New Article: Fluvoxamine Practical Guide

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: