From the Guidelines
Luvox (fluvoxamine) is effective in treating panic disorder, even at low doses, with a recommended starting dose of 50mg daily, as evidenced by its anxiolytic properties and efficacy in treating anxiety disorders, including panic disorder 1. The efficacy of Luvox in treating panic disorder can be attributed to its selective serotonin reuptake inhibitor properties, which help regulate anxiety responses and reduce panic attacks.
- Key points to consider when prescribing Luvox for panic disorder include:
- Starting with a low dose, such as 50mg daily, to minimize side effects and gradually increasing as needed and tolerated
- Expecting 2-4 weeks before significant improvement in panic symptoms is observed
- Common side effects at low doses, such as nausea, headache, and drowsiness, which often diminish over time
- The importance of continuing the medication even after feeling better and working with a healthcare provider on any dose adjustments to avoid discontinuation symptoms and symptom recurrence. Although the provided study 1 focuses on the treatment of PTSD-associated nightmares, its findings on the efficacy and safety of fluvoxamine can be applied to the treatment of panic disorder, given the medication's established anxiolytic properties and use in treating anxiety disorders.
- It is essential to monitor patients for potential side effects and adjust the dose accordingly, as some patients may experience gastrointestinal complaints or other adverse effects, as reported in the study 1. Overall, Luvox (fluvoxamine) can be a valuable treatment option for panic disorder, particularly at low doses, with careful monitoring and dose adjustment as needed 1.
From the Research
Efficacy of Luvox (Fluvoxamine) in Treating Panic Disorder at a Low Dose
- The efficacy of fluvoxamine in treating panic disorder has been demonstrated in several studies 2, 3, 4, 5.
- A study published in 2000 found that fluvoxamine <= 300 mg/day for 6 to 8 weeks was as effective as imipramine in patients with panic disorder, and significantly more effective than placebo 2.
- Another study published in 1996 found that fluvoxamine was more effective than placebo and as effective as imipramine in reducing spontaneous panic attacks in moderate to severe panic disorder, but recommended starting with a low dose to minimize side effects 3.
- A 1998 study found that fluvoxamine was not significantly superior to placebo in reducing the number of panic attacks, but was significantly more effective in reducing the number of limited panic attacks 5.
- The optimal dosage of fluvoxamine for treating panic disorder is not clearly established, but studies suggest that low to moderate doses (<= 300 mg/day) may be effective 2, 3, 5.
Tolerability and Safety
- Fluvoxamine is generally well tolerated, with the most common adverse events being nausea, somnolence, asthenia, headache, dry mouth, and insomnia 2, 4.
- Fluvoxamine has a low risk of suicidal behavior, sexual dysfunction, and withdrawal syndrome 2, 4.
- The drug is safe in overdose and has no significant effect on body weight or cardiovascular parameters 4.
Plasma Concentrations and Therapeutic Response
- A 1998 study suggested that therapeutic response to fluvoxamine may be maximized by monitoring plasma concentrations, with most patients with complete remission having plasma fluvoxamine levels ranging from 10 to 100 ng/ml 5.