Fluvoxamine

Brand names

• Alti-Fluvoxamine
• Apo-Fluvoxamine
• Luvox
• Novo-Fluvoxamine
• Nu-Fluvoxamine
• PMS-Fluvoxamine
• Riva-Fluvoxamine

Usage

To treat depression and obsessive-compulsive disorder.

How it works

Fluvoxamine affects levels of serotonin, a brain chemical that is thought to be linked to mood, emotions, and mental state.

Side effects

Serious

Decreased libido, sexual dysfunction, diarrhea, dizziness, rapid heartbeat, difficulty breathing, seizures, trembling, vomiting, difficulty swallowing, fainting, psychotic reaction.

Common

Insomnia, decreased appetite, constipation, dry mouth, drowsiness, heartburn, runny nose, unexpected weight loss, headache, frequent urination, increased sweating, change in taste, yawning.

Less common

Swelling of the feet or lower legs, chills, gas, weight gain.

Possible interactions

Other medicaments:

Fluvoxamine taken concurrently with:

• amitriptyline (Elavil, others) can result in amitriptyline toxicity.
• astemizole (Hismanal) may cause serious heart arrhythmias. Do not combine.
• benzodiazepines may result in benzodiazepine toxicity.
• beta blockers may result in decreased medicament clearance and toxicity.
• buspirone (Buspar) may lead to very slow heart rates in some patients. One study found doubling of buspirone levels but no clinical effects. The combination is best avoided, but if deemed clinically necessary, clinical effects on the patient should be closely followed.
• carbamazepine (Tegretol) may cause toxicity.
• cimetidine (Tagamet) may lead to toxicity.
• cisapride (Propulsid) may cause heart toxicity. Don't combine.
• clomipramine (Anafranil) may cause toxicity.
• clozapine (Clozaril) can result in higher clozapine levels and toxicity.
• cyclosporine (Sandimmune, others) may increase cyclosporine levels.
• dextromethorphan may cause hallucinations (reported with similar medicines).
• diltiazem (Cardizem) may cause diltiazem toxicity.
• dofetilide (TIkosyn) may lead to dofetilide toxicity via inhibition of CYP 3A4 inhibition.
• imipramine (Tofranil, others) may result in imipramine toxicity.
• lithium (Lithobid) can cause serotonin syndrome.
• MAO inhibitors can cause toxicity. Do not combine.
• maprotiline can cause maprotiline toxicity.
• methadone may result in increased opioid effects.
• monoamine oxidase inhibitors may lead to central nervous system toxicity or frank serotonin syndrome.
• olanzapine (Zyprexa) may lead to olanzapine toxicity via inhibition of CYP1A2.
• oral antidiabetic medicaments may remain in the body longer than expected, requiring a dose decrease. This has not been reported with fluvoxamine, but has been reported with sertraline, a medicine in the same pharmacological family.
• phenytoin (Dilantin) or fosphenytoin (Cerebyx) may lead to toxicity. Patients should be watched closely for problems walking (ataxia) or drowsiness (early toxicity signs), and their doctor notified at once if these occur.
• ritonavir (Norvir) and perhaps other protease inhibitors may lead to toxicity.
• sibutramine (Meridia) may lead to serotonin syndrome.
• sumatriptan (Imitrex) may lead to weakness and confusion.
• tacrine (Cognex) may lead to tacrine toxicity.
• terfenadine (Seldane) may cause serious heart arrhythmias. Do not combine.
• theophylline may result in theophylline toxicity.
• tramadol (Ultram) may increase seizure risk.
• tricyclic antidepressants (imipramine, others) may lead to tricyclic toxicity.
• triptans, such as naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex) or zolmitriptan (Zomig), may lead to weakness and incoordination.
• tryptophan may increase serotonin effects of fluvoxamine and cause severe vomiting.
• warfarin (Coumadin) can result in increased warfarin concentrations and may lead to bleeding; more frequent INR testing is needed.

Foods:

Vitamin C (500 mg daily) may stop bruising that is possible with this medicine.

Herbal medicines or minerals:

Since fluvoxamine and St. John's wort may both act to increase serotonin, the combination is not advised. Since part of the way ginseng works may be as a MAO inhibitor, do not combine ginseng with fluvoxamine. Ma huang and yohimbe are also best avoided while taking this medicine. Valerian and kava kava may interact additively (drowsiness). Avoid these combinations. Indian snakeroot is also best avoided while taking this medicine. Talk to your doctor before adding any herbal medicine to this medicine.

Tobacco smoking:

Fluvoxamine stays in the body of smokers up to one-quarter less time than in -nonsmokers, and fluvoxamine benefits may be blunted.

Discontinuation:

A withdrawal syndrome has been reported if this medicine is abruptly stopped. The doses should be slowly tapered.

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