Fluvoxamine

Not to be confused with Fluoxetine.

Fluvoxamine
Names
Trade namesLuvox, Faverin, Fluvoxin, others
IUPAC name
  • 2-{[(E)-{5-Methoxy-1-[4-(trifluoromethyl)phenyl]
    pentylidene}amino]oxy}ethanamine[1]
Clinical data
Drug classSelective serotonin reuptake inhibitor (SSRI)
Main usesObsessive–compulsive disorder, depression[2][3]
Side effectsNausea, sleepiness, sexual dysfunction, sweating, agitation[2]
WHO AWaReUnlinkedWikibase error: ⧼unlinkedwikibase-error-statements-entity-not-set⧽
Pregnancy
category
  • AU: C[4]
  • US: C (Risk not ruled out)[4]
    BreastfeedingNot a reason to stop[5]
    Routes of
    use    		By mouth
    External links
    AHFS/Drugs.comMonograph
    MedlinePlusa695004
    Legal
    License data
    Legal status
    Pharmacokinetics
    Bioavailability53% (90% confidence interval: 44–62%)[6]
    Protein binding77–80%[6][7]
    MetabolismHepatic (via cytochrome P450 enzymes. Mostly via oxidative demethylation)[6]
    Elimination half-life12–13 hours (single dose), 22 hours (repeated dosing)[6]
    ExcretionKidney (98%; 94% as metabolites, 4% as unchanged drug)[6]
    Chemical and physical data
    FormulaC15H21F3N2O2
    Molar mass318.335 g·mol−1
    3D model (JSmol)
    SMILES
    • FC(F)(F)c1ccc(\C(=N\OCCN)CCCCOC)cc1
    InChI
    • InChI=1S/C15H21F3N2O2/c1-21-10-3-2-4-14(20-22-11-9-19)12-5-7-13(8-6-12)15(16,17)18/h5-8H,2-4,9-11,19H2,1H3/b20-14+ checkY
    • Key:CJOFXWAVKWHTFT-XSFVSMFZSA-N checkY

    Fluvoxamine, sold under the brand name Luvox among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class.[2] It is used primarily for the treatment of obsessive–compulsive disorder (OCD).[2] Other uses include depression, bulemia, and anxiety disorders, such as panic disorder, social anxiety disorder, and post-traumatic stress disorder.[3][8][9] It is taken by mouth.[2]

    Common side effects include nausea, sleepiness, sexual dysfunction, sweating, and agitation.[2] Other side effects include an increased risk of suicide in those under the age of 25 and liver problems.[2][3] Use during pregnancy is of unclear safety.[2] Use of fluvoxamine is not a requirement to stop breastfeeding.[5]

    Fluvoxamine was approved for medical use in the United States in 1994.[2] It is on the World Health Organization's List of Essential Medicines as an alternative to fluoxetine.[10] It is available as a generic medication.[3] In the United Kingdom it costs the NHS about 18 pounds per month for the typical dose of 100 mg per day as of 2020.[3] This amount in the United States costs about 15 USD as of 2021.[11]

    Medical uses

    Fluvoxamine is approved in the United States for OCD,[12][13] and social anxiety disorder.[14] In other countries (Australia,[15][16] the UK,[17] and Russia[18]) it also has indications for major depressive disorder. In Japan it is approved to treat OCD, SAD and MDD.[19][20] Fluvoxamine is used for children and adolescents with OCD.[21] The drug works long-term, and retains its therapeutic efficacy for at least one year.[22]

    There is tentative evidence that fluvoxamine is effective for social phobia in adults.[23] Fluvoxamine is also effective for GAD, SAD, panic disorder and separation anxiety disorder in children and adolescents.[24] There is tentative evidence that fluvoxamine may help some people with negative symptoms of chronic schizophrenia.[25][26]

    Dosage

    It is often started at a dose of 50 mg per day.[3] Long term doses of 100 mg per day are typically used though doses up to 300 mg per day may be used.[3]

    Side effects

    Gastrointestinal side effects are more common in those receiving fluvoxamine than with other SSRIs.[27] Otherwise, fluvoxamine's side-effect profile is very similar to other SSRIs.[6][12][15][17][28][29]

    Common (1–10%)

    Uncommon (0.1–1%)

    • 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%)

    • Mania
    • Seizures
    • Abnormal hepatic (liver) function
    • Photosensitivity (being abnormally sensitive to light)
    • Galactorrhoea (expulsion of breast milk unrelated to pregnancy or breastfeeding)

    Unknown frequency

    Interactions

    Luvox (fluvoxamine) 100 mg film-coated scored tablets

    Fluvoxamine inhibits the following cytochrome P450 enzymes:[31][32][33][34][35][36][37][38][39]

    By so doing, fluvoxamine can increase serum concentration of the substrates of these enzymes.[31]

    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)[42][43] is unlikely to be affected by fluvoxamine.[44] It appears that benzodiazepines metabolized by nitro-reduction (clonazepam, nitrazepam) are unlikely to be affected by fluvoxamine.[45] Using fluvoxamine and alprazolam together can increase alprazolam plasma concentrations.[46] If alprazolam is coadministered with fluvoxamine, the initial alprazolam dose should be reduced to the lowest effective dose.[47][48]

    Fluvoxamine and ramelteon coadministration is not indicated.[49][50]

    Fluvoxamine has been observed to increase serum concentrations of mirtazapine, which is mainly metabolized by CYP1A2, CYP2D6, and CYP3A4, by three- to four-fold in humans.[51] Caution and adjustment of dosage as necessary are warranted when combining fluvoxamine and mirtazapine.[51]

    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.[52]

    Fluvoxamine's interaction with St John's wort can lead to increased serotonin levels and potentially lead to serotonin syndrome.

    Pharmacology

    Receptor affinity profile[53][54][55]
    SiteKi (nM)
    SERT2.5
    NET1,427
    5-HT2C5,786
    α1-adrenergic1,288
    σ136

    Fluvoxamine is a potent selective serotonin reuptake inhibitor with around 100-fold affinity for the serotonin transporter over the norepinephrine transporter.[32] It has negligible affinity for the dopamine transporter or any other site, with the sole exception of the σ1 receptor.[56][57] It behaves as a potent agonist at this receptor and has the highest affinity (36 nM) of any SSRI for doing so.[56] This may contribute to its antidepressant and anxiolytic effects and may also afford it some efficacy in treating the cognitive symptoms of depression.[58] Unlike fluoxetine, fluvoxamine's metabolites are inactive, without a significant effect on serotonin or norepinephrine uptake.[59]

    History

    Fluvoxamine was developed by Kali-Duphar,[60] part of Solvay Pharmaceuticals, Belgium, now Abbott Laboratories, and introduced as Floxyfral in Switzerland in 1983.[60] It was approved by the U.S. Food and Drug Administration (FDA) in 1994, and introduced as Luvox in the US.[61] In India, it is available, among several other brands, as Uvox by Abbott.[62] It was one of the first SSRI antidepressants to be launched, and is prescribed in many countries to patients with major depression.[63] It was the first SSRI, a non-TCA drug, approved by the U.S. FDA specifically for the treatment of OCD.[64] At the end of 1995, more than ten million patients worldwide had been treated with fluvoxamine.[65] Fluvoxamine was the first SSRI to be registered for the treatment of obsessive compulsive disorder in children by the FDA in 1997.[66] In Japan, fluvoxamine was the first SSRI to be approved for the treatment of depression in 1999[67][68] and was later in 2005 the first drug to be approved for the treatment of social anxiety disorder.[69] Fluvoxamine was the first SSRI approved for clinical use in the United Kingdom.[70]

    It was notably used by Eric Harris, one of the Columbine shooters.[71]

    Society and culture

    Manufacturers include BayPharma, Synthon, and Teva, among others.[72]

    Research

    A randomized clinical trial in October 2021 reported that early treatment with fluvoxamine among those at high risk with COVID-19 may decease hospitalization.[73]

    See also

    References

    1. ↑ "Luvox". ChemSpider. Royal Society of Chemistry. Archived from the original on 15 November 2013. Retrieved 21 October 2013.
    2. 1 2 3 4 5 6 7 8 9 "FluvoxaMINE Monograph for Professionals". Drugs.com. Archived from the original on 8 May 2021. Retrieved 14 April 2021.
    3. 1 2 3 4 5 6 7 BNF (80 ed.). BMJ Group and the Pharmaceutical Press. September 2020 – March 2021. p. 384. ISBN 978-0-85711-369-6.
    4. 1 2 Use During Pregnancy and Breastfeeding
    5. 1 2 "Fluvoxamine use while Breastfeeding". Drugs.com. Archived from the original on 8 May 2021. Retrieved 15 April 2021.
    6. 1 2 3 4 5 6 "Product Information Luvox". TGA eBusiness Services. Abbott Australasia Pty Ltd. 15 January 2013. Archived from the original on 9 October 2017. Retrieved 21 October 2013.
    7. ↑ van Harten J (March 1993). "Clinical pharmacokinetics of selective serotonin reuptake inhibitors". Clinical Pharmacokinetics. 24 (3): 203–20. doi:10.2165/00003088-199324030-00003. PMID 8384945. S2CID 84636672.
    8. ↑ Figgitt DP, McClellan KJ (October 2000). "Fluvoxamine. An updated review of its use in the management of adults with anxiety disorders". Drugs. 60 (4): 925–54. doi:10.2165/00003495-200060040-00006. PMID 11085201.
    9. ↑ Irons J (December 2005). "Fluvoxamine in the treatment of anxiety disorders". Neuropsychiatric Disease and Treatment. 1 (4): 289–99. PMC 2424117. PMID 18568110.
    10. ↑ World Health Organization (2021). World Health Organization model list of essential medicines: 22nd list (2021). Geneva: World Health Organization. hdl:10665/345533. WHO/MHP/HPS/EML/2021.02.
    11. ↑ "Fluvoxamine Prices, Coupons & Savings Tips". GoodRx. Archived from the original on 8 May 2021. Retrieved 15 April 2021.
    12. 1 2 "Fluvoxamine Maleate tablet, coated prescribing information". DailyMed. 14 December 2018. Archived from the original on 19 October 2020. Retrieved 28 November 2019.
    13. ↑ McCain JA (July 2009). "Antidepressants and suicide in adolescents and adults: a public health experiment with unintended consequences?". P T. 34 (7): 355–78. PMC 2799109. PMID 20140100.
    14. ↑ "Luvox CR approved for OCD and SAD". MPR. 29 February 2008. Archived from the original on 28 August 2021. Retrieved 2 March 2019.
    15. 1 2 Rossi S, ed. (2013). Australian Medicines Handbook (2013 ed.). Adelaide: The Australian Medicines Handbook Unit Trust. ISBN 978-0-9805790-9-3.
    16. ↑ "Luvox Tablets". NPS MedicineWise. Archived from the original on 22 October 2018. Retrieved 22 October 2018.
    17. 1 2 Joint Formulary Committee (2013). British National Formulary (BNF) (65 ed.). London, UK: Pharmaceutical Press. ISBN 978-0-85711-084-8.
    18. ↑ "Summary of Full Prescribing Information: Fluvoxamine". Drug Registry of Russia (RLS) Drug Compendium (in русский). Archived from the original on 2 April 2015. Retrieved 21 March 2015.
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    22. ↑ Wilde MI, Plosker GL, Benfield P (November 1993). "Fluvoxamine. An updated review of its pharmacology, and therapeutic use in depressive illness". Drugs. 46 (5): 895–924. doi:10.2165/00003495-199346050-00008. PMID 7507038.
    23. ↑ Williams T, Hattingh CJ, Kariuki CM, Tromp SA, van Balkom AJ, Ipser JC, Stein DJ (October 2017). "Pharmacotherapy for social anxiety disorder (SAnD)". The Cochrane Database of Systematic Reviews. 10 (10): CD001206. doi:10.1002/14651858.CD001206.pub3. PMC 6360927. PMID 29048739.
    24. ↑ Cheer SM, Figgitt DP (2002). "Spotlight on fluvoxamine in anxiety disorders in children and adolescents". CNS Drugs. 16 (2): 139–44. doi:10.2165/00023210-200216020-00006. PMID 11825104. S2CID 26774895.
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    51. 1 2 Anttila AK, Rasanen L, Leinonen EV (October 2001). "Fluvoxamine augmentation increases serum mirtazapine concentrations three- to fourfold". The Annals of Pharmacotherapy. 35 (10): 1221–3. doi:10.1345/aph.1A014. PMID 11675851. S2CID 44807359.
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    68. ↑ Wishart, David S.; Djombou Feunang, Yannick; Marcu, Ana; Guo, An Chi; Liang, Kevin; Vázquez Fresno, Rosa; Sajed, Tanvir; Johnson, Daniel; Li, Carin; Karu, Naama; Sayeeda, Zinat; Lo, Elvis; Assempour, Nazanin; Berjanskii, Mark; Singhal, Sandeep; Arndt, David; Liang, Yonjie; Badran, Hasan; Grant, Jason; Serra Cayuela, Arnau; Liu, Yifeng; Mandal, Rupa; Neveu, Vanessa; Pon, Allison; Knox, Craig; Wilson, Michael; Manach, Claudine; Scalbert, Augustin. "Showing metabocard for Fluvoxamine (HMDB0014322)". Human Metabolome Database, HMDB. 4.0.
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