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GENERIC NAME: fluvoxamine
BRAND NAME: Luvox
DRUG CLASS AND MECHANISM: Fluvoxamine is an antidepressant medication that affects the chemicals within the brain that serve as messengers between the nerve cells. These chemical messengers are called neurotransmitters. Many experts believe that an imbalance in these neurotransmitters is the cause of depression. Fluvoxamine works by inhibiting the uptake by the nerve cells of a neurotransmitter, serotonin, an action which results in more serotonin in the brain. Fluvoxamine is in the class of drugs called selective serotonin reuptake inhibitors (SSRIs), a class that also includes fluoxetine (Prozac) sertraline (Zoloft), and paroxetine (Paxil). Fluvoxamine was approved by the FDA for the treatment of obsessive-compulsive disorder on December, 1994.
PRESCRIPTION: yes
GENERIC AVAILABLE: yes
PREPARATIONS: Tablets (oval): 50mg (yellow).
STORAGE: Tablets should be kept at room temperature, 15- 30C (59-86F).
PRESCRIBED FOR: Fluvoxamine is currently FDA-approved for use in obsessive-compulsive disorder (OCD). However, like other SSRIs, it also has been used in the treatment of major depression. It also has been used in the management of obesity, bulimia, schizophrenia, and panic disorder.
DOSING: Fluvoxamine is given as a single daily dose, usually in the morning. As with all antidepressants, it may take a few weeks of treatment before the full effects become manifest. Elderly patients, debilitated persons, and patients with certain kidney or liver diseases may need lower doses.
DRUG INTERACTIONS: All SSRIs (selective serotonin reuptake inhibitors), including fluvoxamine, should not be taken with any of the MAO (mono-amine oxidase) inhibitor-class of antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane). Such combinations may lead to confusion, high blood pressure, tremor, and increased activity. This same type of interaction also may occur with selegiline (Eldepryl), fenfluramine (Pondimin), and dexfenfluramine (Redux). Fluvoxamine can inhibit the rate of metabolism of astemizole (Hismanal). This can theoretically can lead to dangerous heart arrythmias. Terfenadine (Seldane) is metabolized in the same way as astemizole. Thus, fluvoxamine should not be used with these two antihistamines.Fluvoxamine also can inhibit the metabolism of clozapine (Clozaril), necessitating dosage reductions of clozapine. Fluvoxamine also inhibits theophylline) Theodur, Slobid, Uniphyl) metabolism, sometimes leading to toxicity (e.g. nausea, vomiting). Other drugs which may be similarly affected include warfarin (Coumadin), alprazolam (Xanax), and triazolam (Halcion).fluvoxamine
PREGNANCY: There are no adequate studies of fluvoxamine in pregnant women.
NURSING MOTHERS: Only negligible amounts of fluvoxamine are excreted into breast milk. It is unknown if these minimal concentrations will have an effect on nursing infants.
SIDE EFFECTS: The most commonly noted side effects associated with SSRIs are anxiety, sweating, nausea, decreased appetite, somnolence (sleepiness), dizziness, insomnia, and male sexual disturbances. Sedation is more common with fluvoxamine than with other SSRIs (e.g., fluoxetine, sertraline). Loss of appetite and weight loss is less of a concern with fluvoxamine than with fluoxetine. SSRIs can delay ejaculation in men; fluvoxamine may cause this problem less frequently than the other medications in this class.
The withdrawal of treatment with many antidepressants has been associated with troublesome symptoms. Symptoms have been particularly frequent with antidepressants classified as selective serotonin reuptake inhibitors (SSRI's). Specifically, the incidence of symptoms upon withdrawal is between 17% and 30% with the SSRI's, paroxetine (Paxil) and fluvoxamine (Luvox), but less than 5% with other SSRI's.
The most common symptoms of withdrawal have been dizziness, tiredness, tingling of the extremities, nausea, vivid dreams, irritability, and poor mood. Other symptoms have included 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 have recommended that treatment be discontinued by tapering the dose (by gradually reducing the dose), symptoms have occurred despite tapering. 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.
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