Fluvoxamine: Sedation Effects and Relationship to OCD
Fluvoxamine can cause sedation as a side effect but does not cause OCD; rather, it is specifically indicated for the treatment of obsessive-compulsive disorder. 1, 2
Sedative Effects of Fluvoxamine
- Fluvoxamine, a selective serotonin reuptake inhibitor (SSRI), can cause sedation in some patients, though it is not among the most commonly reported side effects 2
- Somnolence (drowsiness) is reported as one of the less common adverse events, occurring in fewer than 10% of patients taking fluvoxamine 3
- Sedation may manifest as fatigue, drowsiness, or somnolence, particularly during initial treatment or with dose increases 4
- Unlike some other psychotropic medications, fluvoxamine is generally not associated with significant cognitive impairment despite its potential sedative effects 2
Fluvoxamine and OCD
- Fluvoxamine is FDA-approved specifically for the treatment of obsessive-compulsive disorder (OCD), not as a cause of it 1
- It was the first SSRI to be registered for the treatment of OCD in children and has demonstrated efficacy in both pediatric and adult populations 2, 5
- Fluvoxamine works by inhibiting serotonin reuptake, which helps reduce obsessions and compulsions in patients with OCD 6
- Multiple controlled trials have shown fluvoxamine (100-300 mg/day) significantly reduces OCD symptoms compared to placebo, with response rates of 38-52% versus 0-18% for placebo 3
Other Common Side Effects of Fluvoxamine
- Nausea is the most frequently reported adverse event with fluvoxamine 2, 3
- Other common side effects include:
Special Considerations
- Fluvoxamine has significant drug interaction potential due to its inhibitory effects on multiple cytochrome P450 enzymes, particularly CYP1A2, CYP2C19, CYP2C9, CYP3A4, and CYP2D6 4
- It has been associated with discontinuation syndrome when stopped abruptly, characterized by dizziness, fatigue, headaches, nausea, sensory disturbances, anxiety, and irritability 4
- Fluvoxamine, like other SSRIs, carries a risk of serotonin syndrome, especially when combined with other serotonergic medications 4, 7
- Behavioral activation/agitation can occur, particularly early in treatment or with dose increases 4
Clinical Implications
- When prescribing fluvoxamine, start at a low dose and titrate slowly to minimize sedation and other side effects 4
- For patients experiencing sedation, consider administering the medication at bedtime 4
- Monitor for sedation particularly during the first few weeks of treatment and following dose adjustments 4
- Be aware that fluvoxamine does not cause OCD but is used to treat it; any worsening of obsessive-compulsive symptoms should prompt clinical evaluation 1, 6