What is the recommended dosage of fluvoxamine (Selective Serotonin Reuptake Inhibitor - SSRI) for treating major depressive disorder?

From the Guidelines

Fluvoxamine for depression is typically started at 50 mg once daily and gradually increased to an effective dose of 150 mg daily, with a maximum recommended dose of 300 mg per day. The dosage of fluvoxamine for depression should be adjusted based on the patient's response and tolerance to the medication, with dose adjustments made at 4-7 day intervals to allow assessment of response and side effects 1.

Key Considerations

• The starting dose of 50 mg once daily is recommended, with increments of 50 mg as needed and tolerated.
• The effective dose of fluvoxamine for depression is typically in the range of 150 mg daily, although some patients may require higher or lower doses.
• The maximum recommended dose of fluvoxamine is 300 mg per day, and doses above this level are not recommended due to the increased risk of adverse effects.
• Patients should be closely monitored for adverse effects, particularly during the initial treatment period, and the dosage of fluvoxamine should be adjusted as needed to minimize side effects.
• Fluvoxamine should be taken consistently with or without food as directed by the healthcare provider, and patients should be aware of potential drug interactions, particularly with other medications that affect serotonin 1.

Monitoring and Follow-up

• Patients should be monitored regularly for response to treatment and adverse effects, with follow-up visits scheduled at least every 1-2 weeks during the initial treatment period.
• The patient's status, therapeutic response, and adverse effects of antidepressant therapy should be assessed on a regular basis, and the treatment plan should be modified as needed to ensure optimal outcomes.
• Patients should be informed about the possible adverse effects of fluvoxamine, including nausea, headache, insomnia, and drowsiness, and should be advised to contact their healthcare provider if they experience any of these symptoms.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Dosage for Adults The recommended starting dose for Fluvoxamine Maleate Tablets in adult patients is 50 mg, administered as a single daily dose at bedtime. In the controlled clinical trials establishing the effectiveness of Fluvoxamine Maleate Tablets in OCD, patients were titrated within a dose range of 100 to 300 mg/day Consequently, the dose should be increased in 50 mg increments every 4 to 7 days, as tolerated, until maximum therapeutic benefit is achieved, not to exceed 300 mg per day.

The dosage of fluvoxamine for depression is not explicitly stated in the provided drug label, as the label primarily discusses the treatment of OCD. However, based on the available information, the recommended starting dose for adults is 50 mg per day, and the dose can be increased in 50 mg increments every 4 to 7 days, up to a maximum of 300 mg per day 2.

From the Research

Dosage of Fluvoxamine for Depression

• The dosage of fluvoxamine for depression is typically in the range of 100 to 300 mg/day, as reported in studies 3, 4.
• This dosage range has been shown to be effective in reducing symptoms of depression, with response rates comparable to other antidepressants such as imipramine and clomipramine 3.
• The dosage can be administered in once daily or divided dosage regimens, with a treatment duration of 4 to 6 weeks or longer 3, 4.
• Some studies have reported that fluvoxamine may have an earlier beneficial effect on suicidal ideation and/or anxiety or somatic complaints compared to other antidepressants 3.
• The efficacy of fluvoxamine has been maintained for up to 1 year, but long-term data are limited, and there are no comparative studies of fluvoxamine with other selective serotonin reuptake inhibitors 3.

Comparison with Other Antidepressants

• Fluvoxamine has been compared to other antidepressants such as paroxetine, sertraline, and imipramine, with similar efficacy and tolerability profiles 3, 4.
• A study reported that switching to sertraline from fluvoxamine or paroxetine may be effective and well-tolerated in patients with non-remitted or treatment-intolerant major depressive disorder 5.
• Another study reported that fluvoxamine monotherapy was effective in treating psychotic major depression, with an opposite effect to sertraline 6.

Tolerability and Safety

• Fluvoxamine is generally well-tolerated, with common adverse effects including nausea, headache, sedation, dry mouth, and insomnia 3, 4.
• The tolerability profile of fluvoxamine appears to be more favorable than that of tricyclic antidepressants, with fewer cardiotoxic and anticholinergic adverse effects 3, 4.