Fluvoxamine

DEA Class;  Rx

Common Brand Names; Luvox, Luvox CR (DSC)

Hypersensitivity

• Nausea (40%)
• Headache (22-35%)
• Somnolence (22-27%)
• Weakness (14-26%)
• Insomnia (20-35%)
• Diarrhea (11-18%)
• Dizziness (11-15%)
• Xerostomia (10-14%)
• Anorexia (6-14%)
• Abnormal ejaculation (8-11%)
• Pain (10%)
• Dyspepsia (8-10%)
• Constipation (4-10%)
• Decreased libido (2-10%)
• Upper respiratory infections (9%)
• Anxiety (5-8%)
• Tremor (5-8%)
• Sweating (6-7%)
• Vomiting (4-6%)
• Abdominal pain (5%)
• Myalgia (5%)
• Abnormal taste (2-5%)
• Bruising (4%)
• Abnormal dreams (3%)
• Abnormal thinking (3%)
• Chest pain (3%)
• Palpitation (3%)
• Agitation (2-3%)
• Vasodilation (2-3%)
• Hypertension (1-2%)
• Increased LFTs (1-2%)
• Weight change (1-2%)
• Manic reaction
• <1%
• Activation of mania/hypomania, seizures (discontinue)
• Sinusitis
• Edema
• Amnesia
• Apathy
• Asthenia
• Malaise
• Nervousness
• Dry mouth
• Myoclonus
• Cough

Conflicting evidence regarding use of SSRIs during pregnancy and increased risk of persistent pulmonary hypertension of the newborn (see Pregnancy)

In neonates exposed to SNRIs/SSRIs late in third trimester: Risk of complications such as feeding difficulties, irritability, and respiratory problems

Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy

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 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 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 (see Contraindications)

May impair ability to operate heavy machinery and other tasks requiring mental alertness

Bone fractures have been associated with antidepressant treatment; consider possibility of fragility fracture if 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

There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy

Data from published literature report presence of drug in human milk; no adverse effects on breastfed infant have been reported in most cases of maternal use of fluvoxamine during breastfeeding