What is Luvox (fluvoxamine) used for?

Luvox (Fluvoxamine) Uses and Indications

Fluvoxamine (Luvox) is primarily FDA-approved for the treatment of Obsessive-Compulsive Disorder (OCD), but is also used off-label for various anxiety disorders including social anxiety disorder, panic disorder, and post-traumatic stress disorder. 1

Primary FDA-Approved Indication

• Obsessive-Compulsive Disorder (OCD): Fluvoxamine is indicated for treating obsessions and compulsions in patients with OCD, characterized by recurrent, persistent thoughts (obsessions) and/or repetitive behaviors (compulsions) that cause marked distress or significantly interfere with social or occupational functioning 1

Common Off-Label Uses

• Social Anxiety Disorder (SAD): Fluvoxamine is covered by national health insurance in Japan for treating social anxiety disorder and is suggested as a first-choice SSRI for this condition 2

• Panic Disorder: Studies have shown fluvoxamine ≤300 mg/day for 6-8 weeks to be as effective as imipramine and significantly more effective than placebo for panic disorder 3

• Post-Traumatic Stress Disorder (PTSD): Fluvoxamine has demonstrated efficacy in treating PTSD symptoms, including associated nightmares 2

Other Off-Label Uses

• Obsessive-Compulsive Spectrum Disorders: Fluvoxamine has shown efficacy in treating:

  • Body dysmorphic disorder 3, 4
  • Pathological gambling 3, 4
  • Compulsive buying 3
  • Trichotillomania 3
  • Kleptomania 3
  • Eating disorders (including binge eating disorder and bulimia nervosa) 3, 4

• Nightmare Disorder: Some evidence supports fluvoxamine use in treating PTSD-associated nightmares 2

Pharmacological Properties

• Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) with antidepressant and anxiolytic properties 2, 3
• It selectively inhibits serotonin reuptake with little to no effect on other monoamine reuptake mechanisms 3
• Relative to other SSRIs, fluvoxamine is:
  • A weak inhibitor of CYP2D6
  • A moderate inhibitor of CYP2C19 and CYP3A4
  • A potent inhibitor of CYP1A2 3

Dosing Considerations

• For adults with OCD: Typically 100-300 mg/day 1, 5
• For anxiety disorders: Similar dosing range of 100-300 mg/day 3
• For adolescents (12-17 years): Maximum dosage can be as high as 300 mg/day 6, 7
• For children (6-11 years): Maximum recommended dosage is 200 mg/day due to 2-3 times higher steady-state plasma concentrations compared to adolescents 6, 7

Safety Profile

• Generally well-tolerated with nausea being the most common adverse event (>10% of patients) 3, 4
• Other common side effects include:
  • Somnolence, asthenia, headache, dry mouth, and insomnia 3
  • Gastrointestinal complaints 2
• Advantages compared to other antidepressants:
  • Lower risk of anticholinergic or cardiovascular events compared to tricyclic antidepressants 3
  • Low risk of sexual dysfunction, suicidality, and withdrawal reactions 4
  • No significant effect on body weight or cardiovascular parameters 4
  • Safe in overdose 4

Important Precautions

• Risk of serotonin syndrome when combined with other serotonergic medications, especially MAOIs 2
• Potential for drug interactions due to its effects on cytochrome P450 enzymes 2, 3
• May cause discontinuation syndrome, though less commonly than with paroxetine 2

Clinical Pearls

• Fluvoxamine was the first SSRI to be registered for the treatment of OCD in children 4
• Response rates of 38-52% have been reported with fluvoxamine in OCD, compared to 0-18% with placebo 3
• Maintenance therapy with fluvoxamine may reduce relapse likelihood in up to 67% of OCD patients 3
• When comparing efficacy for OCD, fluvoxamine has demonstrated similar effectiveness to clomipramine but with a better tolerability profile 3, 5