FLUVOXAMINE

FLUVOXAMINE (flu-vox'a-meen) Luvox Classifications: psychotherapeutic agent; selective serotonin reuptake inhibitor (ssri); antidepressant; Therapeutic: antidepressant; ssri Prototype: Fluoxetine Pregnancy Category: C

Availability

25 mg, 50 mg, 100 mg tablets

Action

Antidepressant with potent, selective, inhibitory activity on neuronal (5-HT) serotonin reuptake (SSRI). Compared with TCAs, shows fewer anticholinergic effects and no severe cardiovascular effects.

Therapeutic Effect

Effective as an antidepressant and for control of obsessive-compulsive disorders.

Uses

Treatment of depression and obsessive-compulsive disorders.

Unlabeled Uses

Chronic tension-type headaches, panic attacks.

Contraindications

Hypersensitivity to fluvoxamine or fluoxetine; suicidal ideation; concurrent MAOI therapy; bipolar disorder; pregnancy (category C), children ≤6 y, and ≤8 y for use with obsessive-compulsive disorder.

Cautious Use

Liver disease, renal impairment, abrupt discontinuation; cardiac disease, dehydration, hyponatremia, older adults, ECT, seizure disorders, history of suicidal ideation, tobacco smoking; lactation.

Route & Dosage

Depression, Obsessive-Compulsive Disorder Adult: PO Start with 50 mg q.d., may increase slowly up to 300 mg/d given q.h.s. or divided b.i.d. Child (8–11 y): PO Start with 25 mg q.h.s., may increase by 25 mg q4–7d (max: 200 mg/d in divided doses)

Administration

Oral

• Give starting doses at bedtime to improve tolerance to nausea and vomiting; both are common early in therapy.
• Store at room temperature, 15°–30° C (59°–86° F), away from moisture and light.

Adverse Effects (≥1%)

CNS: Somnolence, headache, agitation, insomnia, dizziness, seizures. CV: Orthostatic hypotension, slight bradycardia. GI: Nausea, vomiting, dry mouth, constipation, anorexia. Urogenital: Sexual dysfunction. Skin: Stevens-Johnson syndrome, toxic epidermal necrolysis (rare).

Diagnostic Test Interference

Gamma-glutamyl transferase increased by more than 3-fold following 3 wk of therapy.

Interactions

Drug: Fluvoxamine has been shown to significantly increase plasma levels of amitriptyline, clomipramine, and other tricyclic antidepressants to mildly increase levels of their metabolites. May antagonize the blood pressure-lowering effects of atenolol and other beta blockers. May increase levels and toxicity of carbamazepine, mexiletine. May increase lithium levels causing neurotoxicity, serotonin syndrome, somnolence, and mania. One report of increased theophylline levels with toxicity. Increases prothrombin time in patients on warfarin; increased ergotamine toxicity with dihydroergotamine, ergotamine. Use with cyp 1a2 inhibitors (thioridazine, pimozide, alosetron, tizanidine) increases fluvoxamine levels and toxicity. Herbal: Melatonin may increase and prolong drowsiness; St. John's wort may cause serotonin syndrome.

Pharmacokinetics

Absorption: Almost completely absorbed from GI tract. Onset: 4–7 d. Distribution: Approximately 77% bound to plasma proteins; excreted in human breast milk but in an amount that poses little risk to the nursing infant. Metabolism: In liver. Elimination: Completely in urine. Half-Life: 16–24 h.

Nursing Implications

Assessment & Drug Effects

• Monitor for significant nausea and vomiting, especially during initial therapy.
• Monitor for worsening of depression or emergence of suicidal ideations.
• Assess safety; drowsiness and dizziness are common adverse effects.
• Monitor PT and INR carefully with concurrent warfarin therapy; adjust warfarin as needed.

Patient & Family Education

• Note: Nausea and vomiting are common in early therapy. Notify physician if these adverse effects last more than a few days.
• Exercise caution with hazardous activity until response to the drug is known.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug