Luvox (Fluvoxamine) Dose Increase from 50mg Daily
The next dose increase for a patient on Luvox 50mg daily is 100mg daily, administered as a single dose at bedtime or split into two divided doses (50mg twice daily). 1
Standard Dose Titration Protocol
Increase the dose by 50mg increments every 4 to 7 days, as tolerated, until maximum therapeutic benefit is achieved. 1 This titration schedule allows adequate time to assess tolerability at each dose level before advancing further.
Specific Dosing Instructions for 100mg Daily
- If continuing once-daily dosing: Administer the full 100mg dose at bedtime 1
- If splitting the dose: Divide into two doses (e.g., 50mg morning and 50mg evening), with the larger dose given at bedtime if doses are unequal 1
- Total daily doses exceeding 100mg should be given in two divided doses to optimize tolerability 1
Target Dose Range and Maximum Limits
- Therapeutic dose range for adults: 100-300mg/day 1, 2, 3
- Maximum daily dose: 300mg/day 1
- Higher doses (100-150mg/day) demonstrate superior efficacy: 73.7% improvement rate compared to 47.1% with lower doses (50-75mg/day) 4
Critical Monitoring During Dose Escalation
Monitor closely for adverse effects during the first 24-48 hours after each dose increase, particularly:
- Gastrointestinal symptoms: Nausea, abdominal discomfort (most common) 2, 3
- CNS effects: Insomnia, anxiety, agitation 5
- Discontinuation syndrome risk: Increases with higher doses (dizziness, fatigue, sensory disturbances) 5
Time to Therapeutic Response
Allow 6 weeks at the target dose before determining treatment efficacy. 4 The cumulative responder rate exceeds 80% by 6 weeks of treatment at adequate doses. If no improvement occurs by 6 weeks, consider altering the treatment regimen rather than continuing indefinitely. 4
Special Populations Requiring Modified Titration
Elderly or hepatically impaired patients require slower titration and lower maximum doses due to decreased fluvoxamine clearance. 1 Consider more conservative dose increases (e.g., 25mg increments) and longer intervals between adjustments in these populations.
Common Pitfalls to Avoid
- Do not increase doses more frequently than every 4 days 1 - premature escalation increases adverse effects without improving efficacy
- Do not judge efficacy before 6 weeks at target dose 4 - fluvoxamine requires adequate time for full therapeutic effect
- Do not abruptly discontinue if switching medications 1 - gradual dose reduction is recommended to minimize withdrawal symptoms
- Do not overlook drug interactions 5 - fluvoxamine inhibits CYP1A2 and can significantly elevate levels of other medications (theophylline, warfarin, tricyclic antidepressants, clozapine) 6, 7
Pharmacokinetic Considerations
Fluvoxamine displays nonlinear pharmacokinetics at steady-state, with disproportionately higher plasma concentrations at higher doses. 6 Steady-state is achieved within 5-10 days, and concentrations are 30-50% higher than predicted from single-dose data. 6 This supports the 4-7 day interval between dose increases to allow stabilization.