Classifications: psychotherapeutic agent; selective serotonin reuptake inhibitor (ssri); antidepressant; Therapeutic: antidepressant; ssri
Pregnancy Category: C
25 mg, 50 mg, 100 mg tablets
Antidepressant with potent, selective, inhibitory activity on neuronal (5-HT) serotonin reuptake (SSRI). Compared with TCAs,
shows fewer anticholinergic effects and no severe cardiovascular effects.
Effective as an antidepressant and for control of obsessive-compulsive disorders.
Treatment of depression and obsessive-compulsive disorders.
Chronic tension-type headaches, panic attacks.
Hypersensitivity to fluvoxamine or fluoxetine; suicidal ideation; concurrent MAOI therapy; bipolar disorder; pregnancy (category
C), children ≤6 y, and ≤8 y
for use with obsessive-compulsive disorder.
Liver disease, renal impairment, abrupt discontinuation; cardiac disease, dehydration, hyponatremia, older adults, ECT, seizure
disorders, history of suicidal ideation, tobacco smoking; lactation.
Route & Dosage
|Depression, Obsessive-Compulsive Disorder
Adult: PO Start with 50 mg q.d., may increase slowly up to 300 mg/d given q.h.s. or divided b.i.d.
Child (811 y): PO Start with 25 mg q.h.s., may increase by 25 mg q47d (max: 200 mg/d in divided doses)
- Give starting doses at bedtime to improve tolerance to nausea and vomiting; both are common early in therapy.
- Store at room temperature, 15°30° C (59°86° F), away from moisture and light.
Adverse Effects (≥1%)CNS: Somnolence, headache, agitation, insomnia, dizziness,
Orthostatic hypotension, slight bradycardia. GI: Nausea, vomiting, dry mouth, constipation, anorexia
Sexual dysfunction. Skin: Stevens-Johnson syndrome
, toxic epidermal necrolysis
Diagnostic Test Interference
Gamma-glutamyl transferase increased by more than 3-fold following 3 wk of therapy.
Fluvoxamine has been shown to significantly increase plasma
levels of amitriptyline, clomipramine,
and other tricyclic antidepressants
to mildly increase levels of their metabolites. May antagonize the blood pressure-lowering effects of atenolol
and other beta blockers
. May increase levels and toxicity
of carbamazepine, mexiletine.
May increase lithium
levels causing neurotoxicity, serotonin syndrome
, somnolence, and mania. One report of increased theophylline
levels with toxicity
. Increases prothrombin time in patients on warfarin;
increased ergotamine toxicity
with dihydroergotamine, ergotamine.
Use with cyp 1a2 inhibitors (thioridazine, pimozide, alosetron, tizanidine)
levels and toxicity
. Herbal: Melatonin
may increase and prolong drowsiness; St. John's wort
may cause serotonin syndrome
Almost completely absorbed from GI tract. Onset:
47 d. Distribution:
Approximately 77% bound to plasma proteins
; excreted in human breast milk but in an amount that poses little risk to the
nursing infant. Metabolism:
In liver. Elimination:
Completely in urine. Half-Life:
Assessment & Drug Effects
- Monitor for significant nausea and vomiting, especially during initial therapy.
- Monitor for worsening of depression or emergence of suicidal ideations.
- Assess safety; drowsiness and dizziness are common adverse effects.
- Monitor PT and INR carefully with concurrent warfarin therapy; adjust warfarin as needed.
Patient & Family Education
- Note: Nausea and vomiting are common in early therapy. Notify physician if these adverse effects last more than a few days.
- Exercise caution with hazardous activity until response to the drug is known.