What is fluvoxamine, and how does it work (mechanism of action)?
- Fluvoxamine is a drug that is used for
treating several psychiatric disorders. It is a member of 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. Neurotransmitters are
released by nerves, travel across the spaces between nerves and then attach to
receptors on other nerves. Many experts believe that an imbalance in
neurotransmitters is the cause of
depression and other psychiatric disorders.
Fluvoxamine works by inhibiting the uptake of serotonin, a neurotransmitter,
from the spaces between nerve cells following its release. Therefore, there is
more serotonin available in the spaces to attach to other nerves and stimulate
them. - Fluvoxamine was approved by the FDA for the treatment of
obsessive-compulsive disorder in December 1994.
Is fluvoxamine available as a generic drug?
GENERIC AVAILABLE: Yes
Do I need a prescription for fluvoxamine?
Yes
What are the uses for fluvoxamine?
- Fluvoxamine is used for treating
obsessive-compulsive
disorder (OCD) and
social anxiety disorder. - Fluvoxamine also
has been used in the treatment of
major depression, management of
obesity,
bulimia,
schizophrenia, and
panic disorder.
What are the side effects of fluvoxamine?
Side effects of fluvoxamine include:
- Nervousness
- Somnolence (sleepiness)
- Weight loss
- Indigestion
- Vomiting
- Stomach pain
- Palpitations
- Abnormal dreams
- Sexual dysfunction
Fluvoxamine also may cause abnormal bleeding,
seizures, and
manic episodes.
Withdrawal of fluvoxamine 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 discontinuing treatment by gradually reducing the
dose, symptoms still may 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 also may
increase the risk of suicide 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.
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What is the dosage for fluvoxamine?
- The usual starting dose for adults is 50 mg daily given as a
single dose at bedtime. - The dose may be increased in 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 be administered as a divided dose. - When using
extended release tablets the starting dose is 100 mg at bedtime and the maximum
dose is 300 mg. - Children (8 to 17 years old) should start with 25 mg daily given
at bedtime, and the dose may be increased by 25 mg every 4-7 days up to a
maximum of 200 mg/day (8-11 years old) or 300 mg/day (12-17 years old). Doses
greater than 50 mg should be administered as a divided dose.
Which drugs or supplements interact with fluvoxamine?
- All SSRIs, including fluvoxamine, should not be taken with any of the
monoamine oxidase inhibitor (MAOI) class of antidepressants such as isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane) other drugs that inhibit monoamine oxidase such as
linezolid
(Zyvox) and intravenous
methylene blue. 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, and MAO inhibitors should not be administered within 14 days of stopping fluvoxamine. Similar reactions occur if fluvoxamine is combined with other drugs, for example,
tryptophan,
St. John’s wort,
meperidine (Demerol), and
tramadol (Ultram) that increase serotonin in the brain. - Fluvoxamine can inhibit
the elimination of
clozapine (Clozaril), necessitating dosage reductions of
clozapine. - Fluvoxamine also may inhibit the elimination and increase the blood
levels of
theophylline (Theodur,
Uniphyl),
alprazolam (Xanax), and
triazolam (Halcion)
leading to side effects from these drugs. - Fluvoxamine may increase the effect of
warfarin (Coumadin,
Jantoven), leading to excessive bleeding. Warfarin therapy should be
monitored more frequently in patients who also are taking fluoxetine. - Combining SSRIs with
aspirin,
nonsteroidal anti-inflammatory drugs or other drugs that
affect bleeding may increase the likelihood of upper
gastrointestinal bleeding. Fluvoxamine may increase blood levels of
tizanidine (Zanaflex),
thioridazine (Mellaril),
alosetron (Lotronex), and
pimozide (Orap), leading to increased side effects of
these drugs.
QUESTION
Depression is a(n) __________ .
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Is fluvoxamine safe to take if I’m pregnant or breastfeeding?
- There are no adequate studies of fluvoxamine in
pregnant
women. Infants exposed to SSRIs in
late pregnancy may have an increased risk for
persistent
pulmonary hypertension of the
newborn (PPHN), which can be fatal. - Fluvoxamine is excreted into
breast milk. There are
no adequate studies in lactating women.
What else should I know about fluvoxamine?
What preparations of fluvoxamine are available?
- Tablets: 25, 50 and 100 mg.
- Tablets (extended release):
100 and 150 mg.
How should I keep fluvoxamine stored?
Tablets should be kept at room temperature, 15 C – 30 C (59 F – 86
F).