Are there any interactions between Luvox (fluvoxamine) and Dupixent (dupilumab)?

Interactions Between Fluvoxamine (Luvox) and Dupilumab (Dupixent)

There are no documented direct pharmacokinetic interactions between fluvoxamine (Luvox) and dupilumab (Dupixent), and they can generally be used together safely.

Mechanism of Action and Metabolism Differences

Fluvoxamine (Luvox)

• Selective serotonin reuptake inhibitor (SSRI) that works by inhibiting serotonin reuptake in the central nervous system
• Extensively metabolized by liver enzymes
• Potent inhibitor of multiple cytochrome P450 enzymes, particularly:
  • Strong inhibitor of CYP1A2
  • Moderate inhibitor of CYP2C19, CYP2C9, CYP3A4
  • Weak inhibitor of CYP2D6 1

Dupilumab (Dupixent)

• Monoclonal antibody that binds to IL-4 receptor alpha subunit
• Blocks both IL-4 and IL-13 signaling pathways
• Not metabolized through cytochrome P450 enzymes
• Eliminated via proteolytic degradation into small peptides and amino acids 1

Why No Significant Interaction Is Expected

1. Different metabolic pathways: Dupilumab, as a monoclonal antibody, is not metabolized through the cytochrome P450 system that fluvoxamine inhibits 1

2. Different mechanisms of action: Fluvoxamine affects serotonin neurotransmission in the central nervous system, while dupilumab targets immune pathways in type 2 inflammation 1

Important Considerations

Fluvoxamine-Specific Concerns

• Fluvoxamine has significant drug interaction potential with many medications due to its inhibition of multiple CYP450 enzymes 1
• Common interactions occur with:
  • Tricyclic antidepressants
  • Benzodiazepines (alprazolam, bromazepam, diazepam)
  • Warfarin
  • Theophylline
  • Propranolol
  • Carbamazepine 2, 3

Dupilumab-Specific Concerns

• Most common adverse effects include:
  • Injection site reactions
  • Ocular surface disorders (conjunctivitis, dry eyes, blepharitis) in approximately 25% of patients 1
  • Nasopharyngitis
  • Headache 4, 5

Monitoring Recommendations

1. Baseline assessment:

   • If patient has pre-existing ocular surface disease, consider prophylactic ocular lubricants when starting dupilumab 1
   • For patients with severe corneal or conjunctival disease, consider ophthalmology consultation before starting dupilumab 1

2. Ongoing monitoring:

   • Watch for signs of ocular surface disorders (redness, irritation, dryness)
   • Monitor for common side effects of both medications
   • No specific additional monitoring is needed for the combination beyond what would be done for each medication individually

Management of Side Effects

If ocular symptoms develop on dupilumab:

1. Mild symptoms: Preservative-free ocular lubricants
2. Moderate symptoms: Consider topical corticosteroid eye drops
3. Severe or persistent symptoms: Ophthalmology referral and possible consideration of alternative therapy 1

Conclusion

While both fluvoxamine and dupilumab have their own side effect profiles that require monitoring, there is no evidence suggesting a direct interaction between these medications. The primary concern with fluvoxamine is its potential to interact with other medications metabolized by CYP450 enzymes, while dupilumab's main concern is the development of ocular surface disorders.