Maximum Dose of Fluvoxamine for Adults
The maximum dose of fluvoxamine (Luvox) for adults is 300 mg per day, typically given in two divided doses with the larger dose at bedtime.
Dosing Guidelines
Initial Dosing
- Starting dose: 50 mg once daily at bedtime 1
- Titration: Increase in 50 mg increments every 4-7 days as tolerated 1
- Divided dosing: When total daily dose exceeds 100 mg, it's advisable to give in two divided doses 1
Maximum Dosing by Age Group
- Adults: Maximum 300 mg per day 1, 2
- Adolescents (12-17 years): Maximum 300 mg per day 3, 4
- Children (8-11 years): Maximum 200 mg per day 3, 4
Administration Considerations
Divided Dosing
When the total daily dose exceeds 100 mg:
- Split into two divided doses
- Give the larger portion at bedtime
- This approach helps minimize daytime sedation and other side effects 1
Special Populations
- Elderly patients: Lower doses recommended due to decreased clearance 1
- Hepatically impaired patients: Lower doses recommended due to decreased clearance 1
- Pregnant women (third trimester): Consider tapering dose due to potential complications in neonates 1
Discontinuation
- Gradual reduction rather than abrupt cessation is recommended
- Monitor for discontinuation symptoms (dizziness, nausea, headache, irritability) 1
Common Side Effects
- Nausea (most common, >10% of patients)
- Somnolence
- Asthenia
- Headache
- Dry mouth
- Insomnia 5
Monitoring
While specific monitoring parameters aren't detailed in the evidence, routine toxicity monitoring tests (complete blood count, renal function, liver function) should be performed periodically throughout treatment 2.
Clinical Pearls
- Fluvoxamine has potent inhibitory effects on CYP1A2, moderate effects on CYP2C19 and CYP3A4, and weak effects on CYP2D6 5
- This creates potential for significant drug interactions with medications metabolized by these enzymes
- Exercise caution when using fluvoxamine with alprazolam or triazolam due to potential interactions 2
Remember that while 300 mg per day is the maximum recommended dose, many patients achieve therapeutic benefit at lower doses. Always aim for the lowest effective dose to minimize side effects while maintaining clinical efficacy.