Fluvoxamine (Luvox)

Question 1

Brand name

Answer 1

Luvox

Luvox CR

Question 2

Class, MOA

Answer 2

SSRI - 1A receptors

Binds Sigma 1 receptors too

Question 3

Onset

Answer 3

2-4 weeks

Question 4

Used mainly for

Answer 4

• OCD

* Social anxiety disorder

Question 5

S/Es

Answer 5

Same as Sertraline

Unique-
-sigma 1 antagonism - sedation, fatigue

Question 6

Dose

Answer 6

OCD - 100 to 300 mg
Depression - 100 to 200 mg
Social anxiety disorder - 100 to 300 mg

• For Luvox -
• Start at 50, can inc by 50 every 4-7 days, max 300
• Dose less than 100 can be given once a day at bedtime
• Dose more than 100 can be given as once at bedtime or 2 doses with larger dose at bedtime
• For Luvox CR - Don’t chew or crush.
• Start at 100, can inc by 50 every week, max 200.

Question 7

OD

Answer 7

Rarely fatal

Sedation, dizziness, vomiting, diarrhea, irregular heartbeat, seizures, coma, breathing difficulty

Question 8

Taper

Answer 8

50% for 3 days, another 50% for 3 days, stop

Question 9

Half life

Answer 9

9 - 28 hours

Question 10

CYP action

Answer 10

Inhibits CYP450

• 3A4 (inc conc of statins, pimozide, carbamazepine, alprazolam, triazolam)
• 1A2 (inc conc of theophylline and clozapine)
• 2C9/2C19

Question 11

Any specific DIs with fluvoxamine

Answer 11

• Jitteriness, excess stimulation, rarely seizures with caffeine and theophylline
• Metabolism faster in smokers, so need higher dose
• CYP action

Question 12

C/I with

Answer 12

• MAOIs
• Thioridazine
• Pimozide
• Tizanidine
• Alosetron
• Ramelteon

Allergy

Question 13

Special populations

Answer 13

*Lower initial dose in hepatic, renal and elderly.

*Approved for OCD in age 8-17 years - Start at 25 mg/day at bedtime, inc by 25 every 4-7 days, max 200mg.
If above 50 mg, divide into 2 doses with larger dose at bedtime.

Question 14

Advantages

Answer 14

*Mixed anxiety/depression

Question 15

Disadvantages

Answer 15

• Pts with irritable bowel or multiple GI complaints

* Can need dose titration and BID dosing

Question 16

Note

Answer 16

*Preferred inn anxiety+depression pts
Sigma 1 action leads to early effect in anxiety and insomnia, and helps in psychotic depression and delusional depression t/t.
*Lower sexual S/Es
*NOT FDA approved for depression
*For t/t resistant OCD, consider fluvoxamine + clomipramine

Question 17

How does Fluvoxamine + Clomipramine combo work in treatment resistant OCD?

Answer 17

• Clomipramine is a potent serotonin reuptake blocker.
  At steady state, it is metabolized into its active metabolite desmethyl-clomipramine, a potent noradrenergic reuptake blocker.
• So, at steady state, plasma drug activity is more noradrenergic than serotoninergic.
• Adding a CYP450 1A2 inhibitor, Fluvoxamine, blocks this conversion and results in higher clomipramine levels than desmethyl-clomipramine levels. This enhances serotoninergic effect of clomipramine.
  -Plus added Serotoninergic effect of fluvoxamine itself.
  -These 2 factors help in t/t resistant OCD.