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Fluvoxamine, sold under the brand name Luvox among others, is a medication which is used primarily for the treatment of obsessive–compulsive disorder (OCD), and σ 1 receptor agonist.
The FDA has added a black box warning for this drug in reference to increased risks of suicidal thoughts and behavior in young adults and children.
Contents
1 Medical uses
2 Adverse effects
3 Interactions
4 Pharmacology
5 History
6 See also
7 References
8 External links
Medical uses
Fluvoxamine’s only FDA approved indication is in the treatment of OCD,
Some evidence shows fluvoxamine may be a helpful adjunct in the treatment of schizophrenia, improving the depressive, negative, and cognitive symptoms of the disorder.
Adverse effects
Gastrointestinal side effects are more common in those receiving fluvoxamine than with other SSRIs.
Common (1–10% incidence) adverse effects
Nausea
Vomiting
Weight loss
Yawning
Loss of appetite
Agitation
Nervousness
Anxiety
Insomnia
Somnolence
Tremor
Headache
Dizziness
Palpitations
Tachycardia (high heart rate)
Abdominal pain
Dyspepsia (indigestion)
Diarrhea
Constipation
Dry mouth
Hyperhidrosis (excess sweating)
Asthenia (weakness)
Malaises
Sexual dysfunction (including delayed ejaculation, erectile dysfunction, decreased libido, etc.)
Uncommon (0.1–1% incidence) adverse effects
Arthralgia
Hallucination
Confusional state
Extrapyramidal side effects (e.g. dystonia, parkinsonism, tremor, etc.)
Orthostatic hypotension
Cutaneous hypersensitivity reactions (e.g. oedema [buildup of fluid in the tissues], rash, pruritus)
Rare (0.01–0.1% incidence) adverse effects
Mania
Seizures
Abnormal hepatic (liver) function
Photosensitivity (being abnormally sensitive to light)
Galactorrhoea (expulsion of breast milk unrelated to pregnancy or breastfeeding)
Unknown frequency adverse effects
Hyperprolactinaemia (elevated plasma prolactin levels leading to galactorrhoea, amenorrhoea [cessation of menstrual cycles], etc.)
Bone fractures
Glaucoma
Mydriasis
Urinary incontinence
Urinary retention
Bed-wetting
Serotonin syndrome — a potentially fatal condition characterised by abrupt onset muscle rigidity, hyperthermia (elevated body temperature), rhabdomyolysis, mental status changes (e.g. coma, hallucinations, agitation), etc.
Neuroleptic malignant syndrome — practically identical presentation to serotonin syndrome except with a more prolonged onset
Akathisia — a sense of inner restlessness that presents itself with the inability to stay still
Paraesthesia
Dysgeusia
Haemorrhage
Withdrawal symptoms
Weight changes
Suicidal ideation and behaviour
Violence towards others
Hyponatraemia
Syndrome of inappropriate antidiuretic hormone secretion
Interactions
Luvox (fluvoxamine) 100 mg film-coated scored tablets
Fluvoxamine inhibits the following cytochrome P450 enzymes:
CYP1A2 (strongly) which metabolizes agomelatine, amitriptyline, caffeine, clomipramine, clozapine, duloxetine, haloperidol, imipramine, phenacetin, tacrine, tamoxifen, theophylline, olanzapine, etc.
CYP3A4 (weakly) which metabolizes alprazolam, aripiprazole, clozapine, haloperidol, quetiapine, pimozide, ziprasidone, etc.
CYP2D6 (weakly) which metabolizes aripiprazole, chlorpromazine, clozapine, codeine, fluoxetine, haloperidol, olanzapine, oxycodone, paroxetine, perphenazine, pethidine, risperidone, sertraline, thioridazine, zuclopenthixol, etc.
CYP2C9 (moderately) which metabolizes nonsteroidal anti-inflammatory drugs, phenytoin, sulfonylureas, etc.
CYP2C19 (strongly) which metabolizes clonazepam, diazepam, phenytoin, etc.
CYP2B6 (weakly) which metabolizes bupropion, cyclophosphamide, sertraline, tamoxifen, valproate, etc.
By so doing, fluvoxamine can increase serum concentration of the substrates of these enzymes.
The plasma levels of oxidatively metabolized benzodiazepines (e.g., triazolam, midazolam, alprazolam and diazepam ) are likely to be increased when co-administered with fluvoxamine. However the clearance of benzodiazepines metabolized by glucuronidation (e.g., lorazepam, oxazepam, temazepam )
Fluvoxamine and ramelteon coadministration is not indicated.
Fluvoxamine has been observed to increase serum concentrations of mirtazapine, which is mainly metabolized by CYP1A2, CYP2D6, and CYP3A4, by 3- to 4-fold in humans.
Fluvoxamine seriously affects the pharmacokinetics of tizanidine and increases the intensity and duration of its effects. Because of the potentially hazardous consequences, the concomitant use of tizanidine with fluvoxamine, or other potent inhibitors of CYP1A2, should be avoided.
Pharmacology
Binding profile
Site
K i (nM)
SERT
2,3
NET
1,427
5-HT 2C
5,786
α 1 -adrenergic
1,288
σ 1
36
Fluvoxamine is a potent selective serotonin reuptake inhibitor with around 100-fold affinity for the serotonin transporter over the norepinephrine transporter.
History
Fluvoxamine was developed by Kali-Duphar,
See also
Clovoxamine, a chemically similar drug with a chlorine atom substituted for the CF 3 substituent
Caproxamine
Demexiptiline, a tricyclic antidepressant with the same ketoxime termination chain as fluvoxamine

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