What is the recommended dosing for fluvoxamine (Luvox)?

From the Guidelines

Fluvoxamine should be initiated at a dose of 50 mg twice daily, with a maximum dosage of 150 mg twice daily, and its use should be exercised with caution when combined with certain medications like alprazolam or triazolam. When considering the dosing of fluvoxamine, it's crucial to weigh the potential benefits against the risks, particularly in terms of morbidity, mortality, and quality of life. The primary concern with fluvoxamine, as with other SSRIs, is its potential to interact with other medications by inhibiting various cytochrome P450 isoenzymes, which can lead to prolonged half-lives of those drugs 1. Key considerations for fluvoxamine dosing include:

• Initial dosage: 50 mg twice daily
• Maximum dosage: 150 mg twice daily
• Potential interactions: Exercise caution when using fluvoxamine with alprazolam or triazolam due to potential drug interactions
• Side effects: Typical side effects can include sweating, tremors, nervousness, insomnia or somnolence, dizziness, and various gastrointestinal and sexual disturbances, as noted in the guidelines for managing conditions where SSRIs like fluvoxamine are prescribed 1. Given the potential for significant drug interactions and side effects, careful monitoring and dose adjustment are necessary to optimize the therapeutic effect of fluvoxamine while minimizing its risks.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Dosage for Adults The recommended starting dose for Fluvoxamine Maleate Tablets in adult patients is 50 mg, administered as a single daily dose at bedtime. In the controlled clinical trials establishing the effectiveness of Fluvoxamine Maleate Tablets in OCD, patients were titrated within a dose range of 100 to 300 mg/day Consequently, the dose should be increased in 50 mg increments every 4 to 7 days, as tolerated, until maximum therapeutic benefit is achieved, not to exceed 300 mg per day.

Dosage for Pediatric Population (children and adolescents) The recommended starting dose for Fluvoxamine Maleate Tablets in pediatric populations (age 8-17 years) is 25 mg, administered as a single daily dose at bedtime In a controlled clinical trial establishing the effectiveness of Fluvoxamine Maleate Tablets in OCD, pediatric patients (ages 8-17) were titrated within a dose range of 50 to 200 mg/day.

Dosage for Elderly or Hepatically Impaired Patients Elderly patients and those with hepatic impairment have been observed to have a decreased clearance of fluvoxamine maleate Consequently, it may be appropriate to modify the initial dose and the subsequent dose titration for these patient groups.

The recommended dosing for fluvoxamine is as follows:

• Adults: starting dose of 50 mg at bedtime, increased in 50 mg increments every 4 to 7 days, up to a maximum of 300 mg per day.
• Pediatric population (age 8-17): starting dose of 25 mg at bedtime, increased in 25 mg increments every 4 to 7 days, up to a maximum of 200 mg per day for children up to age 11, and up to 300 mg per day for adolescents.
• Elderly or hepatically impaired patients: initial dose and subsequent dose titration may need to be modified due to decreased clearance of fluvoxamine maleate 2.

From the Research

Fluvoxamine Dosing

• The dosing and administration of fluvoxamine are reviewed in a study published in 1992 3.
• However, the study does not provide specific details on the dosing of fluvoxamine.
• Another study published in 1997 compares the safety and side-effect profiles of fluvoxamine, fluoxetine, sertraline, and paroxetine, but does not discuss dosing 4.
• A systematic review and guide to the selection of selective serotonin reuptake inhibitors, including fluvoxamine, is published in 1999, but it does not provide specific dosing information 5.
• A study on SSRI-induced sexual dysfunction published in 1997 mentions that sexual dysfunction was positively correlated with dose, but does not provide specific dosing information for fluvoxamine 6.
• A recent study published in 2025 develops a method for simultaneous determination of 23 antidepressants, including fluvoxamine, in human serum, but does not discuss dosing 7.

Available Information

• The available evidence does not provide specific information on the dosing of fluvoxamine.
• The studies reviewed focus on the pharmacology, pharmacokinetics, efficacy, and safety of fluvoxamine, but do not provide detailed dosing information.
• Further research is needed to determine the optimal dosing of fluvoxamine for specific indications and patient populations.