Is it safe to use Abilify (aripiprazole) and Luvox (fluvoxamine) together?

Safety of Combining Abilify (Aripiprazole) and Luvox (Fluvoxamine)

The combination of Abilify (aripiprazole) and Luvox (fluvoxamine) should be used with caution due to significant drug interactions, but can be beneficial in specific clinical scenarios such as treatment-resistant depression or OCD with careful monitoring and dose adjustments.

Pharmacokinetic Interaction

Fluvoxamine is a potent inhibitor of several cytochrome P450 enzymes, which can significantly affect the metabolism of aripiprazole:

• Fluvoxamine inhibits CYP2D6 enzymes, which are involved in aripiprazole metabolism 1
• This inhibition can lead to increased blood levels of aripiprazole
• When these medications are combined, aripiprazole concentrations may increase by 40-50%

Clinical Recommendations

Dosing Adjustments

• When combining aripiprazole with fluvoxamine, the aripiprazole dose should be reduced by approximately 50% from the standard dose
• Start with lower doses of aripiprazole (2.5-5mg) when adding to fluvoxamine
• Titrate slowly based on clinical response and side effects
• Monitor more frequently during the first 2-4 weeks of combination therapy

Monitoring Parameters

• Regular assessment for:
  • Extrapyramidal symptoms (tremor, rigidity, akathisia)
  • Metabolic parameters (weight, glucose, lipids)
  • Cardiac effects (QTc prolongation)
  • Sedation or activation
  • Suicidal ideation, especially during initial treatment period

Clinical Applications

This combination may be particularly useful in:

1. Treatment-resistant depression: Aripiprazole augmentation of SSRIs has shown efficacy in patients who failed to respond to SSRI monotherapy 2

   • 58.3% response rate when aripiprazole was added to SSRIs in treatment-resistant depression
   • 41.7% achieved remission in an intent-to-treat analysis

2. Obsessive-Compulsive Disorder: The combination may be beneficial for OCD symptoms 3, 4

   • Aripiprazole has demonstrated effectiveness in reducing obsessive-compulsive symptoms
   • Fluvoxamine is an established first-line treatment for OCD

Safety Considerations

Potential Side Effects

• Increased risk of extrapyramidal symptoms with long-term treatment 3
• Lower risk of metabolic side effects compared to other antipsychotic combinations
• Potential for QTc prolongation (though less than with some other combinations)
• Increased risk of akathisia, especially during initial treatment

Contraindications

• Patients with known hypersensitivity to either medication
• Caution in elderly patients who may be more sensitive to side effects
• Careful consideration in patients with hepatic impairment, as both medications undergo hepatic metabolism

Practical Approach

1. Start with standard dose of fluvoxamine
2. If adding aripiprazole, begin with 2.5mg daily (50% reduction from typical starting dose)
3. Assess tolerability after 1-2 weeks before considering dose increases
4. Maximum aripiprazole dose should generally not exceed 10-15mg when combined with fluvoxamine
5. Monitor for side effects at each dose adjustment
6. Evaluate clinical response after 4-6 weeks of combined therapy at stable doses

While this combination requires careful management, the evidence suggests it can be effective for treatment-resistant depression and OCD when properly monitored and with appropriate dose adjustments.