Fluvoxamine

Fluvoxamine is a prescription medication used to treat obsessive compulsive disorder (OCD). Fluvoxamine belongs to a group of drugs called selective serotonin reuptake inhibitors (SSRIs). These work by increasing the amount of serotonin in the brain, which helps maintain mental balance.

This medication comes in tablet and extended-release capsule forms.

The tablets are taken once or twice a day, with or without food. If it is taken only once daily, it is best taken at bedtime.

The extended-release capsule is taken once daily, at bedtime. Do not chew or crush the extended-release fluvoxamine capsule.

Common side effects include nausea, insomnia, and headache. Fluvoxamine can also cause dizziness, drowsiness, and blurred vision. Do not drive or operate heavy machinery until you know how fluvoxamine affects you.

CYP2D6 is a protein in your body that is involved in the elimination of fluvoxamine and other drugs from your body. Some patients have less of this protein in their bodies, affecting how much of the drug gets eliminated. Levels of CYP2D6 can vary greatly between individuals, and those having less of this protein are known as "poor metabolizers." 

CYP2D6 testing is done to determine whether you are a poor metabolizer. If you are a poor metabolizer, the levels of fluvoxamine in your blood can become too high. As a result you may be at an increased risk of having more side effects from fluvoxamine. 

Your doctor may adjust your dose of fluvoxamine if you are a poor metabolizer.

Fluvoxamine is a prescription medication used to treat obsessive compulsive disorder (OCD). It can also be used to treat social anxiety disorder.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Fluvoxamine may be found in some form under the following brand names:

• Luvox

• Luvox CR

Serious side effects have been reported with fluvoxamine. See the "Fluvoxamine Precautions" section.

Common side effects include:

• nausea
• insomnia
• drowsiness
• headache
• lack of energy
• vomiting
• nervousness
• agitation
• dizziness

This is not a complete list of fluvoxamine side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• alprazolam (Xanax)
• anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven)
• aspirin or aspirin-containing products and other nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)
• beta-blockers such as metoprolol (Lopressor, Toprol) and propranolol (Inderal, in Inderide); buspirone (BuSpar)
• carbamazepine (Tegretol)
• clopidogrel (Plavix), clozapine (Clozaril)
• cyclosporine (Neoral, Sandimmune)
• dextromethorphan (in cough medications)
• diazepam (Valium)
• diltiazem (Cardizem)
• diuretics ('water pills')
• fentanyl (Abstral, Actiq, Fentora, Onsolis, others)
• haloperidol (Haldol)
• ketoconazole (Nizoral)
• lithium
• medications for migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig)
• methadone (Dolophine, Methadose)
• mexiletine (Mexitil)
• metoclopramide
• midazolam (Versed)
• omeprazole (Prilosec, Zegerid)
• other medications for anxiety, depression, or mental illness
• phenytoin (Dilantin)
• sibutramine (Meridia)
• tacrine (Cognex)
• theophylline (Theo-Dur)
• tramadol (Ultram, in Ultracet)
• triazolam (Halcion)
• quinidine

This is not a complete list of fluvoxamine drug interactions. Ask your doctor or pharmacist for more information.

Serious side effects have been reported with fluvoxamine, including the following:

• chest pain
• problems with coordination
• dizziness
• hallucination (seeing things or hearing voices that do not exist)
• fever, sweating, confusion, fast or irregular heartbeat, and severe muscle stiffness
• pain, burning, numbness, or tingling in the hands or feet
• shaking of a part of the body that you cannot control
• rash
• hives
• slowed or difficult breathing
• seizures
• loss of consciousness
• unusual bleeding or bruising
• bloody nose
• vomiting blood or a material that looks like coffee grounds
• red blood in stool or black and tarry stools

Fluvoxamine can also cause dizziness, drowsiness, and blurred vision. Do not drive or operate heavy machinery until you know how fluvoxamine affects you.

Do not take fluvoxamine if you:

• are allergic to fluvoxamine or to any of its ingredients
• are taking thioridazine, astemizole, cisapride (Propulsid), pimozide (Orap), alosetron (Lotronex), tizanidine (Zanaflex)

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of fluvoxamine, there are no specific foods that you must exclude from your diet when receiving this medication.

Before taking fluvoxamine, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• are allergic to fluvoxamine or to any of its ingredients
• consume large amounts of alcohol
• have or ever have used or overused illegal drugs or prescription medications
• have had seizures
• have heart disease
• have liver disease
• have adrenal disease
• have liver disease
• are pregnant or breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take St. John's Wort or supplements containing tryptophan.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X - are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Fluvoxamine falls into category C. In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

Tell your doctor if you are breastfeeding or plan to breastfeed.

Fluvoxamine has been detected in human breast milk. Because of the possibility for adverse reactions in nursing infants from fluvoxamine, a choice should be made whether to stop nursing or to stop use of this medication. The importance of the drug to the mother should be considered.

Take fluvoxamine exactly as prescribed.

This medication comes in tablet and extended release capsule forms.

The tablets are taken once or twice a day, with or without food. If it is taken only once daily, it is best taken at bedtime.

The extended-release capsule is taken once daily, at bedtime. Do not chew or crush the extended-release fluvoxamine capsule.

If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take 2 doses of fluvoxamine at the same time.

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

• the condition being treated
• other medical conditions you have
• other medications you are taking
• how you respond to this medication
• your age

The recommended starting dose of fluvoxamine for adults is 50 mg once daily at bedtime. The recommended starting dose of extended-release fluvoxamine is 100 mg once daily at bedtime. The dose may be increased slowly based on patient response. The maximum recommended dose is 300 mg.

The recommended starting dose of fluvoxamine for children and adolescents is 25 mg once daily at bedtime. The dose may be increased slowly based on patient response. The maximum recommended dose is 200 mg for children up to age 11 years. The maximum recommended dose is 300 mg for adolescents up to age 18 years.

If you take too much fluvoxamine, call your healthcare provider or local Poison Control Center or seek emergency medical attention right away.

If fluvoxamine is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

• Store fluvoxamine at room temperature. Protect from heat, light, and humidity.
• Keep this and all medications out of the reach of children.

Suicidality and Antidepressant Drugs

Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of fluvoxamine or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Fluvoxamine is not approved for use in pediatric patients except for patients with obsessive compulsive disorder (OCD).