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Fluvoxamine is a widely prescribed psychiatric medication belonging to the selective serotonin reuptake inhibitor (SSRI) class. It works by elevating levels of the neurotransmitter serotonin in the brain to regulate mood and reduce compulsive behaviors, with a relatively mild adverse effect profile compared to older tricyclic antidepressants, and is primarily used to treat obsessive-compulsive disorder, major depressive episodes, and social anxiety disorder.
Key moments
Late 1970sFirst entered initial clinical trials for the treatment of major depression
1983First launched for mainstream clinical use as one of the earliest commercially available SSRI drugs
Mid 1990sSecured formal regulatory approval in multiple global regions for the dedicated treatment of obsessive-compulsive disorder
2002Large-scale global post-marketing surveillance data covering more than 28 million exposed patients formally confirmed its long-term safety profile
2020-2022Widely studied as a potential low-cost oral repurposed candidate for early outpatient COVID-19 treatment, though it did not receive widespread regulatory approval for this indication
Distinct positioning among SSRI medications
Unlike most other SSRIs that were first authorized and marketed for major depressive disorder, fluvoxamine carved out an early niche as a first-line dedicated treatment for obsessive-compulsive disorder, with proven safety and efficacy even for pediatric OCD patients in many jurisdictions. It has no significant anticholinergic, sedative or cardiovascular side effects linked to many older antidepressants, including no elevated risk of orthostatic hypotension, making it a particularly suitable treatment option for elderly psychiatric patient populations.
COVID-19 repurposing case significance
Fluvoxamine became a highly discussed candidate therapeutic during the global COVID-19 public health crisis, driven by its very low production cost, easy oral administration route and preliminary in vitro evidence of anti-inflammatory properties. While some observational real-world studies suggested it could reduce risk of severe hospitalization for high-risk early-stage patients, larger randomized controlled trials failed to produce sufficiently consistent evidence to earn widespread formal regulatory authorization for this use. This episode became a widely cited case study of the challenges of validating low-cost repurposed generic drugs as part of pandemic preparedness frameworks.
Unique clinical prescribing considerations
Fluvoxamine has well-documented strong interactions with specific cytochrome P450 liver enzymes, which can alter the metabolism of dozens of co-administered common medications including benzodiazepines, theophylline, and certain anticoagulants. This trait requires prescribers to conduct careful medication reconciliation and dose adjustment for patients with multiple comorbidities, to avoid unexpected adverse drug events that are far less common with other members of the SSRI drug class.
Fluvoxamine, sold under the brand name Luvox among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class.[5] It is primarily used to treat major depressive disorder and, perhaps more-especially, obsessive–compulsive disorder (OCD),[6] but is also used to treat anxiety disorders[7] such as panic disorder, social anxiety disorder, and post-traumatic stress disorder.[8][9]
Fluvoxamine's side-effect profile is similar to that of other SSRIs. Common adverse effects include constipation, gastrointestinal problems, headache, anxiety, irritation, sexual problems, dry mouth, sleep problems, and an increased risk of suicide at the start of treatment.These effects appear to be significantly weaker than with other SSRIs, with the exception of gastrointestinal side-effects.[10] In some patients, sexual dysfunction may persist even after the drug is discontinued, a condition known as post-SSRI sexual dysfunction; regulatory agencies including the European Medicines Agency and Health Canada have recommended that fluvoxamine's product labeling warn of this risk.
Fluvoxamine appears to be more tolerable than other SSRIs, particularly with respect to cardiovascular complications.[11]
It is on the World Health Organization's List of Essential Medicines.[12]
Medical uses
In many countries (e.g., Australia,[13] the United Kingdom, and Russia[14]) it is commonly used for major depressive disorder.Fluvoxamine is also approved in the United States for obsessive–compulsive disorder (OCD),[6] and social anxiety disorder.[15] In Japan, it is also approved to treat OCD, social anxiety disorder, and major depressive disorder.[16][17] Fluvoxamine is indicated for children and adolescents with OCD.[18]
Adverse effects
Fluvoxamine's side-effect profile is very similar to other SSRIs. Gastrointestinal side effects are characteristic of those receiving treatment with fluvoxamine.[34][35][36][37][38][39] However, compared to escitalopram and sertraline, fluvoxamine's gastrointestinal profile may be less intense,[40] often being limited to nausea.[41]
Fluvoxamine is a potent selective serotonin reuptake inhibitor with around 100-fold affinity for the serotonin transporter over the norepinephrine transporter.[55] It has negligible affinity for the dopamine transporter or any other site, with the sole exception of the σ1 receptor.[98][11] It behaves as a potent agonist at this receptor and has the highest affinity (36 nM) of any SSRI for doing so.[98] This may contribute to its antidepressant and anxiolytic effects and may also afford it some efficacy in treating the cognitive symptoms of depression.[99]
History
Fluvoxamine was developed by Kali-Duphar, part of Solvay Pharmaceuticals, Belgium, now Abbott Laboratories, and introduced as Floxyfral in Switzerland in 1983.[106] It was approved by the U.S. Food and Drug Administration (FDA) in 1994, and introduced as Luvox in the US.[107] In India, it is available, among several other brands, as Uvox by Abbott.[108] It was one of the first SSRI antidepressants to be launched, and is prescribed in many countries to patients with major depression.[109] It was the first SSRI, a non-TCA drug, approved by the U.S. FDA specifically for the treatment of OCD.[110] At the end of 1995, more than ten million patients worldwide had been treated with fluvoxamine.[111]
Research directions
A 2022 review concluded that according to low-certainty evidence, fluvoxamine may slightly decrease all-cause mortality by day 28 and potentially reduce the risk of hospitalization or death in outpatients with mild COVID-19.[118] While early studies have suggested potential benefits for fluvoxamine as an anti-inflammatory agent and a possible impact on reducing cytokine storms, further studies did not confirm this expected benefit on COVID-19 patients.[119][120] A cytokine storm refers to an excessive immune response characterized by a release of large amounts of pro-inflammatory cytokines.[121]
In May 2022, based on a review of available scientific evidence, the U.S. Food and Drug Administration (FDA) did not issue an emergency use authorization covering the use of fluvoxamine to treat COVID-19, saying that, at the time, the data was not sufficient to conclude that fluvoxamine may be effective in treating non-hospitalized people with COVID-19 to prevent serious illness or hospitalization.The agency stated that study results suggest that further clinical trials may be warranted.[122]
Environment
Fluvoxamine is a common finding in waters near human settlement. Christensen et al. 2007 finds it is "very toxic to aquatic organisms" by European Union standards.[127]
3.Clinical pharmacokinetics of selective serotonin reuptake inhibitors Clinical Pharmacokinetics, March 1993^
4.
The
NICE
guidelines in the United Kingdom have, as of 2005, authorized its use for OCD in adults and adolescents of any age and children over the age of 7.
There is evidence that fluvoxamine is effective for generalised social anxiety in adults, although, as with other SSRIs, some of the results may be compromised by having been funded by pharmaceutical companies.[19][20] Of the SSRIs, however, fluvoxamine, paroxetine, and sertraline do appear consistent as viable treatments for generalised social anxiety.[21][22]
Fluvoxamine is also effective for treating a range of anxiety disorders in children and adolescents, including generalized anxiety disorder, social anxiety disorder, panic disorder, and separation anxiety disorder.[23][24][25]
The drug works long-term, and retains its therapeutic efficacy for at least one year.[26]
The average therapeutic dose for fluvoxamine is 100 to 300 mg/day, with 300 mg being the upper daily limit normally recommended. OCD, however, often requires higher doses; doses of up to 450 mg/day may be prescribed in this case.[27][28][29] The (off-label) upper daily limits for other serotonin-reuptake inhibitors used in the treatment of OCD, by analogy, are 400 mg for sertraline,[30] 100 mg for paroxetine, 120 mg for both fluoxetine and citalopram, 60 mg for escitalopram and 300 mg for clomipramine.[31][32]
In any case with fluvoxamine, treatment is generally begun at 50 mg and increased in 50 mg increments every 4 to 7 days until a therapeutic optimum is reached.[33]
Mosapride
has demonstrated efficacy in treating fluvoxamine-induced nausea.
It is also advised practice to divide total daily doses of fluvoxamine greater than 100 mg, with the higher fraction being taken in the evening (e.g., 50 mg at the beginning of the waking day and 200 mg at bedtime).
In any case, high starting daily doses of fluvoxamine rather than the recommended gradual titration (starting at 50 mg and gradually titrating, up to 300 mg if necessary) may increase the likelihood of nausea.[43]
In comparison to other SSRIs, fluvoxamine has the second highest rate of causing discontinuation syndrome, as a result of the low half-life of fluvoxamine.[44]
Common
Common side effects occurring with 1–10% incidence:
Abdominal pain
Agitation
Anxiety
Asthenia (weakness)
Constipation
Diarrhea
Dizziness
Dyspepsia (indigestion)
Headache
Hyperhidrosis (excess sweating)
Insomnia
Loss of appetite
Malaise
Nausea
Nervousness
Palpitations
Restlessness
Sexual dysfunction (including delayed ejaculation, erectile dysfunction, decreased libido, etc.)
Somnolence (drowsiness)
Tachycardia (high heart rate)
Tremor
Vomiting
Weight loss
Xerostomia (dry mouth)
Yawning
Uncommon
Uncommon side effects occurring with 0.1–1% incidence:
Arthralgia
Confusional state
Cutaneous hypersensitivity reactions (e.g. oedema [buildup of fluid in the tissues], rash, pruritus)
Extrapyramidal side effects (e.g. dystonia, parkinsonism, tremor, etc.)
Hallucination
Orthostatic hypotension
Rare
Rare side effects occurring with 0.01–0.1% incidence:
Abnormal hepatic (liver) function
Galactorrhoea (expulsion of breast milk unrelated to pregnancy or breastfeeding)
Mania
Photosensitivity (being abnormally sensitive to light)
Seizures
Unknown frequency
Akathisia – a sense of inner restlessness that presents itself with the inability to stay still
Bed-wetting
Bone fractures
Dysgeusia
Ecchymoses
Glaucoma
Haemorrhage
Hyperprolactinaemia (elevated plasma prolactin levels leading to galactorrhoea, amenorrhoea [cessation of menstrual cycles], etc.)
Hyponatraemia
Mydriasis
Neuroleptic malignant syndrome – practically identical presentation to serotonin syndrome except with a more prolonged onset
Paraesthesia
Serotonin syndrome – a potentially fatal condition characterised by abrupt onset muscle rigidity, hyperthermia (elevated body temperature), rhabdomyolysis, mental status changes (e.g. coma, hallucinations, agitation), etc.
Post-SSRI sexual dysfunction
Post-SSRI sexual dysfunction (PSSD) is an iatrogenic condition in which sexual side effects persist after discontinuation of serotonin reuptake inhibiting antidepressants, including fluvoxamine.[46][47] Characteristic symptoms include genital numbness, pleasureless or weak orgasm, loss of libido, and erectile dysfunction; non-sexual symptoms such as emotional blunting and cognitive impairment may also occur.[47] The condition can arise after even brief exposure to a serotonin reuptake inhibitor and may persist indefinitely; there is currently no established treatment.[48] The DSM-5 noted in 2013 that serotonin reuptake inhibitor-induced sexual dysfunction may persist after the agent is discontinued.[49]
A 2023 retrospective cohort study of over 12,000 males estimated the risk of irreversible sexual dysfunction at approximately 0.46% of patients treated with serotonergic antidepressants, including SSRIs, though the actual prevalence remains uncertain and the condition is likely underreported.
By so doing, fluvoxamine can increase serum concentration of the substrates of these enzymes.[54]
Fluvoxamine may also elevate plasma levels of olanzapine by approximately two times.[65] Combined olanzapine and fluvoxamine, which may cause increased sedation,[66] should be used cautiously and controlled clinically and by therapeutic drug monitoring to avoid olanzapine induced adverse effects and/or intoxication.[67][68]
The plasma levels of oxidatively metabolized benzodiazepines (e.g., triazolam, midazolam, alprazolam, and diazepam) are likely to be increased when co-administered with fluvoxamine.However, the clearance of benzodiazepines metabolized by glucuronidation (e.g., lorazepam; oxazepam, which is coincidentally a metabolite of diazepam;[69]temazepam)[70][71] are not affected by fluvoxamine and may be safely taken alongside fluvoxamine should concurrent treatment with a benzodiazepine be necessary.[72] Additionally, it appears that benzodiazepines metabolized by nitro-reduction (clonazepam, nitrazepam) may also, in a somewhat similar vein, be unlikely to be affected by fluvoxamine.[73][74]
Using fluvoxamine and alprazolam together can increase alprazolam plasma concentrations.[75] If alprazolam is coadministered with fluvoxamine, the initial alprazolam dose should be reduced to the lowest effective dose.[76][77]
As with all SSRI medications, using fluvoxamine with NSAIDs like ibuprofen may increase the risk of bleeding, particularly in the GI tract.[78]
Fluvoxamine is contraindicated with other medications that increase serotonin (dextromethorphan, ondansetron, amphetamine, sumatriptan, Tramadol, Hypericum perforatum, etc.).[79] Combining these medications may rarely lead to a life-threatening complication known as serotonin syndrome.
Fluvoxamine and ramelteon coadministration is not indicated.[80][81]
Fluvoxamine has been observed to increase serum concentrations of mirtazapine, which is mainly metabolized by CYP1A2, CYP2D6, and CYP3A4, by three- to four-fold in humans.[82] Caution and adjustment of dosage as necessary are warranted when combining fluvoxamine and mirtazapine.[82]
Fluvoxamine seriously affects the pharmacokinetics of tizanidine and increases the intensity and duration of its effects.Because of the potentially hazardous consequences, the concomitant use of tizanidine with fluvoxamine, or other potent inhibitors of CYP1A2, should be avoided.[83]
When a beta-blocker is required, atenolol,[84]pindolol[85][86][87] and, possibly, metoprolol[88][89][63][90] may be safer choices than propranolol, as the latter's metabolism is seriously, potentially dangerously, inhibited by fluvoxamine.[91] Indeed, fluvoxamine may increase propranolol blood-levels by five-fold.[92]
Clomipramine increases fluvoxamine levels and, conversely-likewise, fluvoxamine increases clomipramine levels (thereby its serotonergic potential) and inhibits its metabolism to its strongly-noradrenergic metabolite, norclomipramine.[93][94]
CYP1A2 (strongly) which metabolizes agomelatine, amitriptyline, caffeine, clomipramine, clozapine, duloxetine, haloperidol, imipramine, phenacetin, tacrine, tamoxifen, theophylline, olanzapine, etc.
Literature reviews have stated that fluvoxamine is metabolized primarily by CYP2D6 and to a minor extent by CYP1A2.[102][103] However, CYP2D6 poor metabolizers do not have considerably higher fluvoxamine levels than extensive metabolizers.[102] Fluvoxamine inhibits oxidative drug metabolising enzymes (particularly CYP1A2, and less potently CYP3A4 and CYP2D6)[104] The mean plasma half-life of fluvoxamine after multiple oral doses of 100 mg/day in healthy, young volunteers was 13.6-15.6 hours.In the elderly, however the half life ranged from 17.4 to 25.9.[105] Steady-state plasma fluvoxamine concentrations were 2-3 fold higher in children than in adolescents.
Fluvoxamine was the first SSRI to be registered for the treatment of obsessive compulsive disorder in children by the FDA in 1997.
Reviews published in 2024 indicate that clinical trials have shown fluvoxamine to be more effective than a placebo in reducing clinical deterioration and hospitalization in COVID-19 patients, particularly those taking 200 mg or more daily.[124][125][126]
Luvox ChemSpider, Royal Society of Chemistry, retrieved 21 October 2013
6.Antidepressants and suicide in adolescents and adults: a public health experiment with unintended consequences? P & T: A Peer-Reviewed Journal for Formulary Management, July 2009^
7.Fluvoxamine for the treatment of anxiety disorders in children and adolescents. The Research Unit on Pediatric Psychopharmacology Anxiety Study Group The New England Journal of Medicine, April 2001^
8.Fluvoxamine. An updated review of its use in the management of adults with anxiety disorders Drugs, October 2000^
9.Fluvoxamine in the treatment of panic disorder: a multi-center, double-blind, placebo-controlled study in outpatients Psychiatry Research, August 2001^
10.Pharmacokinetics and efficacy of fluvoxamine and amitriptyline in depression Journal of Pharmacological Sciences, May 2009^
11.Tolerability and safety of fluvoxamine and other antidepressants International Journal of Clinical Practice, April 2006^
12.The selection and use of essential medicines: web annex A: World Health Organization model list of essential medicines: 23rd list World Health Organization, 2023^
13.Luvox Tablets NPS MedicineWise, retrieved 22 October 2018^
18.Fluvoxamine Product Insert Jazz Pharmaceuticals, Inc., U.S. Food and Drug Administration, March 2005, retrieved 4 November 2022^
19.Pharmacotherapy for social anxiety disorder (SAnD) The Cochrane Database of Systematic Reviews, October 2017^
20.Efficacy and tolerability of fluvoxamine in adults with social anxiety disorder: A meta-analysis Medicine, July 2018^
21.Williams, T., McCaul, M., Schwarzer, G., Cipriani, A., Stein, D. J., & Ipser, J. (2020). Pharmacological treatments for social anxiety disorder in adults: a systematic review and network meta-analysis. Acta neuropsychiatrica, 32(4), 169–176. https://doi.org/10.1017/neu.2020.6^
22.Davidson J. R. (2003). Pharmacotherapy of social phobia. Acta psychiatrica Scandinavica. Supplementum, (417), 65–71. https://doi.org/10.1034/j.1600-0447.108.s417.7.x^
24.Antidepressants in Children and Adolescents: Meta-Review of Efficacy, Tolerability and Suicidality in Acute Treatment Frontiers in Psychiatry, 2 September 2020^
25.Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review World Psychiatry, June 2021^
26.Fluvoxamine. An updated review of its pharmacology, and therapeutic use in depressive illness Drugs, November 1993^
27.Seibell PJ, Hamblin RJ, Hollander E. Obsessive-compulsive disorder: Overview and standard treatment strategies. Psychiatric Annals. 2015 Jun 1;45(6):297-302.^
28.Rivas-Vazquez, R.A., and Blais, M.A., 1997. Selective serotonin reuptake inhibitors and atypical antidepressants: A review and update for psychologists. Professional Psychology: Research and Practice, 28(6), p.526.^
29.Middleton, R., Wheaton, M.G., Kayser, R., and Simpson, H.B., 2019. Treatment resistance in obsessive-compulsive disorder. Treatment resistance in psychiatry: risk factors, biology, and management, pp.165-177.^
30.Ninan PT, Koran LM, Kiev A, Davidson JR, Rasmussen SA, Zajecka JM, Robinson DG, Crits-Christoph P, Mandel FS, Austin C. High-dose sertraline strategy for nonresponders to acute treatment for obsessive-compulsive disorder: a multicenter double-blind trial. J Clin Psychiatry. 2006 Jan;67(1):15-22. doi: 10.4088/jcp.v67n0103. PMID 16426083.^
32.Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB; American Psychiatric Association. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. 2007 Jul;164(7 Suppl):5-53. PMID 17849776.^
33.Figgitt, D.P., and McClellan, K.J., 2000. Fluvoxamine: an updated review of its use in the management of adults with anxiety disorders. Drugs, 60, pp.925-954.^
34.Product Information Luvox TGA eBusiness Services, Abbott Australasia Pty Ltd, 15 January 2013, retrieved 21 October 2013^
40.Gastrointestinal side effects associated with antidepressant treatments in patients with major depressive disorder: A systematic review and meta-analysis Progress in Neuro-psychopharmacology & Biological Psychiatry, Elsevier BV, July 2021^
41.Fluvoxamine in the treatment of anxiety disorders Neuropsychiatric Disease and Treatment, December 2005^
42.Characteristics of fluvoxamine-induced nausea Psychiatry Research, Elsevier BV, November 2001^
44.SSRIs and SNRIs: A review of the Discontinuation Syndrome in Children and Adolescents Journal of the Canadian Academy of Child and Adolescent Psychiatry, February 2011^
46.Post-SSRI Sexual Dysfunction: A Literature Review Sexual Medicine Reviews, January 2018^
47.Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin International Journal of Risk & Safety in Medicine, 2022^
48.Enduring sexual dysfunction after treatment with antidepressants, 5-alpha-reductase inhibitors and isotretinoin: 300 cases International Journal of Risk & Safety in Medicine, 2018^
49.Post-SSRI sexual dysfunction: barriers to quantifying incidence and prevalence Epidemiology and Psychiatric Sciences, 2024^
50.Estimating the risk of irreversible post-SSRI sexual dysfunction (PSSD) due to serotonergic antidepressants Annals of General Psychiatry, April 2023^
51.Selective serotonin reuptake inhibitors, post-treatment sexual dysfunction and persistent genital arousal disorder: A systematic review Pharmacoepidemiology and Drug Safety, October 2023^
65.Metabolic drug interactions with newer antipsychotics: a comparative review Basic & Clinical Pharmacology & Toxicology, January 2007^
66.Olanzapine augmentation of fluvoxamine-refractory obsessive-compulsive disorder (OCD): a 12-week open trial Psychiatry Research, October 2000^
67.Fluvoxamine augmentation of olanzapine in chronic schizophrenia: pharmacokinetic interactions and clinical effects Journal of Clinical Psychopharmacology, October 2002^
68.Movox NPS MedicineWise, 23 November 2020, retrieved 4 November 2022^
69.Metabolic profile of oxazepam and related benzodiazepines: clinical and forensic aspects Drug Metabolism Reviews, November 2017^
73.Luvox Data Sheet Medsafe, New Zealand, 2017, retrieved 16 September 2018^
74.Faverin Tablets NPS MedicineWise, July 2022, retrieved 4 November 2022^
75.Effects of concomitant fluvoxamine on the metabolism of alprazolam in Japanese psychiatric patients: interaction with CYP2C19 mutated alleles European Journal of Clinical Pharmacology, April 2003^
77.A pharmacokinetic and pharmacodynamic evaluation of the combined administration of alprazolam and fluvoxamine European Journal of Clinical Pharmacology, 1994^
78.Selective serotonin reuptake inhibitors increase risk of upper gastrointestinal bleeding when used with NSAIDs: a systemic review and meta-analysis Scientific Reports, August 2022^
79.Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions International Journal of Tryptophan Research, 2019^
80.Metabolism of ramelteon in human liver microsomes and correlation with the effect of fluvoxamine on ramelteon pharmacokinetics Drug Metabolism and Disposition: The Biological Fate of Chemicals, August 2010^
81.Pharmacotherapy of insomnia with ramelteon: safety, efficacy and clinical applications Journal of Central Nervous System Disease, 12 April 2011^
82.Fluvoxamine augmentation increases serum mirtazapine concentrations three- to fourfold The Annals of Pharmacotherapy, October 2001^
83.Fluvoxamine drastically increases concentrations and effects of tizanidine: a potentially hazardous interaction Clinical Pharmacology and Therapeutics, April 2004^
84.Clinical pharmacokinetics of fluvoxamine Clinical Pharmacokinetics, September 1994^
85.Factors affecting fluvoxamine antidepressant activity: influence of pindolol and 5-HTTLPR in delusional and nondelusional depression Biological Psychiatry, September 2001^
86.The effects of pindolol addition to fluvoxamine and buspirone in chronic mild stress model of depression. Behavioural Pharmacology, May 1996^
87.Effect of adjuvant pindolol on the antiobsessional response to fluvoxamine: a double-blind, placebo-controlled study International Clinical Psychopharmacology, September 1998^
89.In vivo inhibition of CYP2C19 but not CYP2D6 by fluvoxamine British Journal of Clinical Pharmacology, October 1996^
90.Inhibition of the oxidative metabolism of metoprolol by selective serotonin reuptake inhibitors in human liver microsomes. Fundamental and Clinical Pharmacology, 1997^
91.Overview of the pharmacokinetics of fluvoxamine Clinical Pharmacokinetics, 1995^
92.Clinically relevant drug interactions in anxiety disorders Human Psychopharmacology, May 2012^
93.Combination treatment with clomipramine and fluvoxamine: drug monitoring, safety, and tolerability data The Journal of Clinical Psychiatry, June 1996^
94.Clomipramine in Combination with Fluvoxamine: A Potent Medication Combination for Severe or Refractory Pediatric OCD Journal of the Canadian Academy of Child and Adolescent Psychiatry, November 2021^
95.High occupancy of sigma-1 receptors in the human brain after single oral administration of fluvoxamine: a positron emission tomography study using [11C]SA4503 Biological Psychiatry, October 2007^
96.The American Psychiatric Publishing textbook of psychopharmacology American Psychiatric Pub., 2009^
97.Possibility of Predicting Serotonin Transporter Occupancy From the In Vitro Inhibition Constant for Serotonin Transporter, the Clinically Relevant Plasma Concentration of Unbound Drugs, and Their Profiles for Substrates of Transporters Journal of Pharmaceutical Sciences, September 2017^
98.Sigma-1 receptors and selective serotonin reuptake inhibitors: clinical implications of their relationship Central Nervous System Agents in Medicinal Chemistry, September 2009^
99.Cognition and depression: the effects of fluvoxamine, a sigma-1 receptor agonist, reconsidered Human Psychopharmacology, April 2010^
100.Increase in the cerebrospinal fluid content of neurosteroids in patients with unipolar major depression who are receiving fluoxetine or fluvoxamine Proceedings of the National Academy of Sciences of the United States of America, March 1998^
101.Pharmacology of serotonin uptake inhibitors: focus on fluvoxamine Journal of Psychiatry & Neuroscience, July 1991^
102.Pharmacokinetic evaluation of fluvoxamine for the treatment of anxiety disorders Expert Opinion on Drug Metabolism & Toxicology, April 2015^
113.Japanese experience with milnacipran, the first serotonin and norepinephrine reuptake inhibitor in Japan Neuropsychiatric Disease and Treatment, February 2007^
116.Clinical Pharmacy and Therapeutics Churchill Livingstone Elsevier, 2007^
117.Fluvoxamine www.drugbank.ca, retrieved 22 October 2019^
118.Fluvoxamine for the treatment of COVID-19 The Cochrane Database of Systematic Reviews, September 2022^
119.Fluvoxamine in Nonhospitalized Patients With Acute COVID-19 Infection and the Lack of Efficacy in Reducing Rates of Hospitalization, Mechanical Ventilation, and Mortality in Placebo-Controlled Trials: A Systematic Review and Meta-Analysis American Journal of Therapeutics, 2022^
120.Selective serotonin reuptake inhibitors: New hope in the fight against COVID-19 Frontiers in Pharmacology, 2022^
121.The cytokine storm and COVID-19 Journal of Medical Virology, January 2021^
124.Evaluating fluvoxamine for the outpatient treatment of COVID-19: A systematic review and meta-analysis Reviews in Medical Virology, January 2024^
125.A systematic review and meta-analysis, investigating dose and time of fluvoxamine treatment efficacy for COVID-19 clinical deterioration, death, and Long-COVID complications Scientific Reports, June 2024^
126.The efficacy and safety of fluvoxamine in patients with COVID-19: A systematic review and meta-analysis from randomized controlled trials PLOS ONE, 2024^
127.Susceptibility of phytoplankton to the increasing presence of active pharmaceutical ingredients (APIs) in the aquatic environment: A review Aquatic Toxicology (Amsterdam, Netherlands), Elsevier, May 2021Mixture and single-substance toxicity of selective serotonin reuptake inhibitors toward algae and crustaceans Environmental Toxicology and Chemistry, John Wiley & Sons, Inc. (Society of Environmental Toxicology and Chemistry (SETAC)), January 2007^
Suicidal ideation and behaviour
Syndrome of inappropriate antidiuretic hormone secretion
A 2023 systematic review noted that while data on fluvoxamine is more limited than for some other SSRIs, it was included in the EMA's class-wide signal assessment and cases have been reported with SNRIs, SRI tricyclic antidepressants, and other serotonin reuptake inhibiting drugs in addition to SSRIs.
A citizen petition submitted to regulators in 2018 suggested that SNRIs and other serotonin reuptake inhibiting drugs, including fluvoxamine, may be less likely to induce PSSD than SSRIs, though this remains unconfirmed.
In 2019, the European Medicines Agency's Pharmacovigilance Risk Assessment Committee (PRAC) reviewed evidence on fluvoxamine as part of its class-wide signal assessment and recommended that product labels for all SSRIs and SNRIs be updated to state that sexual dysfunction may be long-lasting even after treatment is stopped.[52]Health Canada followed with similar label updates in 2021.[49] In 2024, Australia's Therapeutic Goods Administration aligned all SSRI and SNRI product information to reflect this risk; fluvoxamine was among the products requiring updated warnings.[53]
