Fluvoxamine is an antidepressant medication classified as a selective serotonin reuptake inhibitor (SSRI). It works by increasing the availability of serotonin in the brain, a neurotransmitter that influences mood and behavior. This action helps alleviate symptoms associated with certain mental health conditions.
FDA-Approved Indications for Fluvoxamine
The U.S. Food and Drug Administration (FDA) has approved fluvoxamine for specific uses. A healthcare professional should determine if it's the right treatment for a patient.
Obsessive-Compulsive Disorder (OCD)
Fluvoxamine was the first SSRI approved by the FDA for treating OCD in adults and children aged 8 and older. It effectively reduces the severity of obsessions and compulsions and is considered a first-line treatment. The prescribed amount may differ for OCD compared to other conditions.
Social Anxiety Disorder (SAD)
Fluvoxamine is also FDA-approved for social anxiety disorder. Studies support its effectiveness in improving SAD symptoms and reducing the impact on daily life.
Common Off-Label Applications
Fluvoxamine is sometimes used off-label for conditions not officially approved by the FDA, based on clinical evidence and medical judgment.
- Major Depressive Disorder (MDD): Though not FDA-approved for depression in the U.S., it is used for this purpose in other countries and has shown effectiveness, particularly with co-occurring anxiety.
- Panic Disorder: Fluvoxamine has demonstrated efficacy in treating panic disorder.
- Post-Traumatic Stress Disorder (PTSD): Research suggests potential benefits for PTSD symptoms.
- Eating Disorders: It has been explored for conditions like bulimia and binge-eating disorder.
- Body Dysmorphic Disorder (BDD): Fluvoxamine can be helpful for managing BDD.
Forms and Administration
Fluvoxamine is available as immediate-release tablets and extended-release capsules. The prescribed amount and frequency will depend on the individual and the condition being treated.
- Tablets: Administration frequency is determined by a healthcare provider.
- Extended-Release Capsules (CR): Typically taken once daily, designed for slow release.
Important Warnings and Side Effects
Boxed Warnings
Like other antidepressants, fluvoxamine has an FDA boxed warning about increased risk of suicidal thoughts and behavior in young adults under 24, especially when starting or adjusting the prescribed amount. Monitoring for changes in behavior is essential.
Serious Side Effects
Less common but serious side effects requiring immediate medical attention include:
- Serotonin Syndrome: A serious condition from excess serotonin, with symptoms like agitation, fast heart rate, and muscle stiffness.
- Mania: Can be triggered in individuals with undiagnosed bipolar disorder.
- Increased Bleeding Risk: Especially with other medications like NSAIDs or warfarin.
- Low Sodium Levels (Hyponatremia): Symptoms include headache and confusion.
- Angle-Closure Glaucoma: Increased eye pressure potentially leading to vision loss.
Drug Interactions
Fluvoxamine can interact with many medications, particularly by affecting liver enzymes (CYP1A2). Certain drugs are contraindicated, including MAOIs, tizanidine, thioridazine, pimozide, and alosetron.
How Fluvoxamine Compares to Other SSRIs
While sharing a similar mechanism, SSRIs differ in approved uses, side effects, and interactions. Fluvoxamine is uniquely approved for OCD and SAD and has a notable drug interaction profile. Other common SSRIs include sertraline and fluoxetine.
| Feature | Fluvoxamine | Sertraline | Fluoxetine |
|---|---|---|---|
| Primary FDA Approvals | OCD, Social Anxiety Disorder | MDD, OCD, Panic Disorder, PTSD, SAD, PMDD | MDD, OCD, Panic Disorder, Bulimia, Bipolar Depression |
| Administration Frequency | Determined by physician | Once daily | Daily or weekly |
| Common Side Effects | Nausea, drowsiness, insomnia, headache, GI upset | Nausea, diarrhea, dry mouth, sleepiness | Insomnia, nausea, headache, weakness |
| Significant Drug Interactions | Potent CYP1A2 inhibitor; many interactions | Fewer interactions | Notable interactions |
| Use in Children | FDA-approved for OCD in children 8+ | FDA-approved for OCD in children 6+ | FDA-approved for MDD and OCD in children 8+ |
Conclusion
Fluvoxamine is an effective SSRI primarily for treating obsessive-compulsive disorder and social anxiety disorder. It also has potential off-label uses for conditions like depression and panic disorder. Key considerations include a boxed warning regarding suicidality in young patients and significant drug interactions. Treatment should be managed by a healthcare professional to ensure appropriate administration, monitor side effects, and discuss risks and benefits. Abrupt discontinuation should be avoided. For further information, the National Alliance on Mental Illness (NAMI) is a helpful resource.
