The Psychopharmacology Institute has published an essential guide for prescribers on the use of fluvoxamine.
Below some key points.
- Fluvoxamine is FDA-approved for OCD in children and adults, but evidence does not show it is more effective than other SSRIs for OCD.
- Fluvoxamine is used off-label for depression, panic disorder, and as an adjunct to clozapine.
- Fluvoxamine has a long half-life of 16 hours. It is a potent inhibitor of CYP1A2 and should not be used with MAOIs.
- Common side effects include nausea, somnolence, sexual dysfunction, and antidepressant-induced excessive sweating (dose-related).
- Discontinuation symptoms tend to be worse with fluvoxamine compared to other SSRIs. Gradual tapering is recommended.
- Hyponatremia and bleeding are potential serious side effects. Risk of bleeding may increase with aspirin, NSAIDs or warfarin.
- In hepatic impairment, clearance is reduced by 30%. Start with a low dose and slowly increase.
- Fluvoxamine inhibits CYP1A2, 2C19, 2C9, 2D6, and 3A4. Dose adjustments may be needed for substrates like warfarin, theophylline, omeprazole, and tizanidine.
- Animal studies show fluvoxamine is a sigma-1 receptor agonist, which may play a role in effects on psychotic depression.
Check out the full guide for more details on using fluvoxamine in your practice: