Luvox (Fluvoxamine) Dosing and Treatment Approach
Recommended Dosage for OCD in Adults
For adults with OCD, start fluvoxamine at 50 mg once daily at bedtime, then increase by 50 mg increments every 4-7 days as tolerated to a target range of 100-300 mg/day, with doses above 100 mg split into two divided doses (larger dose at bedtime). 1
Specific Dosing Algorithm
- Initial dose: 50 mg at bedtime 1
- Titration schedule: Increase by 50 mg every 4-7 days based on tolerability 1
- Therapeutic range: 100-300 mg/day (established in controlled trials) 2, 1
- Maximum dose: 300 mg/day 1
- Dosing frequency:
Pediatric Dosing (Ages 8-17)
For children and adolescents with OCD, start at 25 mg at bedtime, increase by 25 mg every 4-7 days, with maximum doses of 200 mg/day for children up to age 11 and 300 mg/day for adolescents. 1
- Children (ages 8-11): Maximum 200 mg/day (plasma concentrations 2-3 times higher than adolescents) 1, 3
- Adolescents (ages 12-17): Maximum 300 mg/day 1, 3
- Doses >50 mg/day should be split into two divided doses 1
- Female children may achieve therapeutic effect at lower doses 1
Treatment Approach for Social Anxiety Disorder
Fluvoxamine is recommended as first-line pharmacotherapy for social anxiety disorder in adults, alongside paroxetine and escitalopram, as these are the SSRIs with established efficacy and insurance coverage. 4
Key Treatment Principles
- First-line recommendation: SSRIs (including fluvoxamine) are suggested for social anxiety disorder with weak strength of recommendation but represent standard care 4
- Treatment duration: Symptoms must persist for at least 6 months to meet diagnostic criteria 4
- Combination approach: Consider pharmacotherapy alone, psychotherapy (CBT) alone, or combined treatment based on patient preference and availability 4
Special Populations
Elderly and Hepatically Impaired Patients
Reduce initial dose and slow titration in elderly patients and those with hepatic impairment due to decreased fluvoxamine clearance. 1
Pregnant Women (Third Trimester)
Carefully weigh risks versus benefits when treating in the third trimester, as neonates may develop complications requiring prolonged hospitalization; consider tapering before delivery. 1
Critical Drug Interactions
Fluvoxamine is a potent CYP1A2 inhibitor and moderate inhibitor of CYP2C19 and CYP3A4—avoid concomitant use with alprazolam or triazolam, and exercise caution with other substrates of these enzymes. 2
- More significant CYP1A2 inhibition compared to other SSRIs 5
- Lower CYP2D6 inhibition than other SSRIs 5
Discontinuation Strategy
Taper fluvoxamine gradually rather than stopping abruptly to minimize discontinuation syndrome, which occurs more commonly with fluvoxamine due to its shorter half-life compared to other SSRIs. 2, 1
- Monitor for discontinuation symptoms during dose reduction 1
- If intolerable symptoms occur, resume previous dose and taper more slowly 1
- Discontinuation syndrome risk is present but lower than with some other SSRIs 5
Maintenance Treatment
Continue treatment in responding OCD patients beyond 10 weeks, as OCD is a chronic condition; maintenance therapy may reduce relapse risk in up to 67% of patients. 1, 5
- Periodically reassess need for continued treatment 1
- Maintain patients on lowest effective dosage 1
- Long-term efficacy demonstrated for up to 1 year in pediatric OCD patients 6, 3
Efficacy Benchmarks
- Response rates in OCD: 38-52% with fluvoxamine versus 0-18% with placebo 5
- Responder definition: "Much" or "very much" improved on Clinical Global Impression scale 7
- Time to response: Significant improvement typically seen by week 6 7
Tolerability Profile
Fluvoxamine is generally well tolerated with nausea being the most common adverse event (>10% of patients); it has lower anticholinergic and cardiovascular effects than tricyclic antidepressants and low risk of suicidal behavior or sexual dysfunction. 5, 7