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Drugs, Supplies and Delivery
Fluvoxamine
Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) primarily prescribed for obsessive-compulsive disorder (OCD) and major depressive disorder (MDD). Known for its distinct pharmacokinetic profile and receptor activity, it is also used off-label for anxiety disorders. This article draws on the British National Formulary (BNF), Lippincott Textbook of Pharmacology, and Lange Basic & Clinical Pharmacology to detail fluvoxamine’s mechanism, uses, dosing, side effects, precautions, interactions, and availability.
Fluvoxamine selectively inhibits the reuptake of serotonin (5-HT) at presynaptic neurons, increasing serotonin levels in the synaptic cleft to enhance mood regulation (Lippincott Textbook of Pharmacology). Unlike other SSRIs, it also binds to sigma-1 receptors, which may contribute to its efficacy in anxiety and obsessive-compulsive symptoms (Lange Basic & Clinical Pharmacology). It has minimal affinity for histamine, acetylcholine, or adrenergic receptors, reducing sedative or anticholinergic side effects (BNF).
- Obsessive-Compulsive Disorder (OCD):
- First-line treatment for adults and children (≥8 years) to reduce intrusive thoughts and compulsions (BNF).
- Major Depressive Disorder (MDD):
- Used when other SSRIs are ineffective or poorly tolerated.
- Off-Label Uses:
- Social anxiety disorder, panic disorder, and post-traumatic stress disorder (PTSD) (Lange Basic & Clinical Pharmacology).
- COVID-19 (Investigational):
- Studied for anti-inflammatory effects in mild-to-moderate cases, though not yet standard practice (Lippincott).
- Adults:
- OCD: Start with 50 mg nightly, titrate to 100–300 mg/day in divided doses. Max 300 mg/day (BNF).
- Depression: 50–150 mg/day, typically in divided doses or as a single evening dose.
- Children (≥8 years):
- OCD: Start with 25 mg nightly, increase weekly to 50–200 mg/day (Lippincott).
- Elderly/Hepatic Impairment:
- Lower initial doses (e.g., 25–50 mg/day) and slower titration (Lange Basic & Clinical Pharmacology).
Administration:
- Take with food to reduce nausea.
- Extended-release formulations allow once-daily dosing (BNF).
- Common: Nausea, insomnia, dry mouth, somnolence, and dizziness (BNF).
- Serious:
- Serotonin Syndrome: Agitation, hyperthermia, tachycardia (rare but life-threatening).
- Bleeding Risk: Due to platelet dysfunction, especially with NSAIDs or anticoagulants (Lippincott).
- Hyponatremia: More prevalent in elderly patients.
- Seizures: Rare but possible in predisposed individuals (Lange Basic & Clinical Pharmacology).
- Contraindications:
- Concurrent use of MAO inhibitors (risk of serotonin syndrome).
- Hypersensitivity to SSRIs (BNF).
- Monitoring:
- Liver function tests in hepatic impairment.
- Mood changes or suicidal ideation, particularly in adolescents (Lippincott).
- Pregnancy/Lactation:
- Use cautiously; potential neonatal withdrawal or persistent pulmonary hypertension (PPHN) (Lange Basic & Clinical Pharmacology).
- CYP1A2/CYP2D6 Inhibitors: Fluvoxamine inhibits these enzymes, increasing levels of:
- Theophylline: Risk of toxicity (monitor serum levels).
- Clozapine: Elevated risk of seizures and myelosuppression.
- Warfarin: Enhanced anticoagulant effect (BNF).
- Serotonergic Drugs (e.g., tramadol, triptans): Increased serotonin syndrome risk.
- Caffeine: Reduced clearance may cause jitteriness or insomnia (Lippincott).
Fluvoxamine is the generic name. Brand names include Luvox® and Faverin®. Available as:
- Immediate-Release Tablets: 50 mg, 100 mg.
- Extended-Release Capsules: 100 mg, 150 mg (BNF).
