From the Guidelines
To taper off 75mg of fluvoxamine, a gradual reduction of 25mg every 1-2 weeks is recommended, such as decreasing from 75mg to 50mg for 1-2 weeks, then to 25mg for 1-2 weeks, before stopping completely, as suggested by the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1. When tapering off fluvoxamine, it's essential to work closely with your healthcare provider to create a personalized plan, as the rate of tapering may vary depending on individual factors, such as the duration of treatment and the presence of withdrawal symptoms. Some key points to consider during the tapering process include:
- Monitoring for withdrawal symptoms, such as dizziness, nausea, headaches, irritability, and flu-like symptoms, which can occur when reducing the dose or stopping the medication abruptly 1.
- Adjusting the tapering schedule as needed to minimize discomfort and prevent the return of original symptoms.
- Recognizing that fluvoxamine, like other SSRIs, can cause discontinuation syndrome, characterized by symptoms such as dizziness, fatigue, lethargy, and anxiety, especially when stopped abruptly or reduced too quickly 1. The importance of a gradual tapering process is highlighted by the potential for drug-drug interactions and the need for careful monitoring, especially when concomitantly administering other medications that may interact with fluvoxamine 1. By following a gradual tapering schedule and working closely with your healthcare provider, you can minimize the risk of withdrawal symptoms and ensure a safe and effective transition off fluvoxamine.
From the FDA Drug Label
A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate.
To taper off 75mg of fluvoxamine, a gradual reduction in dose is recommended. The exact tapering schedule is not specified, but it is advised to decrease the dose at a rate that is tolerable for the patient. If intolerable symptoms occur, the previously prescribed dose may be resumed, and then the dose can be decreased again at a more gradual rate 2.
From the Research
Tapering Off Fluvoxamine
To minimize the symptoms of antidepressant discontinuation, gradual tapering is necessary for all serotonin reuptake inhibitors (SRIs) except fluoxetine, which has an extended half-life 3.
- Agents with shorter half-lives such as venlafaxine, fluvoxamine, and paroxetine should be tapered gradually 3.
- Guidelines recommend short tapers, of between 2 weeks and 4 weeks, down to therapeutic minimum doses, or half-minimum doses, before complete cessation 4.
- However, studies have shown that these tapers show minimal benefits over abrupt discontinuation, and are often not tolerated by patients 4.
- Tapers over a period of months and down to doses much lower than minimum therapeutic doses have shown greater success in reducing withdrawal symptoms 4.
- Hyperbolically reducing doses of SSRIs reduces their effect on serotonin transporter inhibition in a linear manner, and it is suggested that SSRIs should be tapered hyperbolically and slowly to doses much lower than those of therapeutic minimums 4.
Withdrawal Symptoms
- Discontinuation symptoms, which frequently emerge after abrupt discontinuation or intermittent non-compliance and, less frequently, during dose reduction, are generally mild, short-lived, and self-limiting but can be distressing and may lead to missed work days and decreased productivity 3.
- Symptoms of discontinuation may be somatic (e.g., dizziness and light-headedness; nausea and vomiting; fatigue, lethargy, myalgia, chills, and other flu-like symptoms; sensory and sleep disturbances) or psychological (anxiety and/or agitation, crying spells, irritability) 3.
- Withdrawal symptoms will be minimized with a slow and hyperbolic taper 4.
Specifics of Fluvoxamine
- Fluvoxamine is a potent and selective serotonin reuptake inhibitor (SSRI) that has little or no effect on other monoamine reuptake mechanisms 5.
- Fluvoxamine is generally well tolerated; in postmarketing studies, nausea was the only adverse event occurring in >10% of patients 5.
- Fluvoxamine has a shorter half-life compared to fluoxetine, and therefore requires a more gradual tapering schedule to minimize withdrawal symptoms 3, 6.