Recommended Dosage and Treatment Plan for Fluvoxamine (Luvox) in Anxiety
For adults with anxiety, fluvoxamine should be initiated at 50 mg once daily at bedtime, then gradually increased by 50 mg every 4-7 days as tolerated, up to a maximum of 300 mg daily (divided into two doses if exceeding 100 mg/day). 1
Initial Dosing and Titration
Adult Patients
- Starting dose: 50 mg once daily at bedtime 1
- Titration schedule: Increase by 50 mg increments every 4-7 days as tolerated 1
- Maximum dose: 300 mg per day 1
- Dosing schedule:
- For doses >100 mg/day: Divide into two daily doses
- If doses are unequal, give larger dose at bedtime 1
Special Populations
- Elderly patients: Start with lower doses and titrate more slowly due to decreased clearance 1
- Patients with hepatic impairment: Start with lower doses and titrate more slowly 1
Monitoring and Duration of Treatment
- A full therapeutic trial requires at least 4-8 weeks 2
- Systematic assessment of treatment response using standardized symptom rating scales is recommended 2
- After 9 months of treatment, consider dosage reduction to reassess the need for continued medication 2
Discontinuation Protocol
- Never discontinue abruptly - this can lead to withdrawal symptoms 2
- Discontinue gradually over 10-14 days to limit withdrawal symptoms 2
- If intolerable symptoms occur during discontinuation, resume the previously prescribed dose and then decrease more gradually 1
Potential Side Effects and Precautions
Common Side Effects
- Gastrointestinal disturbances (nausea, vomiting, diarrhea)
- Central nervous system effects (sweating, tremors, nervousness, insomnia or somnolence, dizziness) 2
- Sexual disturbances 2
Important Precautions
- Drug interactions: Exercise caution when using fluvoxamine with alprazolam or triazolam 2
- Fluvoxamine interacts with drugs metabolized by CYP1A2, CYP2C19, CYP2C9, CYP3A4, and CYP2D6 2
- Concomitant use with MAOIs is contraindicated due to risk of serotonin syndrome 2
- Initial adverse effect may include increased anxiety or agitation; consider starting with a subtherapeutic "test" dose 2
Combination Treatment Considerations
For patients with inadequate response to fluvoxamine alone, cognitive behavioral therapy (CBT) in combination with medication may be more effective than either treatment alone 2.
Important Clinical Pearls
- Because an initial adverse effect of SSRIs can be increased anxiety or agitation, starting with a lower dose may help improve tolerability 2
- Discontinuation syndrome is more common with fluvoxamine compared to longer-acting SSRIs like fluoxetine 2
- Fluvoxamine has demonstrated efficacy in various anxiety disorders including OCD, social phobia, separation anxiety disorder, and generalized anxiety disorder 3, 4
- For doses exceeding 100 mg daily, dividing the dose is important to improve tolerability 1
Following this structured approach to fluvoxamine treatment for anxiety will help maximize therapeutic benefits while minimizing adverse effects.