fluvoxaMINE (floo-voks-a-meen) Luvox, Luvox CR

 Indications

Obsessive-compulsive disorder (OCD). Unlabeled

Use: Depression. Generalized anxiety disorder (GAD).

Social anxiety disorder (SAD). Post-traumatic stress

disorder (PTSD).

Action

Inhibits the reuptake of serotonin in the CNS. Therapeutic

Effects: Decrease in obsessive-compulsive

behaviors.

Pharmacokinetics

Absorption: 53% absorbed after oral administration.

Distribution: Excreted in breast milk; enters the

CNS. Remainder of distribution not known.

Metabolism and Excretion: Mostly metabolized

by the liver (CYP2D6 isoenzyme); the CYP2D6 enzyme

system exhibits genetic polymorphism; 7% of

population may be poor metabolizers (PMs) and may

have significantlyqfluvoxamine concentrations and an

qrisk of adverse effects.

Half-life: 13.6–15.6 hr.

TIME/ACTION PROFILE (improvement on

obsessive-compulsive behaviors)

ROUTE ONSET PEAK DURATION

PO within 2–3 wk several mo unknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity to fluvoxamine

or other SSRIs; Concurrent use of MAOIs (or within

14 days of discontinuing fluvoxamine), MAOI-like

drugs (linezolid or methylene blue), alosetron, pimozide,

thioridazine, or tizanidine.

Use Cautiously in: Impaired hepatic function; Risk

of suicide (mayqrisk of suicide attempt/ideation especially

during early treatment or dose adjustment); Angle-

closure glaucoma; OB: Neonates exposed to SSRI in

third trimester may develop drug discontinuation syndrome

including respiratory distress, feeding difficulty, and irritability; Lactation: Discontinue drug or bottlefeed;

Pedi: Mayqrisk of suicide attempt/ideation especially

during early treatment or dose adjustment; may

be greater in children and adolescents (safety not established

in children 18 yr [controlled release] and

8 yr [immediate-release]); Pedi: Safety not established

in children 8 yr (for immediate-release); Geri:

May haveqsensitivity; recommend lower initial dose

and slower dosage titration.

Adverse Reactions/Side Effects

CNS: NEUROLEPTIC MALIGNANT SYNDROME, SUICIDAL

THOUGHTS, sedation, dizziness, drowsiness, headache,

insomnia, nervousness, weakness, agitation, anxiety,

apathy, emotional lability, manic reactions, mental depression,

psychotic reactions, syncope. EENT: sinusitis.

Resp: cough, dyspnea. CV: edema, hypertension,

palpitations, postural hypotension, tachycardia, vasodilation.

GI: constipation, diarrhea, dry mouth, dyspepsia,

nausea, anorexia, dysphagia,qliver enzymes, flatulence,

vomiting. GU:plibido/sexual dysfunction.

Derm:qsweating.Metab: weight gain, weight loss.

MS: hypertonia, myoclonus/twitching. Neuro: hypokinesia/

hyperkinesia, tremor. Misc: SEROTONIN SYNDROME,

allergic reactions, chills, flu-like symptoms,

tooth disorder/caries, yawning.

Interactions

Drug-Drug: Concurrent use with MAO inhibitors

may result in serious potentially fatal reactions (MAO

inhibitors should be stopped at least 14 days before fluvoxamine

therapy. Fluvoxamine should be stopped at

least 14 days before MAO inhibitor therapy). Concurrent

use with MAO-inhibitor-like drugs, such as linezolid

or methylene blue mayqrisk of serotonin

syndrome; concurrent use contraindicated; do not start

therapy in patients receiving linezolid or methylene

blue; if linezolid or methylene blue need to be

started in a patient receiving fluvoxamine, immediately

discontinue fluvoxamine and monitor for signs/symptoms

of serotonin syndrome for 2 wk or until 24 hr after

last dose of linezolid or methylene blue, whichever

comes first (may resume fluvoxamine therapy 24 hr after

last dose of linezolid or methylene blue). Smoking

maypeffectiveness of fluvoxamine. Concurrent use

with tricyclic antidepressants mayqplasma levels of

fluvoxamine. Drugs that affect serotonergic neurotransmitter

systems, including SSRIs, SNRIs, fentanyl,

buspirone, tramadol, amphetamines, and triptans

qrisk of serotonin syndrome.pmetabolism and may

qeffects of some beta blockers (propranolol), alosetron

(avoid concurrent use), some benzodiazepines

(avoid concurrent diazepam), carbamazepine,

methadone, lithium, theophylline (pdose to

33% of usual dose), ramelteon (avoid concurrent

use), warfarin, and L-tryptophan.qrisk of bleeding

with NSAIDS, aspirin, clopidogrel, or warfarin.q

blood levels and risk of toxicity from clozapine (dosage

adjustments may be necessary).

Drug-Natural Products: Use with St. John’s

wortqof serotonin syndrome.

Route/Dosage

PO (Adults): Immediate release—50 mg daily at

bedtime;qby 50 mg q 4–7 days until desired effect is

achieved. If daily dose 100 mg, give in 2 equally divided

doses or give a larger dose at bedtime (not to exceed

300 mg/day); Controlled release—100 mg at

bedtime;qby 50 mg q 7 days until desired effect is

achieved, not to exceed 300 mg/day.

PO (Children 8–17 yr): Immediate release—25

mg at bedtime, mayqby 25 mg/day q 4–7 days (not to

exceed 200 mg/day; daily doses 50 mg should be

given in divided doses with a larger dose at bedtime).

Hepatic Impairment

PO (Adults): Immediate release—25 mg daily at

bedtime initially, slower titration, and longer dosing intervals

should be used.

Availability (generic available)

Tablets: 25 mg, 50 mg, 100 mg. Controlled-release

capsules: 100 mg, 150 mg.