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Fluvoxamine: Difference between revisions

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{{MedTemplate
{{MedTemplate
| generic           = Fluvoxamine
| generic           = Fluvoxamine (maleate)
| brand             = Luvox
| brand             = Luvox (US brand discontinued; generic widely available), Luvox CR, Faverin (other markets)
| structure         =  
| structure         =
| classes           = SSRI, Antidepressant
| classes           = [[:Category:SSRIs|Selective serotonin reuptake inhibitor (SSRI)]], [[:Category:Antidepressants|Antidepressant]], [[:Category:Anxiolytics|Anxiolytic]]
| mechanism          = Selective serotonin reuptake inhibitor
| 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>
| uses               =  
| 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
| starting_dose     =  
| preparations     = IR tablets 25, 50, 100 mg; Luvox CR capsules 100, 150 mg
| preparations       =  
| fda_max           = 300 mg/day (IR or CR)
| fda_max          =  
| pill_id           =
| routes             =  
| routes           = Oral
| onset             =  
| onset             = OCD effect over 1-2 weeks initial, with full effect typically 6-12 weeks; among the slowest SSRIs for OCD response
| duration           =  
| duration         = BID at higher doses (IR); once-daily (CR)
| halflife           =
| 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    =
| bioavailability   = ~53% (oral)<ref name="luvox-label" />
| pregnancy         =  
| pregnancy        = Observational signal for neonatal adaptation syndrome with third-trimester exposure (SSRI class effect).{{citation needed}}
| legal              =  
| 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" />
| intro              =
| 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>.
| pharmacokinetics   =  
| pharmacodynamics  =  
| indications        =  
| dosing             =  
| effects            =  
| interactions      =
| pregnancy_details  =
| monitoring         =  
| counseling        =  
| anecdotes          =
| seealso            =
| references        =  
}}
}}


== References ==
<references />
[[Category:SSRIs]]
[[Category:Antidepressants]]
[[Category:Antidepressants]]
[[Category:Anxiolytics]]

Latest revision as of 20:18, 23 May 2026

Selective serotonin reuptake inhibitor (SSRI), Antidepressant, Anxiolytic
Fluvoxamine (maleate)
Luvox (US brand discontinued; generic widely available), Luvox CR, Faverin (other markets)

Experience

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Problems

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Titration strategies

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Effects

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Summary
Classes
Selective serotonin reuptake inhibitor (SSRI), Antidepressant, Anxiolytic
Pharmacy
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
US FDA Max
300 mg/day (IR or CR)
Pharmacology
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)
Half-life
~15 hours (IR)[2]
Bioavailability
~53% (oral)[2]
Pregnancy
Observational signal for neonatal adaptation syndrome with third-trimester exposure (SSRI class effect).[citation needed]
Legal status
Rx-only in US. Carries the antidepressant Boxed Warning for suicidality in children, adolescents, and young adults[2]
Purported mechanism
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.0 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[1].

References

  1. ↑ 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/
  2. ↑ 2.0 2.1 2.2 FDA Prescribing Information, Luvox CR (fluvoxamine maleate extended-release), Jazz Pharmaceuticals, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021519s019lbl.pdf
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