Fluvoxamine - Chris Aiken, MD

Q: Depression

Fluvoxamine use based on controlled trials in major depressive disorder. SSRI side effects reviewed with patient.

Q: Anxiety Disorder

Fluvoxamine use based on controlled trials in anxiety disorders and FDA approval of this class in anxiety disorders. SSRI side effects reviewed with patient.

Q: PTSD

Fluvoxamine use based on efficacy of this class in Posttraumatic Stress Disorder. SSRI side effects reviewed with patient.

Q: OCD

Fluvoxamine use based on FDA approval in OCD. SSRI side effects reviewed with patient.

Q: Binge Eating & Bulimia

Fluvoxamine use based on efficacy of this class in binge eating and bulimia. SSRI side effects reviewed with patient.

Q: Premenstrual Syndrome

Fluvoxamine use based on efficacy of this class in Premenstrual Syndrome. SSRI side effects reviewed with patient.

Fluvoxamine (Luvox)

SSRI antidepressant

OCD (age 8+)¹
Major Depression³

Social Anxiety³

Features

Child-Studied, Generic, Medication, Child-Approved, Tolerable, Non-controlled

Handout

Dosing

Depression (100-150 mg/d), Anxiety disorders (100-150 mg/d), OCD (200-300 mg/d).

CHILD OCD: <8 years: Safety and efficacy not established; Ages 8-17 years: 25 mg po qhs initially; may titrate by 25 mg/day increments every 4-7 days to 50-200 mg/day.

INTERACTIONS: Raises levels of meds metabolized through CYP 2D6, 3A4, 2B6. Raise dose by x1.3 if using with carbamazepine. Raises meds metabolized by CYP1A2 (strong), CYP2C19 (strong), CYP2B6 (weak), CYP2C9 (weak), CYP2D6 (weak), CYP3A4 (weak).

Management

Only FDA approved in OCD. Second worst SSRI for WD risks (after paroxetine).

TOLERABILITY: Apathy, sexual dysfunction, sleep disruption, nausea, restless legs, akathisia, sweating, yawning, withdrawal syndrome.

RISKS: Suicidality in age < 25, mania, osteopenia in post-menopausal women, increased bleeding, hyponatremia (mainly in elderly).