Indications for Fluvoxamine Maleate:
≥18yrs: initially 50mg at bedtime, increase in 50mg increments at 4–7 day intervals; range 100–300mg/day; max 300mg/day. Divide total daily doses >100mg into 2 doses; give larger portion at bedtime. Elderly, hepatic impairment: use lower initial dose and titrate more slowly.
Females may respond to lower dose. <8yrs: not established. 8–17yrs: initially 25mg at bedtime, increase in 25mg increments at 4–7 day intervals; usual range 50–200mg/day. Max 8–11yrs: 200mg/day; 12–17yrs: 300mg/day. Divide total daily doses >50mg into 2 doses; give larger portion at bedtime. Hepatic impairment: use lower initial dose and titrate more slowly.
Concomitant alosetron, tizanidine, pimozide, thioridazine. During or within 14 days of MAOIs; do not start an MAOI during or within 14 days of fluvoxamine. Concomitant linezolid, IV methylene blue.
Suicidality and antidepressants.
Increased risk of suicidal thinking and behavior in children, adolescents, and young adults; monitor for clinical worsening or unusual changes. Screen for bipolar disorder. Monitor for serotonin syndrome; discontinue if occurs. History of seizures (discontinue if occurs), mania/hypomania. ECT. Cardiovascular disease. Liver dysfunction. Angle-closure glaucoma. Conditions that affect metabolism or hemodynamic response. Reduced activity of CYP2D6. Reevaluate periodically. Write ℞ for smallest practical amount. Avoid abrupt cessation. Elderly. Labor & delivery. Pregnancy (esp. during 3rd trimester). Nursing mothers: monitor infants.
See Contraindications. Prolongation of QT interval with pimozide, thioridazine. Avoid alcohol. Concomitant ramelteon: not recommended. Increased risk of serotonin syndrome with other serotonergic drugs, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, St. John's wort, linezolid, IV methylene blue; monitor. Potentiates diazepam (not recommended), triazolam and alprazolam (reduce their doses by at least ½), midazolam, theophylline (reduce its dose by ⅔ and monitor), warfarin, carbamazepine, tricyclic antidepressants (reduce their doses and monitor), propranolol, metoprolol (reduce their doses), clozapine, methadone, tacrine. Caution with drugs that inhibit CYP2D6 (eg, quinidine) or 3A4, phenytoin, diltiazem. Increased risk of bleeding with concomitant NSAIDs, aspirin, warfarin, and others that affect coagulation. Monitor mexiletine levels. Smokers may have increased metabolism.
Nausea, somnolence, insomnia, asthenia, nervousness, dyspepsia, abnormal ejaculation, sweating, anorexia, tremor, vomiting, anorgasmia, decreased libido, dry mouth, rhinitis, taste perversion, urinary frequency; hyponatremia (discontinue if symptomatic). Children: also agitation, depression, dysmenorrhea, flatulence, hyperkinesia, rash.
Formerly known under the brand name Luvox.