Fluvoxamine (Luvox) is an SSRI approved exclusively for OCD, a disorder characterized by obsessions (recurrent intrusive thoughts) that the individual may attempt to neutralize with a compulsive repetitive behavior or ritual, e.g., flicking a light switch 50 times.
Three other SSRIs are FDA-approved for OCD—fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). Off-label, escitalopram (Lexapro) at high dose may be a better choice than fluvoxamine for OCD because it highly selective for blocking serotonin transporters and has fewer side effects.
Although not used for depression, fluvoxamine is properly referred to as an antidepressant.
Luvox is a potent inHibitor of multiple CYP enzymes, causing increased serum levels of many co-administered medications. CYP1A2 inhibition by fluvoxamine can be used for strategic advantage in combination with clozapine (Clozaril) as explained in chapter one.
50 mg HS is the starting fluvoxamine dose for the first week, then 50 mg BID. Envision the mascot flicking a light switch 50 times. Additional dose increases will likely be necessary for fluvoxamine to be effective for OCD. With any SSRI, effective treatment of OCD demands a high dose, often exceeding the FDA max.
Fluvoxamine should be dosed BID for maintenance because it has the shortest half-life of all available SSRIs (15 hours). Other SSRIs are generally dosed once daily.
Among SSRIs, fluvoxamine is the least likely to cause sexual dysfunction (La Torre et al, 2013), although > 50% of patients are still affected. Owing to short half-life, fluvoxamine is a reasonable PRN treatment for premature ejaculation.
Dosing: For OCD start 50 mg HS, then increase to 50 mg BID in 4–7 days. May increase by 50 mg/day every 4–7 days. FDA maximum is 300 mg/day but may go as high as 450 mg (Stahl, 2016) in divided doses. Serotonergic medications need to be prescribed at high dose to effectively treat obsessive-compulsive disorder. Dosing is similar for social anxiety disorder. Taper gradually to discontinue.
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