Fluvoxamine
LUVOX
Pronunciation: floo-VOX-a-meen
“gLove-ox man”
Sterile glove → for OCD
Fluffer inHibitor (fluoxetine, fluvoxamine, fluconazole)
What it isSerotonin-reuptake inhibitor and sigma-1 agonist; obsessive-compulsive and social anxiety disorders.
Why this oneSigma-1 agonism distinguishes it pharmacologically from the other SSRIs, though its clinical contribution is uncertain.
What limits it⚑ It is the most interaction-prone SSRI: CYP1A2 and CYP2C19 inhibition can dangerously raise clozapine, theophylline, or tizanidine.
Fluvoxamine prescription history
Animated chart of estimated U.S. prescriptions per year, Antidepressants (1957–2026). Fluvoxamine enters in 1994 (estimated).
FDA-approved for
- OCD (1994)
- social anxiety disorder (2008)
Off-label
- depression
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityStrong CYP1A2/2C19 inhibition creates extensive interactions; sedation and serotonin toxicity are possible.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Obsessive-compulsive disorder (OCD) | Adults | 50 mg QHS | 100–300 mg/day (divide doses >100 mg) | 300 mg/day |
| Obsessive-compulsive disorder (OCD) | Children/adolescents 8–17 yr | 25 mg QHS | Divide doses >50 mg | 200 mg/day (8–11 yr); 300 mg/day (12–17 yr) |
Titration Increase in 50 mg (adult) / 25 mg (pediatric) increments every 4–7 days.
Renal Undefined.
Hepatic Decreased clearance (~30%); begin with a low dose and increase slowly with monitoring.
Instructions
- Give total daily doses over 100 mg (adult) / 50 mg (pediatric) in two divided doses, larger dose at bedtime
- Taper gradually rather than abruptly stopping
Available strengths
- tab 25, 50, 100 mg
- ER cap 100, 150 mg
Contraindications
- Coadministration with tizanidine, thioridazine, alosetron, or pimozide
- MAOIs (for psychiatric disorders) concomitantly or within 14 days; do not start in patients treated with linezolid or IV methylene blue
Cautions
- Serotonin syndrome
- Activation of mania (screen for bipolar disorder)
- Angle-closure glaucoma
- Multiple CYP1A2/CYP3A4 drug interactions
- Sexual dysfunction
Adverse reactions
- Nausea
- Somnolence
- Insomnia
- Asthenia
- Nervousness
- Dyspepsia
- Abnormal ejaculation
- Sweating
- Anorexia
- Tremor
Pregnancy No clear drug-associated risk of major birth defects; possible risks of PPHN, poor neonatal adaptation, and postpartum hemorrhage.
Lactation Present in human milk; monitor infant for diarrhea, vomiting, decreased sleep, agitation.
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 25 mg | tab | 30 qd | $4.54 | offered |
| 50 mg | tab | 30 qd | $5.86 | offered |
| 100 mg | tab | 30 qd | $7.34 | offered |
Other forms: Fluvoxamine CR (LUVOX CR)
Generic entry2000
Serotonin and MAOI
Provisional washout figures
Elevating mechanismSRI
Non-elevating actionNone recorded
Exposure dependenceTherapeutic exposure; severe toxicity requires meaningful MAO-A inhibition
Washout BEFORE an MAOI14 days
Evidence confidenceHigh
InterpretationClinically significant SRI. A second SRI generally represents therapeutic duplication/additive adverse effects, not the classic life-threatening interaction.
Open Fluvoxamine in the interactive console ↗
Memory aids: interaction avatars
Open Fluvoxamine in the interactive console ↗
Self-check
- Which two CYP enzymes does fluvoxamine prominently inhibit?
CYP1A2 and CYP2C19. - Is the clinical contribution of fluvoxamine’s sigma-1 agonism established here?
No—uncertain.