Recommended Dosing for Fluvoxamine (Luvox)
The recommended starting dose for fluvoxamine in adults is 50 mg once daily at bedtime, with titration in 50 mg increments every 4-7 days up to a maximum of 300 mg per day. 1
Adult Dosing Protocol
Initial Dosing and Titration
- Starting dose: 50 mg once daily at bedtime
- Titration: Increase by 50 mg increments every 4-7 days as tolerated
- Maximum dose: 300 mg per day
- Dosing strategy:
- Doses >100 mg should be divided into two daily doses
- If using divided doses, the larger dose should be given at bedtime 1
Special Populations
Elderly or Hepatically Impaired Patients
- Lower starting doses and slower titration are recommended due to decreased clearance of fluvoxamine 1
Pregnant Women (Third Trimester)
- Consider tapering fluvoxamine during the third trimester due to potential complications in neonates requiring prolonged hospitalization, respiratory support, and tube feeding 1
Pediatric Dosing
Children (8-11 years)
- Starting dose: 25 mg once daily at bedtime
- Titration: Increase in 25 mg increments every 4-7 days as tolerated
- Maximum dose: 200 mg per day 1
Adolescents (12-17 years)
- Starting dose: 25 mg once daily at bedtime
- Titration: Increase in 25 mg increments every 4-7 days as tolerated
- Maximum dose: 300 mg per day (same as adults) 1
- Note: Therapeutic effect in female adolescents may be achieved with lower doses 1
Discontinuation Protocol
- Gradual reduction rather than abrupt cessation is recommended
- If intolerable symptoms occur during discontinuation:
- Resume previously prescribed dose
- Continue decreasing at a more gradual rate 1
Clinical Pearls and Caveats
Therapeutic Indications
- FDA-approved for Obsessive-Compulsive Disorder (OCD)
- In clinical trials for OCD, effective doses ranged from 100-300 mg/day 1
- Has shown efficacy in anxiety disorders including social phobia, separation anxiety disorder, and generalized anxiety disorder 2, 3
Common Adverse Effects
- Most common: Gastrointestinal disturbances and CNS effects 2, 3
- Abdominal discomfort occurs more frequently with fluvoxamine than placebo 2
- Most adverse events are mild to moderate in severity 4
Drug Interactions
- Exercise caution when using fluvoxamine with alprazolam or triazolam 5
- Fluvoxamine may prolong half-life of other drugs by inhibiting various cytochrome P450 isoenzymes 5
Monitoring
- Regular assessment to determine need for continued treatment
- Maintain patient on lowest effective dosage 1
Evidence Quality Considerations
While a case report has documented use of fluvoxamine at 600 mg daily with good tolerance in a treatment-resistant OCD patient 6, this exceeds the FDA-approved maximum dose of 300 mg daily and should not be routinely recommended without specialist consultation.