Can an adult patient with a history of migraines and a pre-existing mental health condition, such as depression or anxiety, take Ubrelvy (Ubrogepant) with Luvox (Fluvoxamine)?

Can Ubrelvy Be Given With Luvox?

No, Ubrelvy (ubrogepant) should not be taken with Luvox (fluvoxamine) without dose adjustment, and specifically, patients taking fluvoxamine should not take a second dose of Ubrelvy within 24 hours. 1

Critical Drug Interaction Warning

The FDA-approved prescribing information for Ubrelvy explicitly lists fluvoxamine as a medication that requires special dosing considerations 1:

• Patients taking fluvoxamine should NOT take a second dose of Ubrelvy within 24 hours 1
• Fluvoxamine is a moderate-to-potent CYP3A4 inhibitor, which significantly affects ubrogepant metabolism 1, 2
• Fluvoxamine is specifically identified as a potent inhibitor of CYP1A2 and a moderate inhibitor of CYP3A4 2

Dosing Algorithm When Combining These Medications

If the patient must take both medications:

1. Initial dose: A single dose of Ubrelvy can be given 1
2. Second dose restriction: Do NOT allow a second dose of Ubrelvy within 24 hours if the patient is taking fluvoxamine 1
3. Alternative approach: Consider using the patient's first dose of Ubrelvy only, without the option for a second dose 1

Mechanism of Interaction

• Fluvoxamine inhibits CYP3A4 and CYP1A2 enzymes, which are involved in ubrogepant metabolism 1, 2
• This inhibition increases ubrogepant exposure in the bloodstream, raising the risk of adverse effects 1
• The interaction is significant enough to warrant explicit FDA labeling restrictions 1

Clinical Context for This Patient

For an adult with migraines and depression/anxiety:

• Fluvoxamine is an effective SSRI for anxiety disorders and OCD, with demonstrated efficacy in multiple anxiety conditions 2
• Ubrelvy is a CGRP receptor antagonist approved for acute migraine treatment with or without aura 3, 1, 4
• The 2025 American College of Physicians guideline identifies CGRP antagonists (gepants like ubrogepant) as options for patients who don't respond to triptans with NSAIDs 3

Common Pitfalls to Avoid

• Do not assume all migraine medications are safe with fluvoxamine - this specific interaction requires dose limitation 1
• Do not allow patients to take a rescue second dose if they're on fluvoxamine, even if the first dose was ineffective 1
• Counsel patients explicitly about the 24-hour restriction on second doses when prescribing this combination 1

Alternative Considerations

If frequent dosing of Ubrelvy is needed:

• Consider switching from fluvoxamine to an SSRI with less CYP3A4 inhibition (though this requires psychiatric consultation) 5, 2
• Consider alternative acute migraine treatments such as triptans with NSAIDs, which don't have this interaction 3
• Ensure the patient isn't taking other CYP3A4 inhibitors concurrently (verapamil, cyclosporine, ciprofloxacin, fluconazole) 1

Safety Monitoring

• Monitor for ubrogepant adverse effects: nausea, somnolence, dry mouth, and oropharyngeal pain 4, 6
• Watch for allergic reactions, which can occur hours to days after taking Ubrelvy 1
• Ensure patients understand they should not exceed 8 migraine treatments with Ubrelvy in 30 days 1