Fluvoxamine – Usages, Side effects, Risk factors, Precautions
Here in this post, we are discussing the “Fluvoxamine”. You can read usages, side effects, Risk factors, and warning information. Keep visiting Psychology Roots.
Fluvoxamine is an antidepressant SSRI.
Fluvoxamine is available with the following brand name.
● Luvox CR
Disorder to treat
It is used for the treatment of the following disorder
● Obsessive-Compulsive disorder
● Social Phobia
● Panic Disorder
● Posttraumatic Stress Disorder
Forms of Fluvoxamine
Fluvoxamine is available in the following form
Fluvoxamine tablets are available in the following doses
● 25 mg
● 50 mg
● 100 mg
Initially 50 mg every bedtime is given. It may increase by 50 mg per day. Every 4-7 days up to 100-300 mg per day
Dose >100 mg per day should be divided every 12hr
Orally 50 mg is given every day. It may increase by 50 mg at a 1-week interval. The usual dose range is 100-300 mg per day.
Orally 25-50 mg is given every day. After several days, gradually increasing to 100-200 mg per day it may increase to 300 mg per day for patients who fail to respond after several weeks of treatment.
Continue therapy for 1-2 years, and consider discontinuation with close supervision; when discontinuing therapy, a slow taper over 2-6 months is recommended.
Posttraumatic Stress Disorder
Initially, 50 mg per day orally is given. It may increase the dose to 100-250 mg in adults and 100 mg in older adults. It should not exceed 300 mg per day
Patients who respond to therapy may need to continue therapy indefinitely.
May attempt tapering after 6-12 months in patients with acute PTSD. Tapering should occur gradually over 2 weeks to 1 month to avoid withdrawal symptoms. Tapering should take place over 4-12 weeks in patients at risk of relapse.
There are the following side effects of fluvoxamine
● Abnormal ejaculation
● Upper respiratory infections
● Decreased libido
● Abnormal taste
● Abnormal dreams
● Chest pain
● Abnormal thinking
● Abdominal pain
● Weight change
● Increased LFTs
● Manic reaction
● Activation of mania/hypomania, seizures
● Dry mouth
In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses.
This increase was not seen in patients aged >24 years; a slight decrease in suicidal thinking was seen in adults >65 years.
In children and young adults, risks must be weighed against the benefits of taking antidepressants.
Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendency. This should be done during the initial 1-2 months of therapy and dosage adjustments.
The patient’s family should communicate any abrupt changes in behavior to the healthcare provider.
Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy.
This drug is not approved for use in pediatric patients.
Conflicting evidence regarding the use of SSRIs during pregnancy and increased risk of persistent pulmonary hypertension of the newborn.
In neonates exposed to SNRIs/SSRIs late in the third trimester: Risk of complications such as feeding difficulties, irritability, and respiratory problems.
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 the 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 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.
May impair ability to operate heavy machinery and other tasks requiring mental alertness.
Bone fractures have been associated with antidepressant treatment; consider the possibility of a fragility fracture if the 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.
May cause or exacerbate sexual dysfunction.
Syndrome of inappropriate antidiuretic hormone and hyponatremia reported with SSRI and SNRI use; volume deplretion and/or concurrent use of diuretics may increase risk; consider discontinuing therapy if symptomatic hyponatremia occurs.
Use caution in patients with cardiovascular disease or history of seizure disorder.
Prolonged experience with fluvoxamine in pregnant women over decades, based on published observational studies, have not identified a clear drug-associated risk of major birth defects or miscarriage; there are risks associated with untreated depression in pregnancy and risks of persistent pulmonary hypertension of the newborn (PPHN) and poor neonatal adaptation with exposure to selective serotonin reuptake inhibitors (SSRIs), including fluvoxamine, during pregnancy
Women who discontinue antidepressants during pregnancy are more likely to experience a relapse of major depression than women who continue antidepressants; consider the risk of untreated depression when discontinuing or changing treatment with antidepressant medication during pregnancy and postpartum.
Neonates exposed to therapy and other SSRIs or SNRIs late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding; such complications can arise immediately upon delivery; reported clinical findings have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying; these features are consistent with either a direct toxic effect of SSRIs and SNRIs or, possibly, a drug discontinuation syndrome; it should be noted that, in some cases, the clinical picture is consistent with serotonin syndrome.
Animal findings suggest fertility maybe impaired while taking fluvoxamine.
Neonatal adverse effects
Persistent pulmonary hypertension of the newborn
The potential risk of persistent pulmonary hypertension of the newborn when used during pregnancy.
Data from published literature report presence of the drug in human milk; no adverse effects on breastfed infant have been reported in most cases of maternal use of fluvoxamine during breastfeeding; however, there are reports of diarrhea, vomiting, decreased sleep, and agitation; there are no data on the effect of fluvoxamine on milk production
Developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for fluvoxamine and any potential adverse effects on breastfed children from drugs or from the underlying maternal condition.
Monitor infants exposed to fluvoxamine through breast milk for diarrhea, vomiting, decreased sleep, and agitation.
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