar Disorder.

Respiratory: upper respiratory tract infection; rhinitis; sinusitis; coughing.

Common side-effects of Fluvoxamine

Constipation, nausea, dizziness/virtigo, headache, somnolence/fatigue, vomiting, diarrhea, dry mouth, restlessness, sexual dysfunction (see below on managing sexual side-effects). Most of these side-effects resolve after a few weeks.

Rare but serious side-effects of note of Fluvoxamine

Children and adolescents who use antidepressants like Fluvoxamine may develop self-injurious or suicidal behaviors (for more information, see here).

SSRI discontinuation syndrome

Individuals who suddenly stop using Fluvoxamine after taking the medication at moderate or high doses over a significant period of time are at risk of developing a discontinuation syndrome, which can include the following symptoms: dizziness, electric shock-like sensations, sweating, nausea, insomnia, tremor, anxiety, restlessness, agitation, depressed mood, irritability, confusion, lethargy, and vertigo. These symptoms usually start anywhere from one day to one week after the medication was stopped, and can persists for days or even weeks.

This syndrome can be treated by restarting the medication at its prior dose. It can be prevented by decreasing the dose gradually over a period of 6-8 weeks when wanting to stop the medication. In rare cases, individuals may experience the discontinuation syndrome even when the medication is being tapered gradually; in such cases, an extremely slow and gradual taper will be necessary.

Managing sexual side-effects of Fluvoxamine

The first step to manage this is to try to lower the dose of the Fluvoxamine. If this is not possible, or is not an effective solution, then either Bupropion, or Sildenafil (Viagra) or Vardenafil (Levitra), can be added [ref]. (Sildenafil and Vardenafil can be effective for female sexual side-effects as well, including difficulty achieving orgasm [ref, ref]). Note that Fluvoxamine can cause elevated blood concentrations of Sildenafil.

Bupropion and Mirtazepine are two antidepressants that tend to have very low rates of sexual side-effects.

Fluvoxamine overdose

Sedation, dizziness, vomiting, diarrhea, irregular heart beat, low blood pressure, breathing difficulties, seizures, coma. Can be fatal.

Fluvoxamine and pregnancy

Category C: some animal studies show adverse effects at very high doses, but no controlled human studies have been done; should only be used in pregnancy if clearly needed and if benefits outweigh potential risks. For further information, see the section on treating Depression in pregnancy.

Medical Monitoring for Fluvoxamine

None for healthy individuals.

Drug Interactions with Fluvoxamine

  • Caution should be used when combining Fluvoxamine with other medications that can increase bleeding time and reduce blood clotting, including Aspirin, NSAIDs, anti-platelet agents, Heparin and Coumadin.
  • Combination with other serotonergic medications, including SSRI antidepressants, could potentially precipitate a serotonin syndrome.
  • Dangerous heart arrhythmias could occur if Fluvoxamine is combined with Thioridazine or Pimozide.
  • Fluvoxamine should not be used during or within 14 days following the administration of an MAOI, because a hypertensive crisis may result.
  • Fluvoxamine can increase blood concentrations of benzodiazepines, beta-blockers, Carbamazepine, Clozapine, Lidocaine, Methadone, Mexiletine, Phenytoin, Sildenafil, proton pump inhibitors, Quinidine, Ramelteon, Ropivacaine, Tacrine, Theophylline, and Tricyclic Antidepressants.
  • Cyproheptadine can decrease the pharmacological effects of Fluvoxamine.