fluvoxamine

Pronunciation

Generic Name: fluvoxamine (floo VOX a meen)
Brand Name: Luvox, Luvox CR

What is fluvoxamine?

Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) antidepressant. Fluvoxamine affects chemicals in the brain that may become unbalanced and cause obsessive-compulsive symptoms.

Fluvoxamine is used to treat social anxiety disorder (social phobia), or obsessive-compulsive disorders involving recurring thoughts or actions.

Fluvoxamine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about fluvoxamine?

You should not take fluvoxamine if you are also using alosetron, pimozide, ramelteon, thioridazine, tizanidine, or methylene blue injection.

Do not use fluvoxamine if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

Slideshow: Depression, the Risk of Suicide, and Treatment Options

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using fluvoxamine.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Do not give fluvoxamine to anyone younger than 18 years old without the advice of a doctor.

What should I discuss with my healthcare provider before taking fluvoxamine?

You should not take fluvoxamine if you are allergic to it, or if you are also using alosetron, pimozide, ramelteon, thioridazine, tizanidine, or methylene blue injection.

Do not use fluvoxamine if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine. After you stop taking fluvoxamine, you must wait at least 14 days before you can take thioridazine or an MAOI.

To make sure fluvoxamine is safe for you, tell your doctor if you have:

  • liver or kidney disease;

  • narrow-angle glaucoma;

  • heart disease, high blood pressure, or a history of stroke;

  • a bleeding or blood clotting disorder;

  • seizures or epilepsy;

  • bipolar disorder (manic depression); or

  • low levels or sodium in your blood (an electrolyte imbalance).

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using fluvoxamine. Your family or other caregivers should also be alert to changes in your mood or symptoms.

FDA pregnancy category C. Tell your doctor right away if you become pregnant while taking this medicine. Fluvoxamine may cause serious lung problems or other complications in a newborn if you take the medication during late pregnancy. However, you may have a relapse of OCD symptoms if you stop taking fluvoxamine. Do not start or stop taking the medication during pregnancy without your doctor's advice.

Fluvoxamine can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using fluvoxamine.

Do not give this medicine to anyone under 18 years old without medical advice.

How should I take fluvoxamine?

Fluvoxamine is usually taken at night. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

You may take fluvoxamine with or without food.

Do not crush, chew, break, or open an extended-release capsule. Swallow it whole.

You should not stop using fluvoxamine suddenly. Follow your doctor's instructions about tapering your dose.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking fluvoxamine?

Drinking alcohol can increase certain side effects of fluvoxamine.

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. Using an NSAID with fluvoxamine may cause you to bruise or bleed easily.

Fluvoxamine may impair your thinking or reactions. Avoid driving or operating machinery until you know how fluvoxamine will affect you.

Fluvoxamine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have;

  • blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;

  • seizure (convulsions);

  • changes in weight or appetite;

  • easy bruising or unusual bleeding;

  • anxiety, racing thoughts, risk-taking behavior, sleep problems (insomnia), feelings of extreme happiness or irritability;

  • high levels of serotonin in the body--agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting;

  • low levels of sodium in the body--headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady; or

  • severe nervous system reaction--very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.

Common side effects may include:

  • indigestion, gas, nausea, vomiting, loss of appetite;

  • increased urination;

  • weakness, drowsiness, depressed mood;

  • sweating, mild skin rash;

  • vision changes;

  • dry mouth, stuffy nose;

  • unusual or unpleasant taste in the mouth;

  • agitation, feeling restless;

  • shaking;

  • heavy menstrual periods; or

  • decreased sex drive, abnormal ejaculation, trouble having an orgasm.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Fluvoxamine dosing information

Usual Adult Dose for Obsessive Compulsive Disorder:

Initial immediate release tablet dose: 50 mg orally once a day at bedtime.
Maintenance dose: 100 to 300 mg per day. The dose may be increased in 50 mg increments every 4 to 7 days, as tolerated, until maximum therapeutic benefit is achieved.
Maximum Dose: 300 mg per day.
It is advisable that a total daily dose of more than 100 mg should be given in two divided doses. If the doses are not equal, the larger dose should be given at bedtime.

Although the efficacy of fluvoxamine tablets beyond 10 weeks of dosing for OCD has not been documented in controlled trials, OCD is a chronic condition, and it is reasonable to consider continuation for a responding patient. Dosage adjustments should be made to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for continued treatment.

Initial extended release capsule dose: 100 mg once per day.
Fluvoxamine extended release capsules should be administered, with or without food, as a single daily dose at bedtime.

In the controlled clinical trials establishing the effectiveness of fluvoxamine extended release capsules in OCD, patients were titrated in 50 mg increments within a dose range of 100 mg/day to 300 mg/day. Consequently, the dose should be increased in 50 mg increments every week, as tolerated, until maximum therapeutic benefit is achieved, not to exceed 300 mg per day.

Although the efficacy of fluvoxamine extended release capsules beyond 12 weeks of dosing for OCD has not been documented in controlled trials, social anxiety disorder is a chronic condition, and it is reasonable to consider continuation for a responding patient. Dosage adjustments should be made to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for continued treatment.

Usual Adult Dose for Depression:

Investigational:
Initial dose: 50 mg orally once a day at bedtime
Maintenance Dose: 100 to 300 mg per day. The dose may be increased in 50 mg increments every 4 to 7 days, as tolerated, until maximum therapeutic benefit is achieved. Total daily doses of more than 100 mg should be given in two divided doses. If the doses are not equal, the larger dose should be given at bedtime.

Usual Adult Dose for Panic Disorder:

Investigational:
Initial dose: 50 mg orally once a day at bedtime
Maintenance Dose: 100 to 300 mg per day. The dose may be increased in 50 mg increments every 4 to 7 days, as tolerated, until maximum therapeutic benefit is achieved. Total daily doses of more than 100 mg should be given in two divided doses. If the doses are not equal, the larger dose should be given at bedtime.

Usual Adult Dose for Social Anxiety Disorder:

Initial extended release capsule dose: 100 mg once per day.
Fluvoxamine extended release capsules should be administered, with or without food, as a single daily dose at bedtime.

In the controlled clinical trials establishing the effectiveness of fluvoxamine extended release capsules in social anxiety disorder, patients were titrated in 50 mg increments within a dose range of 100 mg/day to 300 mg/day. Consequently, the dose should be increased in 50 mg increments every week, as tolerated, until maximum therapeutic benefit is achieved, not to exceed 300 mg per day.

Although the efficacy of fluvoxamine extended release capsules beyond 12 weeks of dosing for social anxiety disorder has not been documented in controlled trials, social anxiety disorder is a chronic condition, and it is reasonable to consider continuation for a responding patient. Dosage adjustments should be made to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for continued treatment.

Usual Geriatric Dose for Obsessive Compulsive Disorder:

Initial tablet dose: Due to greater sensitivity to its effects and slower clearance, lower initial doses (25 mg per day at bedtime) may be advisable.
Maintenance dose: 50 to 300 mg per day. Slower titration may be advisable for elderly patients. Total daily doses of more than 100 mg should be given in two divided doses. If the doses are not equal, the larger dose should be given at bedtime.

Although the efficacy of fluvoxamine tablets beyond 10 weeks of dosing for OCD has not been documented in controlled trials, OCD is a chronic condition, and it is reasonable to consider continuation for a responding patient. Dosage adjustments should be made to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for continued treatment.

Initial extended release capsule dose: 100 mg once per day.
Fluvoxamine extended release capsules should be administered, with or without food, as a single daily dose at bedtime.

In the controlled clinical trials establishing the effectiveness of fluvoxamine extended release capsules in OCD, patients were titrated in 50 mg increments within a dose range of 100 mg/day to 300 mg/day. Consequently, the dose should be increased in 50 mg increments every week, as tolerated, until maximum therapeutic benefit is achieved, not to exceed 300 mg per day. Elderly patients have been observed to have a decreased clearance of fluvoxamine maleate. Consequently, it may be appropriate to titrate slowly following the initial dose of 100 mg.

Although the efficacy of fluvoxamine extended release capsules beyond 12 weeks of dosing for OCD has not been documented in controlled trials, social anxiety disorder is a chronic condition, and it is reasonable to consider continuation for a responding patient. Dosage adjustments should be made to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for continued treatment.

Usual Geriatric Dose for Social Anxiety Disorder:

Initial extended release capsule dose: 100 mg once per day.
Fluvoxamine extended release capsules should be administered, with or without food, as a single daily dose at bedtime.

In the controlled clinical trials establishing the effectiveness of fluvoxamine extended release capsules in social anxiety disorder, patients were titrated in 50 mg increments within a dose range of 100 mg/day to 300 mg/day. Consequently, the dose should be increased in 50 mg increments every week, as tolerated, until maximum therapeutic benefit is achieved, not to exceed 300 mg per day. Elderly patients have been observed to have a decreased clearance of fluvoxamine maleate. Consequently, it may be appropriate to titrate slowly following the initial dose of 100 mg.

Although the efficacy of fluvoxamine extended release capsules beyond 12 weeks of dosing for social anxiety disorder has not been documented in controlled trials, social anxiety disorder is a chronic condition, and it is reasonable to consider continuation for a responding patient. Dosage adjustments should be made to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for continued treatment.

Usual Pediatric Dose for Obsessive Compulsive Disorder:

8 to 11 years:
Initial immediate release dose: 25 mg orally once a day at bedtime.
Maintenance dose: 25 to 100 mg orally twice a day. The dose may be increased in 25 mg increments every 4 to 7 days, as tolerated, up to a maximum dose of 200 mg per day. Total daily doses of more then 50 mg should be given in two divided doses. If the two divided doses are not equal, the larger dose should be given at bedtime.

11 to 17 years:
Initial dose: Immediate release: 25 mg orally once a day at bedtime.
Maintenance dose: 25 to 150 mg orally twice a day. The dose may be increased in 25 mg increments every 4 to 7 days, as tolerated, up to a maximum dose of 300 mg per day. Total daily doses of more then 50 mg should be given in two divided doses. If the two divided doses are not equal, the larger dose should be given at bedtime.

Lower doses may be effective in female versus male patients.

What other drugs will affect fluvoxamine?

Taking fluvoxamine with other drugs that make you sleepy or slow your breathing can increase these effects. Ask your doctor before taking fluvoxamine with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Many drugs can interact with fluvoxamine. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with fluvoxamine, especially:

  • methadone, mexiletine, St. John's wort, theophylline, tramadol, tryptophan (also called L-tryptophan);

  • a blood thinner--warfarin, Coumadin, Jantoven;

  • medicine to treat mood disorders, thought disorders, or mental illness--such as clozapine, lithium, antidepressants, or antipsychotics;

  • migraine headache medicine--sumatriptan, rizatriptan, zolmitriptan, and others; or

  • a sedative--diazepam, alprazolam, midazolam, triazolam, Valium, Xanax.

This list is not complete and many other drugs can interact with fluvoxamine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

  • Your pharmacist can provide more information about fluvoxamine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 17.03. Revision Date: 2014-08-25, 9:25:54 AM.

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