Fluvoxamine

1. Mechanism
   1. Selective Serotonin Reuptake Inhibitor (SSRI)
2. Background
   1. Generic in 2001
3. Indications
   1. Obsessive Compulsive Disorder (OCD)
4. Dosing
   1. Adults
      1. Start: 25 mg (half of 50 mg tablet) qhs for 3 days
      2. Next: 50 mg PO qhs for 7 days
      3. Next: 50 mg PO bid OR 100 qhs
      4. Titrate to 150 - 250 mg daily divided bid
   2. Children (Age 8 years or older)
      1. Start: 25 mg PO qhs
      2. Maximum: 200 mg divided bid
5. Pharmacokinetics
   1. Serum half life: 19 hours
6. Adverse Effects
   1. Sedating
   2. Highest Nausea and Vomiting frequency
   3. Less anxiety (more Anxiolytic) than other SSRIs
   4. Less Sexual Dysfunction than Prozac, Zoloft, Paxil
      1. Sexual dysfunction in 10-15% of cases
      2. Similar to Celexa and Effexor
      3. See Antidepressant Induced Sexual Dysfunction
7. Drug Interactions
   1. Inhibits Cytochrome P450-1A and P450-3A
      1. Avoid with Theophylline (risk of toxicity)
      2. Increases caffeine half life
   2. Raises Tricyclic Antidepressant levels
   3. Raises Warfarin (Coumadin) and associated INR levels
   4. Other interactions
      1. Seldane
      2. Hismanal
      3. Xanax
8. Precautions
   1. Relatively safe
   2. Avoid in Hepatic and Renal insufficiency
   3. Avoid in pregnancy and Lactation
   4. No Overdose