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 U.S. 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 disorder, alcoholism, certain types of headaches, post-traumatic stress disorder (PTSD), premenstrual tension and mood swings, and panic disorder.
Fluvoxamine was approved for use in adults in 1993. In 1997, the 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, and 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 inhibitors (MAOIs). 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 MAOIs. People taking any MAOIs, for example Nardil (phenelzine sulfate) or Parmate (tranylcypromine sulfate), should stop the MAOI inhibitor and wait at least 14 days before starting fluvoxamine or any other antidepressant. The same holds true when discontinuing fluvoxamine and starting an MAOI.
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 and diminished 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; and, in women, abnormal milk production. People may also experience symptoms of serotonin syndrome, which usually consists of at least three of the following: restlessness, overexcitement, irritability, confusion, diarrhea, fever,
KEY TERMS
Serotonin syndrome —A condition characterized by at least three of the following symptoms: diarrhea, fever, extreme perspiration, mood or behavior changes, overactive reflexes, fast heart rate, restlessness, shivering or shaking. It is a result of too much serotonin in the body.
overactive reflexes, difficulty with coordination, uncontrollable shivering or shaking, and 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 , anti-seizure drugs phenytoin and carbamazepine , tricyclic antidepressants, pimozide , and cholesterol-lowering drugs such as atorvastatin, lovastatin, and simvastatin.
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 MAOIs.
Fluvoxamine given with warfarin (a blood thinner) may increase the possibility of bleeding.
Resources
BOOKS
Preston, John D., John H. O’Neal, and Mary C. Talaga. Handbook of Clinical Psychopharmacology for Therapists, 4th ed. Oakland, CA: New Harbinger Publications, 2004.
PERIODICALS
Albers, Lawrence J., and others. “Low-Dose Fluvoxamine as an Adjunct to Reduce Olanzapine Therapeutic Dose Requirements: A Prospective Dose-Adjusted Drug Interaction Strategy.” Journal of Clinical Psychopharmacology 25.2 (Apr. 2005): 170–74.
Erzegovesi, Stefano, and others. “Low-Dose Risperidone Augmentation of Fluvoxamine Treatment in Obsessive-Compulsive Disorder: A Double-Blind, Placebo-Controlled Study.” European Neuropsychopharmacology 15.1 (Jan. 2005): 69–74.
Ginsburg, Golda S., Mark A. Riddle, and Mark Davies. “Somatic Symptoms in Children and Adolescents With Anxiety Disorders.” Journal of the American Academy of Child and Adolescent Psychiatry 45.10 (Oct. 2006): 1179–87.
Husted, David S., and others. “Effect of Comorbid Tics on a Clinically Meaningful Response to 8-Week Open-Label Trial of Fluoxetine in Obsessive Compulsive Disorder.” Journal of Psychiatric Research 41.3-4 (Apr.-June 2007): 332–37.
Irons, Jane. “Fluvoxamine in the Treatment of Anxiety Disorders.” Neuropsychiatric Disease And Treatment 1.4 (2005): 289–99.
Mandelli, Laura, and others. “Improvement of Cognitive Functioning in Mood Disorder Patients with Depressive Symptomatic Recovery During Treatment: An Exploratory Analysis.” Psychiatry and Clinical Neurosciences 60.5 (Oct. 2006): 598–604.
Morishita, Shigeru, and Seizabur Arita. “Clinical Characteristics as Predictors of Response to Fluvoxamine, Paroxetine and Milnacipran in Patients with Depression.” Current Psychiatry Reviews 1.3 (Nov. 2005): 319–24.
Morishita, Shigeru, and Seizaburo Arita. “Treatment of Bipolar II Depression with Milnacipran, Fluvoxamine, Paroxetine, or Maprotiline.” International Medical Journal 12.4 (Dec. 2005): 283–85.
O’Connor, K. P., and others. “Cognitive Behaviour Therapy and Medication in the Treatment of Obsessive-Compulsive Disorder.” Acta Psychiatrica Scandinavica 113.5 (May 2006): 408–19.
Preskorn, Sheldon H., and others. “The Potential for Clinically Significant Drug-Drug Interactions Involving the CYP 2D6 System: Effects with Fluoxetine and Paroxetine Versus Sertraline.” Journal of Psychiatric Practice 13.1 (Jan. 2007): 5–12.
Schreiber, Shaul, and Chaim G. Pick. “From Selective to Highly Selective SSRIs: A Comparison of the Antinociceptive Properties of Fluoxetine, Fluvoxamine, Citalopram and Escitalopram.” European Neuropsychopharmacology 16.6 (Aug. 2006): 464–68.
van Oppen, Patricia, and others. “Cognitive Therapy and Exposure in Vivo Alone and in Combination With Fluvoxamine in Obsessive-Compulsive Disorder: A 5-Year Follow-Up.” Journal of Clinical Psychiatry 66.11 (Nov 2005): 1415–22.
Yoshimura, Reiji, and others. “Successful Treatment for Obsessive-Compulsive Disorder with Addition of Low-Dose Risperidone to Fluvoxamine: Implications for Plasma Levels of Catecholamine Metabolites and Serum Brain-Derived Neurotrophic Factor Levels.” Psychiatry and Clinical Neurosciences 60.3 (June 2006): 389–93.
Rosalyn Carson-DeWitt, MD
Ruth A. Wienclaw, PhD
Folie á deux see Shared psychotic disorder
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.