Pharmacy Editor: Jay W. Marks, MD

GENERIC NAME: fluvoxamine

BRAND NAME: Luvox

DRUG CLASS AND MECHANISM: Fluvoxamine is a drug that is used for treating several psychiatric disorders. It is in the class of drugs called selective serotonin reuptake inhibitors (SSRIs), a class that also includes fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). Selective serotonin reuptake inhibitors affect neurotransmitters (chemicals) that nerves in the brain use to communicate with each other. Many experts believe that an imbalance in these neurotransmitters is the cause of depression and other psychiatric disorders. Fluvoxamine works by inhibiting the uptake of serotonin (a neurotransmitter) by nerve cells. Therefore, there is more serotonin available to stimulate other nerves in the brain. Fluvoxamine was approved by the FDA for the treatment of obsessive-compulsive disorder in December, 1994.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Tablets: 25, 50, 100 mg.

STORAGE: Tablets should be kept at room temperature, 15- 30°C (59-86°F).

PRESCRIBED FOR: Fluvoxamine is used for treating obsessive-compulsive disorder (OCD). However, like other SSRIs, it also has been used in the treatment of major depression, management of obesity, bulimia, schizophrenia, and panic disorder.

DOSING: The usual starting dose for adults is 50 mg given as a single dose in the morning. The dose may be increased by 50 mg increments every 4-7 days to achieve the desired response. The maximum dose is 300 mg/day. Doses greater than 100 mg should administered as a divided dose.

Children (8 to 17 years old) should start with 25 mg daily, and the dose may be increased by 25 mg every 4-7 days up to a maximum of 200 mg/day. Doses greater than 50 mg should be administered as a divided dose.

DRUG INTERACTIONS: All SSRIs, including fluvoxamine, should not be taken with any of the mono-amine oxidase inhibitor (MAOI) class of antidepressants such as isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane). Such combinations may lead to confusion, high blood pressure, tremor, and increased activity. Fluvoxamine should not be administered within 14 days of discontinuing an MAO inhibitor. This same type of interaction also may occur with selegiline (Eldepryl), fenfluramine (Pondimin), and dexfenfluramine (Redux). Fluvoxamine can inhibit the elimination of clozapine (Clozaril), necessitating dosage reductions of clozapine. Fluvoxamine may also inhibit the elimination and increase the blood levels of theophylline (Theodur, Uniphyl), warfarin (Coumadin), alprazolam (Xanax), and triazolam (Halcion).

PREGNANCY: There are no adequate studies of fluvoxamine in pregnant women.

NURSING MOTHERS: Fluvoxamine is excreted into breast milk. There are no adequate studies in lactating women.

SIDE EFFECTS: Side effects of all SSRIs include anxiety, nervousness, sweating, nausea, decreased appetite, constipation, diarrhea, dry mouth, somnolence (sleepiness), dizziness, insomnia, and sexual disfunction.

Withdrawal of an SSRI may result in withdrawal symptoms. The most common symptoms of withdrawal are dizziness, tiredness, tingling of the extremities, nausea, vivid dreams, irritability, and poor mood. Other symptoms include visual disturbances and headaches. Withdrawal reactions have been reported after an average of 12 to 36 weeks of treatment, but after as few as 5 weeks. Although most authorities recommend treatment discontinuation by gradually reducing the dose, symptoms may still occur. Symptoms generally appear within a few days of discontinuing medication and persist for an average of 12 days (up to 21 days). They are relieved within 24 hours by re-administering the medication that was discontinued.

Antidepressants may increase the risk of suicide in children and adolescents. There are concerns that antidepressants may also induce suicides in adults. Patients with major depression may experience worsening of depression or suicidal thoughts regardless of whether or not they are treated. Therefore, patients started on antidepressants should be closely observed for signs of worsening suicidal thinking or changes in behavior.

From the Doctors at MedicineNet.com

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