Fluvoxamine: Difference between revisions

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{{MedTemplate

| generic = Fluvoxamine

| generic = Fluvoxamine (maleate)

| brand = Luvox

| brand = Luvox (US brand discontinued; generic widely available), Luvox CR, Faverin (other markets)

| classes = SSRI, Antidepressant

| structure =

| mechanism = Selective serotonin reuptake inhibitor

| classes = [[:Category:SSRIs|Selective serotonin reuptake inhibitor (SSRI)]], [[:Category:Antidepressants|Antidepressant]], [[:Category:Anxiolytics|Anxiolytic]]

| uses = <vote slug="ocd-use">Obsessive-compulsive disorder (FDA; '''the first FDA-approved OCD medicine''', 1994)</vote>, <vote slug="social-anxiety-disorder-use">Social anxiety disorder (FDA, Luvox CR)</vote>, <vote slug="major-depressive-disorder-use">Major depressive disorder (off-label in US; FDA in many other markets)</vote>, <vote slug="ptsd-use">Posttraumatic stress disorder (off-label)</vote>, <vote slug="panic-disorder-use">Panic disorder (off-label)</vote>, <vote slug="covid19-outpatient-fluvoxamine-use">COVID-19 outpatient treatment (off-label; TOGETHER trial signal followed by mixed replication, sigma-1 anti-inflammatory rationale)</vote>

| starting_dose = 50 mg PO at bedtime; titrate by 50 mg every 4-7 days to clinical effect. Total daily doses >100 mg divided BID. Luvox CR: 100 mg PO once daily, may titrate to 300 mg/day

| preparations = IR tablets 25, 50, 100 mg; Luvox CR capsules 100, 150 mg

| fda_max = 300 mg/day (IR or CR)

| pill_id =

| routes = Oral

| onset = OCD effect over 1-2 weeks initial, with full effect typically 6-12 weeks; among the slowest SSRIs for OCD response

| duration = BID at higher doses (IR); once-daily (CR)

| halflife = ~15 hours (IR)<ref name="luvox-label">FDA Prescribing Information, Luvox CR (fluvoxamine maleate extended-release), Jazz Pharmaceuticals, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021519s019lbl.pdf</ref>

| bioavailability = ~53% (oral)<ref name="luvox-label" />

| pregnancy = Observational signal for neonatal adaptation syndrome with third-trimester exposure (SSRI class effect).{{citation needed}}

| legal = [[USLegal:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults<ref name="luvox-label" />

| mechanism = <vote slug="fluvoxamine-mech-claim">Selective serotonin reuptake inhibitor with substantial additional '''sigma-1 receptor agonism''' that distinguishes it from other SSRIs. The sigma-1 activity is the proposed mechanism for the off-label COVID-19 outpatient trials and the anti-inflammatory rationale; it may also contribute to the OCD efficacy.</vote> '''Strong CYP1A2 inhibitor''' (the strongest among SSRIs at that isoenzyme), with major interactions: clozapine and theophylline exposure rises substantially; ramelteon and '''tizanidine combinations are contraindicated''' (~30-fold tizanidine exposure increase with severe hypotension reported); olanzapine, mexiletine, and caffeine all require attention. Also significant CYP2C19 and CYP3A4 inhibition. CPIC PGx guidance applies for CYP2C19<ref name="cpic-ssri">CPIC Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Selective Serotonin Reuptake Inhibitors, 2023. https://cpicpgx.org/guidelines/guideline-for-selective-serotonin-reuptake-inhibitors-and-cyp2d6-and-cyp2c19/</ref>.

}}

== References ==

[[Category:SSRIs]]

[[Category:Antidepressants]]

[[Category:Anxiolytics]]

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