What is the recommended use and dosage of Fluvoxamine (Selective Serotonin Reuptake Inhibitor - SSRI) for treating obsessive-compulsive disorder (OCD) and social anxiety disorder?

From the Guidelines

Fluvoxamine is recommended for the treatment of obsessive-compulsive disorder (OCD) and social anxiety disorder, with an initial dose of 50 mg daily and gradual titration to an effective dose range of 100-300 mg daily, as supported by the most recent guidelines 1. The medication should be taken consistently, and patients should expect that therapeutic effects may take 4-6 weeks to fully develop.

• For adults with OCD, the target dose is usually 200 mg daily, though some patients may require up to 300 mg daily.
• For social anxiety disorder, treatment generally starts at 50 mg daily with gradual titration to an effective dose, typically 100-300 mg daily.
• Children (8-17 years) with OCD usually start at 25 mg daily, with gradual increases to 200 mg daily maximum. Fluvoxamine works by increasing serotonin levels in the brain, which helps regulate mood, anxiety, and obsessive thoughts.
• Abrupt discontinuation should be avoided; instead, the dose should be gradually tapered when stopping treatment to prevent withdrawal symptoms.
• Common side effects include nausea, headache, insomnia, and sexual dysfunction.
• Fluvoxamine has significant drug interactions, particularly with medications metabolized by the CYP1A2 enzyme system, so patients should inform healthcare providers about all medications they are taking 1. It is essential to monitor patients for potential adverse effects, such as suicidal thinking and behavior, behavioral activation/agitation, and serotonin syndrome, especially when combining fluvoxamine with other serotonergic medications 1.

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 recommended use and dosage of Fluvoxamine for treating Obsessive-Compulsive Disorder (OCD) is:

• Starting dose: 50 mg per day at bedtime
• Dose range: 100 to 300 mg per day
• Dose increments: 50 mg every 4 to 7 days
• Maximum dose: 300 mg per day

For Social Anxiety Disorder, the dosage is not explicitly stated in the provided drug label, therefore, no conclusion can be drawn for this specific condition. 2

From the Research

Recommended Use and Dosage of Fluvoxamine

The recommended use and dosage of Fluvoxamine for treating obsessive-compulsive disorder (OCD) and social anxiety disorder are as follows:

• For adults, the dosage of Fluvoxamine is 100 to 300 mg/day for 6 to 10 weeks, which has been shown to significantly reduce symptoms of OCD compared to placebo 3.
• For children and adolescents, the maximum dosage of Fluvoxamine is 200 mg/day for children aged 6 to 11 years and 300 mg/day for adolescents aged 12 to 17 years 4.
• Fluvoxamine has also been shown to be effective in treating social phobia, with a dosage of up to 300 mg/day for 8 weeks 3, 5.

Efficacy and Tolerability

The efficacy and tolerability of Fluvoxamine are:

• Fluvoxamine has been shown to be as effective as clomipramine in treating OCD, but with a better tolerability profile 3, 6.
• Fluvoxamine has a low risk of suicidal behavior, sexual dysfunction, and withdrawal syndrome 3.
• The most common adverse events associated with Fluvoxamine are nausea, somnolence, asthenia, headache, dry mouth, and insomnia 3.

Special Considerations

Special considerations for the use of Fluvoxamine include:

• Fluvoxamine is a potent inhibitor of cytochrome P450 (CYP) 1A2 and a moderate inhibitor of CYP2C19 and CYP3A4, which may lead to drug interactions 3.
• The controlled-release formulation of Fluvoxamine offers less daily fluctuation in fluvoxamine levels and a more rapid titration schedule, with a more rapid onset of effect 5.
• High doses of Fluvoxamine (up to 600 mg/day) may be effective in treating treatment-resistant OCD, but this should be done under close medical supervision 7.