Fluvoxamine

Fluvoxamine

Definition

Fluvoxamine is an antidepressant of the type known as selective serotonin reuptake inhibitors (SSRI). It is marketed in the United States under the brand name Luvox.

Purpose

Fluvoxamine is used to treat depression. It is also the first SSRI to be approved by the United States Food and Drug Administration (FDA) for use in obsessive-compulsive disorder in children, adolescents, and adults.

Description

Serotonin is a brain chemical that carries nerve impulses from one nerve cell to another. Researchers think that depression and certain other mental disorders may be caused, in part, because there is not enough serotonin being released and transmitted in the brain. Like the other SSRI antidepressants, fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil), fluvoxamine increases the level of brain serotonin (also known as 5-HT). Increased serotonin levels in the brain may be beneficial in patients with obsessive-compulsive dirder, alcoholism, certain types of headaches, post-traumatic stress disorder (PTSD), pre-menstrual tension and mood swings, and panic disorder .

Fluvoxamine was approved for use in adults in 1993. In 1997, the United States Food and Drug Administration (FDA) approved this medication for the treatment of obsessive-compulsive disorder in children and adolescents.

Fluvoxamine is available in 25-, 50- and 100-mg tablets.

Recommended dosage

Fluvoxamine therapy in adults is started as a single 50-mg dose taken at bedtime. Based on the patient's response to the medication, the dosage can be increased by 50 mg every four to seven days, until maximum benefit is achieved. Maximum dosage is 300 mg per day. Dosage over 100 mg per day should be given as equally divided morning and afternoon doses.

Fluvoxamine therapy in children is started as a single 25-mg dose, initially taken at bedtime. Based on the patient's response to the medication, the dosage can be increased by 25 mg every four to seven days, until maximum benefit is achieved. Maximum dosage in children is 200 mg per day. Dosage over 100 mg per day should be given as equally divided morning and afternoon doses.

Precautions

Patients taking fluvoxamine should be monitored closely for the onset of mania, seizures , thoughts of suicide , and skin problems (including itching, hives, rashes).

People with impaired liver function, bipolar disorder (manic depression), a history of seizures, or individuals contemplating suicide should take fluvoxamine only under close physician supervision.

A group of serious side effects, called serotonin syndrome, has resulted from the combination of SSRI drugs such as fluvoxamine and members of another class of antidepressants known as monoamine oxidase (MAO) inhibitors. Serotonin syndrome usually consists of at least three of the following symptoms: diarrhea, fever, extreme perspiration, mood or behavior changes, overactive reflexes, fast heart rate, restlessness, shivering or shaking. Because of this, fluvoxamine should never be taken in combination with MAO inhibitors. People taking any MAO inhibitors, for example Nardil (phenelzine sulfate) or Parmate (tranylcypromine sulfate), should stop the MAO inhibitor and wait at least 14 days before starting fluvoxamine or any other antidepressant. The same holds true when discontinuing fluvoxamine and starting an MAO inhibitor.

Physicians and their patients should weigh the risks and benefits of this drug for women who are or wish to become pregnant, as well as in breast-feeding mothers.

Until an individual understands the effects that fluvoxamine may have on them, he or she should avoid driving, operating dangerous machinery, or participating in hazardous activities.

People should not use alcohol while taking fluvoxamine.

Side effects

Common side effects of fluvoxamine therapy include decreased sex drive or decreased sexual performance.

Less common side effects of fluvoxamine therapy include changes in mood, behavior, or thinking, difficulty breathing, difficulty urinating, and twitches or uncontrollable movements of the face or body.

Rare side effects include difficulty moving, blurred vision, clumsiness or problems with balance, seizures, difficulty moving the eyes, increased uncontrollable movements of the body or face, changes in the menstrual period, redness or irritation of the eyes or skin, peeling, itching or burning sensation of the skin, sore throat, fever and/or chills, easy bruising, nosebleeds, abnormal milk production in women, and symptoms of serotonin syndrome (usually at least three of the following: restlessness, overexcitement, irritability, confusion, diarrhea, fever, overactive reflexes, difficulty with coordination, uncontrollable shivering or shaking, trembling or twitching).

Interactions

Fluvoxamine interacts with a long list of other medications. Anyone starting this drug should review the other medications they are taking with their physician and pharmacist for possible interactions. Patients should always inform all their health care providers, including dentists, that they are taking fluvoxamine.

When taken together with fluvoxamine, the effect of the following drugs may be enhanced: benzodiazepines, beta blockers , clozapine , cholesterol-lowering drugs such as atorvastatin, lovastatin, and simvastatin, antiseizure drugs phenytoin and carbamazepine , tricyclic antidepressants, and pimozide .

The diet pills dexfenfluramine and fenfluramine may increase the incidence of serotonin syndrome when taken with fluvoxamine.

When buspirone is given with fluvoxamine, the therapeutic effect of buspirone may be decreased and the risk of seizures increased.

Increased risk of mania and high blood pressure occurs with selegiline.

Severe, fatal reactions mentioned above have occurred when fluvoxamine is given along with MAO inhibitors.

Fluvoxamine given with warfarin (a blood thinner) may increase the possibility of bleeding.

Resources

BOOKS

Ellsworth, Allan J. Mosby's Medical Drug Reference. St. Louis, MO: Mosby, Incorporated, 1999.

Mosby's Drug Consult. St. Louis, MO: Mosby, Incoporated, 2002.

Rosalyn Carson-DeWitt, M.D.