Fluvoxamine (Luvox)

Primer

Fluvoxamine (Trade name: Luvox) is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) class commonly used in the treatment of major depressive disorder and obsessive-compulsive disorder.

Pharmacokinetics

Pharmacokinetics of Fluvoxamine

Absorption
Distribution
Metabolism
Elimination
Half-life

Fluvoxamine: Cytochrome P450 Metabolism

Substrate of (Metabolized by)
Induces
Inhibits* 1A2, 2C19, 3A4 (potent)
* = Fluvoxamine is unfortunately a potent inhibitor of several cytochrome enzymes, which makes it a poor medication choice due to its many drug-drug interactions.

Pharmacodynamics

Mechanism of Action

  • σ1 antagonism may have some anxiolytic effects

Toxicity

Indications

Dosing

Dosing for Fluvoxamine

Starting 50 mg, often split into BID dosing
Titration
Maximum 300 mg
Taper

Formulations

  • Fluvoxamine comes in oral formulation.

Monitoring

Contraindications

Absolute

Relative

Drug-Drug Interactions

  • If a patient is on theophylline, the dose needs to be reduced by 1/3, as fluvoxamine is a potent inhibitor of CYP1A2 (theophylline is metabolized by CYP1A2)

Side Effects

Adverse Events

Clinical Pearls

  • Fluvoxamine is almost exclusively used for OCD

Special Populations

Geriatric

Pediatric

Obstetric and Fetal

Medically Ill

Resources