What is the use of Luvox (Fluvoxamine)?

From the Guidelines

Luvox (fluvoxamine) should be used with caution and considered as a second-line treatment option for social anxiety disorder, due to its potential for significant drug interactions and side effects, as recommended by the Japanese Society of Anxiety and Related Disorders/Japanese Society of Neuropsychopharmacology clinical practice guideline for social anxiety disorder 1.

Key Points to Consider

• The typical starting dose for adults with OCD is 50 mg taken once daily at bedtime, gradually increasing to 100-300 mg daily as needed and tolerated.
• For depression, dosing usually ranges from 50-300 mg daily, often divided into two doses.
• Treatment duration is typically long-term for OCD, often continuing for 6-12 months after symptom improvement, while depression treatment usually lasts at least 6-9 months after remission.
• Fluvoxamine works by increasing serotonin levels in the brain, which helps regulate mood, anxiety, and obsessive thoughts.
• Common side effects include nausea, headache, insomnia, drowsiness, and sexual dysfunction.
• Patients should be aware that full therapeutic effects may take 4-6 weeks to develop, and the medication should not be stopped abruptly as this can cause withdrawal symptoms.
• Fluvoxamine has significant drug interactions, particularly with medications metabolized by the CYP1A2 enzyme system, so patients should inform all healthcare providers about all medications they're taking 1.

Special Considerations

• Fluvoxamine may have greater potential for drug-drug interactions compared to other SSRIs, and caution is advised when using it with certain medications, such as alprazolam or triazolam 1.
• A discontinuation syndrome characterized by various symptoms has been reported following missed doses or acute discontinuation of fluvoxamine, and patients should be advised to gradually taper off the medication when stopping treatment 1.
• The medication should be used with caution in patients with a history of suicidal thoughts or behavior, as SSRIs may increase the risk of suicidal thinking or behavior, particularly in children and adolescents 1.

From the FDA Drug Label

Fluvoxamine Maleate Tablets are indicated for the treatment of obsessions and compulsions in patients with Obsessive Compulsive Disorder (OCD), as defined in the DSM-III-R. The primary use of LUVOX, which contains fluvoxamine, is for the treatment of Obsessive Compulsive Disorder (OCD) in patients with obsessions and compulsions that cause marked distress, are time-consuming, or significantly interfere with social or occupational functioning.

• The efficacy of fluvoxamine was established in three 10-week trials with obsessive compulsive outpatients with the diagnosis of Obsessive Compulsive Disorder as defined in DSM-III-R 2.
• The effectiveness of fluvoxamine for long-term use, i.e., for more than 10 weeks, has not been systematically evaluated in placebo-controlled trials 2.

From the Research

LUVOX Overview

• LUVOX, also known as fluvoxamine, is a selective serotonin reuptake inhibitor (SSRI) used to treat various anxiety disorders 3, 4.
• It has a unique pharmacokinetic profile, with a shorter elimination half-life compared to other SSRIs, and is metabolized to clinically inactive compounds 5.

Efficacy in Anxiety Disorders

• Fluvoxamine has been shown to be effective in treating obsessive-compulsive disorder (OCD), panic disorder, social phobia, and post-traumatic stress disorder (PTSD) 3, 4.
• It has also been used to treat other obsessive-compulsive spectrum disorders, such as trichotillomania, kleptomania, and body dysmorphic disorder 3.
• Fluvoxamine has been found to be as effective as clomipramine in patients with OCD, but with a better tolerability profile 3, 4.

Safety and Tolerability

• Fluvoxamine is generally well-tolerated, with nausea being the most common adverse event 3, 5.
• Other reported adverse effects include somnolence, asthenia, headache, dry mouth, and insomnia 3, 5.
• Fluvoxamine has a low risk of suicidal behavior, sexual dysfunction, and withdrawal syndrome 3.
• Combination therapy with clomipramine and fluvoxamine has been used to treat OCD in children and adolescents, but requires careful monitoring of electrocardiograms, clomipramine blood concentrations, and vital signs due to potential cardiovascular side effects 6.

Comparison to Other SSRIs

• Fluvoxamine has a different drug interaction profile compared to other SSRIs, with a potent inhibition of CYP1A2 and moderate inhibition of CYP2C19 and CYP3A4 3.
• Large trials comparing the efficacy of fluvoxamine and other SSRIs in patients with anxiety disorders are warranted 3.
• Fluvoxamine is recommended as a first-line treatment for several anxiety disorders, including OCD, panic disorder, and social phobia 3, 7.