fluvoxamine LUVOX
Class: SSRIFDA Indications: OCD
Off-Label Use: Bulimia Nervosa, Depression, Panic Disorder, PTSD, Social Anxiety
Prescribing
Forms: 25, 50, 100mg tabletDose Range: 50-300 mg/day
Starting: Start at 50 mg qd then ↑ by 50 mg increments q4-7 days, usual dose range 100-300mg qd
Stopping: A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible
Precautions
Contraindications: Concomitant use of MAOIsSerious Side Effects: Serotonin syndrome; ↑ risk of SI in children and young adults; may impair platelet aggregation; SIADH
Side Effects: headache, sedation/somnolence, insomnia, dizziness, anxiety, diarrhea, nausea, xerostomia, anorexia, anorgasmia, weakness/asthenia
Pharmacodynamics
1° MOA: Selective serotonin reuptake inhibitor2° MOA: Sigma-1 receptor agonism
Target: SERT, σ1R
Pharmacokinetics
t½: 16 (9-28)° TMAX: 1.5-8°Substrate of: 1A2, 2D6
Inhibits: 1A2 & 2C19 (potent, even at low doses), 2B6, 2C9 & 3A4 (moderate), 2D6 (weak); Induces: ∅
Active Metabolites: ∅
DDIs
- - a veritable "pan-inhibitor," possible interactions via CYP inhibition are legion
- - particular attention should be paid to other drugs with narrow therapeutic indices e.g. theophylline, warfarin, phenytoin & 3° TCAs; be cautious when adding any drug to fluvoxamine–"Start low, go slow!"
- - caffeine is also a 1A2 substrate, so Luvox can make that morning cup of coffee a lot more stimulating!
- - a 1A2 substrate itself, its own concentrations can be decreased by cigarette smoke's 1A2 induction
- - nonlinear pharmacokinetics; inhibits its own metabolism
Misc
- - σ1R properties may explain rapid-onset effects on anxiety & insomnia, and pro-cognitive effects in treatment of psychotic depression & schizophrenia
- - may have ↓ sexual SEs than other SSRIs
- - can be cautiously combined with clomipramine for treatment-resistant OCD
- - considered to be the "weight neutral" SSRI
- - actually ↓'s QTc by -5 msec
Special Populations
Category C—A case study of 26 infants exposed to fluvoxamine in utero reported that exposure was not associated with increased risk of malformations, lower birth weights, or younger gestational age.
RID 1-2%; ∅AE's have been reported
Consider a lower dose, titrate slower.
No dosage adjustment necessary.
No dosage adjustments in manufacturer's labeling. Limited data suggest clearance ↓ in patients with impairment
References
Luvox Package InsertOverview Of The Pharmacokinetics Of Fluvoxamine.
The American Psychiatric Publishing Textbook Of Psychopharmacology
Drugbank
Concise Guide To Drug Interaction Principles For Medical Practice
The Use Of Antidepressants In Pregnancy And Lactation
Sigma-1 Receptor Agonists As Therapeutic Drugs For Cognitive Impairment In Neuropsychiatric Diseases
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