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    DEA Class;  Rx

    Common Brand Names; Luvox, Luvox CR (DSC)

    • Antidepressants, SSRIs

    Selective serotonin reuptake inhibitor; little or no affinity for dopamine, alpha-adrenergic histamine, or cholinergic receptor

    Indicated for Obsessive-Compulsive Disorder, Social Phobia (Off-label), Panic Disorder (Off-label), Posttraumatic Stress Disorder (Off-label)


    • Nausea (40%)
    • Headache (22-35%)
    • Somnolence (22-27%)
    • Weakness (14-26%)
    • Insomnia (20-35%)
    • Diarrhea (11-18%)
    • Dizziness (11-15%)
    • Xerostomia (10-14%)
    • Anorexia (6-14%)
    • Abnormal ejaculation (8-11%)
    • Pain (10%)
    • Dyspepsia (8-10%)
    • Constipation (4-10%)
    • Decreased libido (2-10%)
    • Upper respiratory infections (9%)
    • Anxiety (5-8%)
    • Tremor (5-8%)
    • Sweating (6-7%)
    • Vomiting (4-6%)
    • Abdominal pain (5%)
    • Myalgia (5%)
    • Abnormal taste (2-5%)
    • Bruising (4%)
    • Abnormal dreams (3%)
    • Abnormal thinking (3%)
    • Chest pain (3%)
    • Palpitation (3%)
    • Agitation (2-3%)
    • Vasodilation (2-3%)
    • Hypertension (1-2%)
    • Increased LFTs (1-2%)
    • Weight change (1-2%)
    • Manic reaction
    • <1%
    • Activation of mania/hypomania, seizures (discontinue)
    • Sinusitis
    • Edema
    • Amnesia
    • Apathy
    • Asthenia
    • Malaise
    • Nervousness
    • Dry mouth
    • Myoclonus
    • Cough

    Conflicting evidence regarding use of SSRIs during pregnancy and increased risk of persistent pulmonary hypertension of the newborn (see Pregnancy)

    In neonates exposed to SNRIs/SSRIs late in third trimester: Risk of complications such as feeding difficulties, irritability, and respiratory problems

    Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy

    May need to modify dose for hepatic impairment; titrate at smaller increments and longer intervals

    Clinical worsening and suicide ideation may occur despite medication in adolescents and young adults (18-24 years); prescriptions should be written for the smallest quantity consistent with good patient care

    May worsen mania symptoms or precipitate mania in patients with bipolar disorder

    May impair platelet aggregation; increases risk of bleeding in patients taking anticoagulants/antiplatelets concomitantly

    Do not use concurrently with alosetron, astemizole, cisapride, pimozide, terfenadine, or tizanidine due to QT prolongation risk

    Potentially life-threatening serotonin syndrome has been reported with drugs that impair serotonin metabolism (in particular, MAOIs, including nonpsychiatric MAOIs, such as linezolid and IV methylene blue); it has also been reported with reported with SNRIs and SSRIs, including fluvoxamine, alone but particularly with concomitant use of serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John’s Wort (see Contraindications)

    May impair ability to operate heavy machinery and other tasks requiring mental alertness

    Bone fractures have been associated with antidepressant treatment; consider possibility of fragility fracture if patient presents with pain, joint tenderness, or swelling

    Impaired glucose control (hyperglycemia or hypoglycemia) reported; monitor for signs/symptoms of loss of glucose control, especially in patients with diabetes

    There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy

    Data from published literature report presence of drug in human milk; no adverse effects on breastfed infant have been reported in most cases of maternal use of fluvoxamine during breastfeeding


    Obsessive-Compulsive Disorder

    Conventional tablets

    • 50 mg qHS initially; may increase by 50 mg/day q4-7Days up to 100-300 mg/day

    • Dose >100 mg/day should be divided q12hr

    Social Phobia (Off-label)

    Immediate release

    • 50 mg PO qDay; may increase by 50 mg at 1 week interval; usual dose range is 100-300 mg/day

    Panic Disorder (Off-label)

    25-50 mg PO qDay; after several days, gradually increase to 100-200 mg/day; may increase to 300 mg/day for patients who fail to respond after several weeks of treatment


    Obsessive-Compulsive Disorder

    <8 years: Safety and efficacy not established

    Ages 8-17 years (conventional tablets): 25 mg PO qHS initially; may titrate by 25 mg/day increments every 4-7 days to 50-200 mg/day

    Not to exceed 200 mg (for ages 8-11 years) or 300 mg for adolescents

    Give doses >50 mg/day divided q12hr


    The elderly are prone to SSRI/SNRI-induced hyponatremia; monitor closely

    Fluvoxamine maleate


    • 25mg
    • 50mg
    • 100mg