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Resources › Psychotropics A-Z › Fluvoxamine | Luvox | Luvox
Selective Serotonin Reuptake Inhibitor (SSRI)

Fluvoxamine | Luvox

Clinical Overview

Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) indicated for the treatment of obsessive-compulsive disorder (OCD) in adults and children, and social anxiety disorder in adults. It has a unique pharmacological profile among SSRIs with significant inhibition of multiple cytochrome P450 enzymes.

Primary Clinical Applications

Fluvoxamine is particularly effective for OCD and is considered a first-line treatment for this condition. It has also demonstrated efficacy in social anxiety disorder, panic disorder, and depression, though it is less commonly used for depression compared to other SSRIs due to its side effect profile.

Mechanism and Pharmacological Considerations

Fluvoxamine selectively inhibits serotonin reuptake with minimal effects on norepinephrine or dopamine. It has potent inhibitory effects on CYP1A2 and moderate effects on CYP2C19 and CYP3A4, leading to significant drug interaction potential that requires careful medication management.

Clinical Advantages and Considerations

The medication has a relatively short half-life requiring twice-daily dosing for immediate-release formulations. The controlled-release formulation allows for once-daily dosing and may have improved tolerability. Fluvoxamine may be particularly useful in patients with comorbid OCD and depression.

Prescribing Information

Dosing & Administration

OCD – Adults (Immediate Release):

  • Initial: 50 mg at bedtime
  • Titration: Increase by 50 mg every 4-7 days
  • Range: 100-300 mg daily
  • Doses >100 mg: Divide into twice daily dosing

OCD – Children (8-17 years):

  • Initial: 25 mg at bedtime
  • Titration: Increase by 25 mg every 4-7 days
  • Maximum: 200 mg daily (children), 300 mg daily (adolescents)

Social Anxiety Disorder (CR formulation):

  • Initial: 100 mg at bedtime
  • Range: 100-300 mg daily

Indications

  • Obsessive-compulsive disorder (adults and children ≥8 years)
  • Social anxiety disorder (adults, CR formulation)
  • Off-label: Depression, panic disorder, PTSD

Contraindications

  • Hypersensitivity to fluvoxamine
  • Concurrent use with MAOIs (within 14 days)
  • Concurrent use with pimozide, thioridazine, or alosetron
  • Use with linezolid or IV methylene blue

Warnings & Precautions

  • Boxed Warning: Increased risk of suicidal thoughts and behavior in patients under 25 years
  • Serotonin syndrome: Risk with concurrent serotonergic drugs
  • Activation of mania: Monitor for mood changes in bipolar patients
  • Withdrawal syndrome: Taper gradually when discontinuing
  • Bleeding risk: Increased risk with anticoagulants

Drug Interactions

  • CYP1A2 substrates: Significantly increased levels (theophylline, clozapine)
  • Warfarin: Increased anticoagulant effect
  • Benzodiazepines: Increased levels of alprazolam, diazepam
  • TCAs: Increased tricyclic levels
  • MAOIs: Contraindicated – serotonin syndrome risk

Adverse Reactions

Common (≥10%):

  • Nausea, somnolence, insomnia, dizziness, nervousness
  • Tremor, diarrhea, dyspepsia

Sexual:

  • Abnormal ejaculation, impotence, decreased libido

Special Populations

  • Hepatic Impairment: Reduce dose and titrate slowly
  • Elderly: Start with lower doses, monitor for hyponatremia
  • Pregnancy: Category C – use only if benefits outweigh risks
  • Pediatric: Monitor growth and development during treatment
Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. Always consult with qualified healthcare professionals before making any treatment decisions. Individual patient circumstances may vary significantly.