1. Fluvoxamine

2. Overview Effects on s1 receptor
FDA-approved for OCD but not for depression
Potential DDI through inhibition of CYP 450 isoenzymes
Dosage range of mg/day

3. Pharmacology and MOA

4. Pharmacodynamics SERT inhibition Sigma 1 agonism
Hindmarch, I., & Hashimoto, K. (2010). Cognition and depression: the effects of fluvoxamine, a sigma‐1 receptor agonist, reconsidered. Human Psychopharmacology: Clinical and Experimental, 25(3),
Schatzberg, Alan F., and Charles B. Nemeroff, eds. The American psychiatric publishing textbook of psychopharmacology. American Psychiatric Pub, 2009.

5. Clinical Uses

6. FDA-Approved Indications
Fluvoxamine
Fluvoxamine CR
OCD X
Social Anxiety Disorder x
Depression: approved in Europe, Australia, Latin America and other countries.

7. Other clinical uses Anxiety disorders Panic disorder
Generalized anxiety disorder
Posttraumatic stress disorder
Schatzberg, Alan F., and Charles B. Nemeroff, eds. The American psychiatric publishing textbook of psychopharmacology. American Psychiatric Pub, 2009.

8. Pharmacokinetics

9. Fluvoxamine pharmacokinetics
Half-life
9-28 hours
CYP 450
Inhibits a number of CYP 450 isoenzymes

10. Fluvoxamine inhibits CYP1A2 and CYP3A4
Also: CYP 2C9 and CYP 2C19
Luvox CR (Fluvoxamine CR) [Prescribing Information]. Palo Alto, CA: Jazz Pharmaceuticals, Inc. Accessed May 2014
Schatzberg, Alan F., and Charles B. Nemeroff, eds. The American psychiatric publishing textbook of psychopharmacology. American Psychiatric Pub, 2009.

11. CYP450 3A4 Potential Interactions
Can reduce the clearance of:
Antipsychotics:
Pimozide
Thioridazine
Benzodiazepines:
Alprazolam
Diazepam
Carbamazepine
Luvox CR (Fluvoxamine CR) [Prescribing Information]. Palo Alto, CA: Jazz Pharmaceuticals, Inc. Accessed May 2014
Schatzberg, Alan F., and Charles B. Nemeroff, eds. The American psychiatric publishing textbook of psychopharmacology. American Psychiatric Pub, 2009.

12. CYP450 1A2 Potential Interactions
Can increase levels of:
Clozapine
Theophyline
Tizanidine
Luvox CR (Fluvoxamine CR) [Prescribing Information]. Palo Alto, CA: Jazz Pharmaceuticals, Inc. Accessed May 2014
Schatzberg, Alan F., and Charles B. Nemeroff, eds. The American psychiatric publishing textbook of psychopharmacology. American Psychiatric Pub, 2009.

13. Adverse Effects

14. Adverse effects Postmarketing clinical studies: Pregnancy category C
Nausea
Somnolence
Asthenia
Weight gain: “no transient or negligible effect”
Pregnancy category C
Serretti, A., & Mandelli, L. (2010). Antidepressants and body weight: a comprehensive review and meta-analysis. The Journal of clinical psychiatry,71(10),
Sadock, B J., V A. Sadock, and P Ruiz. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia: Lippincott Williams & Wilkins, 2009.

15. Prescribing information

16. Dosage range Dose OCD 100-300 mg/day Social anxiety disorder
Depression
Starting dose: 50 mg at bedtime, increase by 50 mg every 4 to 7 days.
Sadock, B J., V A. Sadock, and P Ruiz. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia: Lippincott Williams & Wilkins, 2009.
Luvox CR (Fluvoxamine CR) [Prescribing Information]. Palo Alto, CA: Jazz Pharmaceuticals, Inc. Accessed May 2014

17. Dosage forms Strength Tablets 25 mg, 50 mg scored, 100 mg scored
Twice daily
(if higher than 100 mg/day)
Capsules (Controlled Release)
100 mg, 150 mg
Once daily
Sadock, B J., V A. Sadock, and P Ruiz. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia: Lippincott Williams & Wilkins, 2009.
Luvox CR (Fluvoxamine CR) [Prescribing Information]. Palo Alto, CA: Jazz Pharmaceuticals, Inc. Accessed May 2014