Recommended Dosage of Fluvoxamine for Obsessive-Compulsive Disorder (OCD)
For adults with OCD, fluvoxamine should be initiated at 50 mg once daily at bedtime and titrated in 50 mg increments every 4-7 days to a therapeutic dose of 100-300 mg/day, not exceeding 300 mg daily. 1
Initial Dosing and Titration
- For adults, start with 50 mg as a single daily dose at bedtime 1
- Increase dose in 50 mg increments every 4-7 days as tolerated 1
- For daily doses exceeding 100 mg, divide into two doses, with the larger dose given at bedtime 1
- For pediatric patients (8-17 years), start with 25 mg once daily at bedtime and increase in 25 mg increments every 4-7 days 1
Target Dosage Range
- Therapeutic dose range for adults with OCD: 100-300 mg/day 1
- Maximum recommended daily dose: 300 mg for adults 1
- For children up to age 11: maximum dose should not exceed 200 mg/day 1
- For adolescents: may be titrated up to the adult maximum dose of 300 mg/day 1
Special Populations
- Elderly patients and those with hepatic impairment have decreased clearance of fluvoxamine 1
- Consider lower initial doses and more gradual titration in these populations 1
- Female children may achieve therapeutic effect with lower doses 1
Efficacy Considerations
- Clinical trials establishing effectiveness in OCD used doses within the 100-300 mg/day range 1
- Therapeutic effects may begin as early as week 2 of treatment 2
- In controlled trials, fluvoxamine demonstrated significant reduction in OCD symptoms compared to placebo, with mean decreases of 31.7% in Yale-Brown Obsessive Compulsive Scale scores 2
Administration Timing
- For single daily dosing, administer at bedtime 1
- For divided doses, administer the larger portion at bedtime 1
- Daily doses exceeding 50 mg in pediatric patients should be given in two divided doses 1
Duration of Treatment
- Although efficacy beyond 10 weeks has not been documented in controlled trials, OCD is a chronic condition 1
- Continuation of treatment for responding patients is reasonable 1
- Periodic reassessment is recommended to determine the need for continued treatment 1
Discontinuation
- Gradual reduction rather than abrupt cessation is recommended when discontinuing treatment 1
- Monitor for discontinuation symptoms when tapering 1
Common Side Effects and Precautions
- Typical side effects include sweating, tremors, nervousness, insomnia or somnolence, dizziness, and gastrointestinal and sexual disturbances 3
- Exercise caution when using fluvoxamine with alprazolam or triazolam due to drug interactions 3
- Fluvoxamine is a potent inhibitor of CYP1A2 and moderate inhibitor of CYP2C19 and CYP3A4, which may lead to drug interactions 4