Fluvoxamine

LUVOX

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Pronunciation: floo-VOX-a-meen

Fluvoxamine ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Fluvoxamine ballicule

Fluvoxamine LUVOX mascot mnemonic cartoon — Visual mnemonic: Fluvoxamine mascot
**“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 molecular structure (skeletal formula) — Molecular structure: Fluvoxamine

FDA-approved for

OCD (1994)
social anxiety disorder (2008)

Off-label

depression

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Suicidality: increased risk of suicidal thinking/behavior in children, adolescents, and young adults. Approved in pediatrics only for OCD.

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

Fluvoxamine (LUVOX)

What pharmacies pay · NADAC 9/30/26

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

⚠ BOXED WARNING

Suicidal thoughts and behaviors in patients under 25

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability1 / 4

Sedation liability1 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilityStrong CYP1A2/2C19 inhibition creates extensive interactions; sedation and serotonin toxicity are possible.

Serotonin and MAOI

Provisional washout figures

SRI significance3 / 4

MAO-A inhibition0 / 4

Serotonin release0 / 4

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.

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