What are the typical doses of fluvoxamine (Selective Serotonin Reuptake Inhibitor) for depression and COVID-19?

From the Guidelines

Fluvoxamine is typically started at 50 mg twice daily for depression, with a maximum recommended dose of 300 mg daily, and 100 mg twice or three times daily for 10-14 days for off-label use in COVID-19, based on its anti-inflammatory properties. For depression, the initial dosage can be adjusted to an effective dose of 100-300 mg daily, with doses above 100 mg usually divided into two administrations [ 1 ]. When considering fluvoxamine for COVID-19, it's essential to note that while not FDA-approved for this use, recent studies suggest its potential therapeutic effect in reducing the cytokine storm associated with severe COVID-19 [ 1 ]. Some key points to consider when prescribing fluvoxamine include:

• Potential side effects such as nausea, headache, insomnia, and sexual dysfunction
• Significant drug interactions, particularly with medications metabolized by CYP1A2 and with other serotonergic drugs, which can lead to serotonin syndrome
• The need for gradual tapering when discontinuing the medication to avoid withdrawal symptoms
• Consulting a healthcare provider before starting fluvoxamine for either depression or COVID-19.

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 typical doses of fluvoxamine for depression and other conditions are:

• Starting dose: 50 mg per day
• Dose range: 100 to 300 mg per day
• Maximum dose: 300 mg per day
• Dose increments: 50 mg every 4 to 7 days However, the provided drug label does not explicitly mention the dose for COVID-19, as it primarily discusses the treatment of OCD and other conditions. 2

From the Research

Fluvoxamine Doses for Depression

• The typical dose of fluvoxamine for depression is 100-150 mg per day, with a significant difference in improvement rates between high and low daily doses 3.
• A study found that 73.7% of patients showed improvement after receiving a high daily dose of 100-150 mg, compared to 47.1% on a low daily dose of 50-75 mg 3.
• Fluvoxamine is recommended at a daily dose of 100 mg or 150 mg as the initial dose, with treatment regimens altered if no improvement is seen after 6 weeks 3.

Fluvoxamine Doses for COVID-19

• There is evidence to support the use of fluvoxamine in the treatment of COVID-19 infection, with two published phase II studies showing positive results for clinical deterioration and hospitalization rate versus a placebo 4.
• The exact dose of fluvoxamine for COVID-19 treatment is not specified in the available studies, but ongoing clinical trials are investigating its use in this context 4.

General Dosage Information

• Fluvoxamine is typically administered in daily doses of 50-300 mg for depression and anxiety disorders 5, 6.
• The maximum dosage recommended for children is 200 mg/day, while adolescents can receive up to 300 mg/day 5.
• Steady-state plasma fluvoxamine concentrations are achieved 5-10 days after initiation of therapy, and are 30-50% higher than those predicted from single-dose data 7.