Fluvoxamine
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Fluvoxamine (maleate)
Luvox (US brand discontinued; generic widely available), Luvox CR, Faverin (other markets)
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Summary
Common uses
Obsessive-compulsive disorder (FDA; the first FDA-approved OCD medicine, 1994)0, Social anxiety disorder (FDA, Luvox CR)0, Major depressive disorder (off-label in US; FDA in many other markets)0, Posttraumatic stress disorder (off-label)0, Panic disorder (off-label)0, COVID-19 outpatient treatment (off-label; TOGETHER trial signal followed by mixed replication, sigma-1 anti-inflammatory rationale)0
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
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
- ↑ 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/
- ↑ 2.0 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