View source for Fluvoxamine

{{Short description|SSRI antidepressant drug}}
{{Distinguish|Fluoxetine}}
{{CS1 config|name-list-style=vanc|display-authors=3}}
{{Use dmy dates|date=December 2023}}
{{Infobox drug
| Verifiedfields = changed
| Watchedfields = changed
| verifiedrevid = 443824781
| image = Fluvoxamine.svg
| image_class = skin-invert-image
| width = 
| alt = 
| caption = 
| image2 = Fluvoxamine 3D 4ENH.png
| width2 = 
| alt2 =

<!-- Clinical data -->
| pronounce = {{respell|floo|VAHK|sə|meen}} <br />
UK: {{IPAc-en|f|l|uː|ˈ|v|ɒ|k|s|ə|m|iː|n}}
US: {{IPAc-en|f|l|uː|ˈ|v|ɑː|k|s|ə|ˌ|m|iː|n}}
| tradename = Luvox, others
| Drugs.com = {{drugs.com|monograph|fluvoxamine-maleate}}
| MedlinePlus = a695004
| DailyMedID = Fluvoxamine
| pregnancy_AU = C
| pregnancy_AU_comment = <ref name= "Drugs.com pregnancy">{{drugs.com|pregnancy|fluvoxamine}}, ''drugs.com''</ref>
| pregnancy_category = 
| routes_of_administration = [[Oral administration|By mouth]]
| class = [[Selective serotonin reuptake inhibitor]] (SSRI)
| ATC_prefix = N06
| ATC_suffix = AB08
| ATC_supplemental = <!-- Legal status -->
| legal_AU = S4
| legal_AU_comment = 
| legal_BR = C1
| legal_BR_comment = <ref name= "Anvisa-2023">{{cite web | vauthors = Anvisa | title = RDC Nº 784 - Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial | date = 31 March 2023 | trans-title = Collegiate Board Resolution No. 784 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control | url = https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-784-de-31-de-marco-de-2023-474904992 | url-status = live | archive-url = https://web.archive.org/web/20230803143925/https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-784-de-31-de-marco-de-2023-474904992 | archive-date = 3 August 2023 | access-date = 16 August 2023 | publisher = [[Diário Oficial da União]] | language = pt-BR | publication-date = 4 April 2023 }}</ref>
| legal_CA = Rx-only
| legal_CA_comment = 
| legal_DE = <!--Anlage I, II, III, or Unscheduled-->
| legal_DE_comment = 
| legal_NZ = <!--Class A, B, C-->
| legal_NZ_comment = 
| legal_UK = POM
| legal_UK_comment = 
| legal_US = Rx-only
| legal_US_comment = 
| legal_UN = <!--N I, II, III, IV / P I, II, III, IV-->
| legal_UN_comment = 
| legal_status = <!--For countries not listed above-->

<!-- Pharmacokinetic data -->| bioavailability = 53% (90% confidence interval: 44–62%)<ref name="LUVOX" />
| protein_bound = 77–80%<ref name= "LUVOX" /><ref name= "vanHarten1993">{{cite journal | vauthors = van Harten J | title = Clinical pharmacokinetics of selective serotonin reuptake inhibitors | journal = Clinical Pharmacokinetics | volume = 24 | issue = 3 | pages = 203–220 | date = March 1993 | pmid = 8384945 | doi = 10.2165/00003088-199324030-00003 | s2cid = 84636672 }}</ref>
| metabolism = [[Liver]] (primarily O-[[demethylation]])<ref name="AltamuraCaldiroliBuoli2015" /><br />Major: [[CYP2D6]] or [[CYP1A2]]<ref name="AltamuraCaldiroliBuoli2015" /><ref name="Wyska2019" /><ref name="LUVOX" /><br />Minor: [[CYP3A4]], [[CYP2C19]], and/or [[CYP1A2]]<ref name="Wyska2019" /><ref name="LUVOX" />
| metabolites = 
| onset = 
| elimination_half-life = 12–13 hours (single dose), 22 hours (repeated dosing)<ref name="LUVOX" />
| duration_of_action = 
| excretion = [[Kidney]] (98%; 94% as metabolites, 4% as unchanged drug)<ref name="LUVOX" />

<!-- Identifiers -->| CAS_number_Ref = {{cascite|correct|??}}
| CAS_number = 54739-18-3
| CAS_supplemental = 
| PubChem = 5324346
| IUPHAR_ligand = 7189
| DrugBank_Ref = {{drugbankcite|changed|drugbank}}
| DrugBank = DB00176
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = 4481878
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = O4L1XPO44W
| KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG = D07984
| ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEBI = 5138
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 814
| NIAID_ChemDB = 
| PDB_ligand = 
| synonyms = <!-- Chemical and physical data -->
| IUPAC_name = 2-<nowiki/>{[(''E'')-<nowiki/>{5-Methoxy-1-[4-(trifluoromethyl)phenyl] pentylidene}amino]oxy}ethanamine<ref name= "ChemSpider-2013">{{cite web | title = Luvox | work = ChemSpider | publisher = Royal Society of Chemistry | access-date = 21 October 2013 | url = http://www.chemspider.com/Chemical-Structure.4481878 | archive-url = https://web.archive.org/web/20131115055836/http://www.chemspider.com/Chemical-Structure.4481878 | archive-date = 15 November 2013 }}</ref>
| C = 15
| H = 21
| F = 3
| N = 2
| O = 2
| SMILES = FC(F)(F)c1ccc(\C(=N\OCCN)CCCCOC)cc1
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI = 1S/C15H21F3N2O2/c1-21-10-3-2-4-14(20-22-11-9-19)12-5-7-13(8-6-12)15(16,17)18/h5-8H,2-4,9-11,19H2,1H3/b20-14+
| StdInChI_comment = 
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey = CJOFXWAVKWHTFT-XSFVSMFZSA-N
| density = 
| density_notes = 
| melting_point = 
| melting_high = 
| melting_notes = 
| boiling_point = 
| boiling_notes = 
| solubility = 
| sol_units = 
| specific_rotation = 
}}

'''Fluvoxamine''', sold under the brand name '''Luvox''' among others, is an [[antidepressant]] of the [[selective serotonin reuptake inhibitor]] (SSRI) class.<ref name="U.S. Food and Drug Administration (FDA)-2015">{{cite web | title = Fluvoxamine Maleate Information | date = 15 July 2015 | website = FDA.gov| publisher= US [[Food and Drug Administration]] | url = https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fluvoxamine-maleate-information | archive-url = https://web.archive.org/web/20191129061058/https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fluvoxamine-maleate-information | archive-date = 29 November 2019 | access-date = 28 November 2019 }}</ref> It is primarily used to treat [[major depressive disorder]] and, perhaps more-especially, [[obsessive–compulsive disorder]] (OCD),<ref name= "pmid20140100">{{cite journal | vauthors = McCain JA | title = Antidepressants and suicide in adolescents and adults: a public health experiment with unintended consequences? | journal = P & T: A Peer-Reviewed Journal for Formulary Management | volume = 34 | issue = 7 | pages = 355–378 | date = July 2009 | pmid = 20140100 | pmc = 2799109 }}</ref> but is also used to treat [[anxiety disorder]]s<ref name= "pmid11323729">{{cite journal | vauthors = | title = Fluvoxamine for the treatment of anxiety disorders in children and adolescents. The Research Unit on Pediatric Psychopharmacology Anxiety Study Group | journal = The New England Journal of Medicine | volume = 344 | issue = 17 | pages = 1279–1285 | date = April 2001 | pmid = 11323729 | doi = 10.1056/NEJM200104263441703 | doi-access = free }}</ref> such as [[panic disorder]], [[social anxiety disorder]], and [[post-traumatic stress disorder]].<ref name= "pmid11085201">{{cite journal | vauthors = Figgitt DP, McClellan KJ | title = Fluvoxamine. An updated review of its use in the management of adults with anxiety disorders | journal = Drugs | volume = 60 | issue = 4 | pages = 925–954 | date = October 2000 | pmid = 11085201 | doi = 10.2165/00003495-200060040-00006 | s2cid = 265712201 }}</ref><ref name="pmid18568110"/><ref name= "pmid11472786">{{cite journal | vauthors = Asnis GM, Hameedi FA, Goddard AW, Potkin SG, Black D, Jameel M, Desagani K, Woods SW | title = Fluvoxamine in the treatment of panic disorder: a multi-center, double-blind, placebo-controlled study in outpatients | journal = Psychiatry Research | volume = 103 | issue = 1 | pages = 1–14 | date = August 2001 | pmid = 11472786 | doi = 10.1016/S0165-1781(01)00265-7 | s2cid = 40412606 }}</ref>

Fluvoxamine's side-effect profile is similar to that of other SSRIs. Common adverse effects include [[constipation]], [[gastrointestinal|gastrointestinal problems]], [[headache]], [[anxiety]], [[irritation]], [[Sexual dysfunction|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.<ref name= "Vezmar-2009">{{cite journal | vauthors = Vezmar S, Miljkovic B, Vucicevic K, Timotijevic I, Prostran M, Todorovic Z, Pokrajac M | title = Pharmacokinetics and efficacy of fluvoxamine and amitriptyline in depression | journal = [[Journal of Pharmacological Sciences]] | volume = 110 | issue = 1 | pages = 98–104 | date = May 2009 | pmid = 19444001 | doi = 10.1254/jphs.09013fp }}</ref>

Fluvoxamine appears to be more tolerable than other SSRIs, particularly with respect to cardiovascular complications.<ref name = "Westenberg_2006">{{cite journal | vauthors = Westenberg HG, Sandner C | title = Tolerability and safety of fluvoxamine and other antidepressants | journal = International Journal of Clinical Practice | volume = 60 | issue = 4 | pages = 482–491 | date = April 2006 | pmid = 16620364 | pmc = 1448696 | doi = 10.1111/j.1368-5031.2006.00865.x }}</ref> Compared to [[escitalopram]] and [[sertraline]], fluvoxamine's gastrointestinal profile may be less intense,<ref name="Oliva Lippi Paci Del Fabro 2021 p. 110266">{{cite journal | vauthors = Oliva V, Lippi M, Paci R, Del Fabro L, Delvecchio G, Brambilla P, De Ronchi D, Fanelli G, Serretti A | title = Gastrointestinal side effects associated with antidepressant treatments in patients with major depressive disorder: A systematic review and meta-analysis | journal = Progress in Neuro-psychopharmacology & Biological Psychiatry | volume = 109 | article-number = 110266 | date = July 2021 | pmid = 33549697 | doi = 10.1016/j.pnpbp.2021.110266 | publisher = Elsevier BV | s2cid = 231809760 }}</ref> often being limited to [[nausea]].<ref name="pmid18568110">{{cite journal | vauthors = Irons J | title = Fluvoxamine in the treatment of anxiety disorders | journal = Neuropsychiatric Disease and Treatment | volume = 1 | issue = 4 | pages = 289–299 | date = December 2005 | pmid = 18568110 | pmc = 2424117}}</ref> [[Mosapride]] has demonstrated efficacy in treating fluvoxamine-induced nausea.<ref name="Ueda Yoshimura Shinkai Terao 2001 pp. 259–264">{{cite journal | vauthors = Ueda N, Yoshimura R, Shinkai K, Terao T, Nakamura J | title = Characteristics of fluvoxamine-induced nausea | journal = Psychiatry Research | volume = 104 | issue = 3 | pages = 259–264 | date = November 2001 | pmid = 11728615 | doi = 10.1016/s0165-1781(01)00320-1 | publisher = Elsevier BV | s2cid = 38761139 }}</ref> 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&nbsp;mg at the beginning of the waking day and 200&nbsp;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 if necessary) may increase the likelihood of nausea.<ref name="Ware 1997 pp. 15–23">{{cite journal | vauthors = Ware MR | title = Fluvoxamine: A Review of the Controlled Trials in Depression | journal = The Journal of Clinical Psychiatry | volume = 58 | issue = suppl 5 | pages = 15–23 | date = 1 March 1997 | pmid = 9184623 | publisher = Physicians Postgraduate Press, Inc. | issn = 0160-6689 | url = https://www.psychiatrist.com/read-pdf/7342/ | access-date = 1 December 2023 | archive-date = 6 December 2022 | archive-url = https://web.archive.org/web/20221206050356/https://www.psychiatrist.com/read-pdf/7342/ | url-status = live }}</ref>

It is on the [[WHO Model List of Essential Medicines|World Health Organization's List of Essential Medicines]].<ref name="WHO23rd">{{cite book | title = The selection and use of essential medicines: web annex A: World Health Organization model list of essential medicines: 23rd list | year = 2023 | hdl = 10665/371090 | publisher = World Health Organization | location = Geneva | id = WHO/MHP/HPS/EML/2023.02 | hdl-access = free | vauthors = Organization WH }}</ref>

==Medical uses== 

In many countries (e.g., Australia,<ref name = AMH/><ref name="NPS-MedicineWise-2018">{{cite web | title = Luvox Tablets | url = https://www.nps.org.au/medical-info/medicine-finder/luvox-tablets | website = NPS MedicineWise | access-date = 22 October 2018 | archive-date = 22 October 2018 | archive-url = https://web.archive.org/web/20181022153450/https://www.nps.org.au/medical-info/medicine-finder/luvox-tablets | url-status = live }}</ref> the United Kingdom,<ref name = BNF/> and Russia<ref name="Drug Registry of Russia (RLS) Drug Compendium">{{cite web | title = Summary of Full Prescribing Information: Fluvoxamine | url = http://www.rlsnet.ru/mnn_index_id_307.htm | website = Drug Registry of Russia (RLS) Drug Compendium | access-date = 21 March 2015 | language = ru | archive-date = 2 April 2015 | archive-url = https://web.archive.org/web/20150402162017/http://www.rlsnet.ru/mnn_index_id_307.htm | url-status = live }}</ref>) it is commonly used for [[major depressive disorder]]. Fluvoxamine is also approved in the United States for [[obsessive–compulsive disorder]] (OCD),<ref name = DailyMed/><ref name="pmid20140100" /> and [[social anxiety disorder]].<ref name="Luvox CR approved for OCD and SAD">{{cite web | title = Luvox CR approved for OCD and SAD | date = 29 February 2008 | url = https://www.empr.com/home/news/luvox-cr-approved-for-ocd-and-sad/ | website = MPR | access-date = 2 March 2019 | archive-date = 28 August 2021 | archive-url = https://web.archive.org/web/20210828090440/https://www.empr.com/home/news/luvox-cr-approved-for-ocd-and-sad/ | url-status = live }}</ref> In Japan, it is also approved to treat [[Obsessive–compulsive disorder|OCD]], [[social anxiety disorder]], and major depressive disorder.<ref name="Astellas-Pharma-2018">{{cite web | title = 2005 News Releases | url = https://www.astellas.com/en/corporate/news/detail/luvox-receives-approval-for-so.html | website = Astellas Pharma | access-date = 16 September 2018 | archive-date = 16 September 2018 | archive-url = https://web.archive.org/web/20180916235231/https://www.astellas.com/en/corporate/news/detail/luvox-receives-approval-for-so.html }}</ref><ref name="www.medscape.com-2018">{{cite web | title = International Approvals: Ebixa, Depromel/Luvox, M-Vax | url = https://www.medscape.com/viewarticle/514804 | website = www.medscape.com | access-date = 16 September 2018 | archive-date = 29 October 2020 | archive-url = https://web.archive.org/web/20201029173810/https://www.medscape.com/viewarticle/514804 | url-status = live }}</ref> Fluvoxamine is indicated for children and adolescents with OCD.<ref name="Jazz Pharmaceuticals, Inc.-2005">{{cite web | title = Fluvoxamine Product Insert | date = March 2005 | url = https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/022235lbl.pdf | work = Jazz Pharmaceuticals, Inc. | publisher = U.S. Food and Drug Administration | access-date = 4 November 2022 | archive-date = 4 November 2022 | archive-url = https://web.archive.org/web/20221104055928/https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/022235lbl.pdf }}</ref> The  [[National Institute for Health and Care Excellence|NICE]] guidelines in the United Kingdom have, as of 2005, authorized its use for [[obsessive-compulsive disorder]] in adults and adolescents of any age and children over the age of 7.{{medical citation needed|date=April 2024}}

There is evidence that fluvoxamine is effective for [[Social anxiety disorder|generalised social anxiety]] in adults, although, as with other [[SSRI]]s, some of the results may be compromised by having been funded by pharmaceutical companies.<ref name="pmid29048739">{{cite journal | vauthors = Williams T, Hattingh CJ, Kariuki CM, Tromp SA, van Balkom AJ, Ipser JC, Stein DJ | title = Pharmacotherapy for social anxiety disorder (SAnD) | journal = The Cochrane Database of Systematic Reviews | volume = 10 | issue = 10 | article-number = CD001206 | date = October 2017 | pmid = 29048739 | pmc = 6360927 | doi = 10.1002/14651858.CD001206.pub3 }}</ref><ref name="pmid29995828">{{cite journal | vauthors = Liu X, Li X, Zhang C, Sun M, Sun Z, Xu Y, Tian X | title = Efficacy and tolerability of fluvoxamine in adults with social anxiety disorder: A meta-analysis | journal = Medicine | volume = 97 | issue = 28 | article-number = e11547 | date = July 2018 | pmid = 29995828 | pmc = 6076099 | doi = 10.1097/MD.0000000000011547}}</ref> Of the SSRIs, however, fluvoxamine, [[paroxetine]], and [[sertraline]] do appear consistent as viable treatments for generalised social anxiety.<ref name="Williams-2020">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 {{Webarchive|url=https://web.archive.org/web/20240907193632/https://www.cambridge.org/core/journals/acta-neuropsychiatrica/article/abs/pharmacological-treatments-for-social-anxiety-disorder-in-adults-a-systematic-review-and-network-metaanalysis/38FA011F8B7B205A8714F57528DF59A4 |date=7 September 2024 }}</ref><ref name="Davidson-2003">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 {{Webarchive|url=https://web.archive.org/web/20240907193630/https://onlinelibrary.wiley.com/doi/10.1034/j.1600-0447.108.s417.7.x |date=7 September 2024 }}</ref>

Fluvoxamine is also effective for treating a range of [[anxiety disorder]]s in children and adolescents, including [[generalized anxiety disorder]], social anxiety disorder, panic disorder, and [[separation anxiety disorder]].<ref name="NIHR-Evidence-2022">{{cite journal | title = Antidepressants for children and teenagers: what works for anxiety and depression? | journal = NIHR Evidence | date = 3 November 2022 | doi = 10.3310/nihrevidence_53342 | url = https://evidence.nihr.ac.uk/collection/antidepressants-for-children-and-teenagers-what-works-anxiety-depression/ | type = Plain English summary | publisher = National Institute for Health and Care Research | s2cid = 253347210 | url-access = subscription | access-date = 7 November 2022 | archive-date = 5 November 2022 | archive-url = https://web.archive.org/web/20221105153958/https://evidence.nihr.ac.uk/collection/antidepressants-for-children-and-teenagers-what-works-anxiety-depression/ | url-status = live }}</ref><ref name="pmid32982805">{{cite journal | vauthors = Boaden K, Tomlinson A, Cortese S, Cipriani A | title = Antidepressants in Children and Adolescents: Meta-Review of Efficacy, Tolerability and Suicidality in Acute Treatment | journal = Frontiers in Psychiatry | volume = 11 | article-number = 717 | date = 2 September 2020 | pmid = 32982805 | pmc = 7493620 | doi = 10.3389/fpsyt.2020.00717 | doi-access = free }}</ref><ref name="pmid34002501">{{cite journal | vauthors = Correll CU, Cortese S, Croatto G, Monaco F, Krinitski D, Arrondo G, Ostinelli EG, Zangani C, Fornaro M, Estradé A, Fusar-Poli P, Carvalho AF, Solmi M | title = Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review | journal = World Psychiatry | volume = 20 | issue = 2 | pages = 244–275 | date = June 2021 | pmid = 34002501 | pmc = 8129843 | doi = 10.1002/wps.20881 }}</ref>

The drug works long-term, and retains its therapeutic efficacy for at least one year.<ref name="pmid7507038">{{cite journal | vauthors = Wilde MI, Plosker GL, Benfield P | title = Fluvoxamine. An updated review of its pharmacology, and therapeutic use in depressive illness | journal = Drugs | volume = 46 | issue = 5 | pages = 895–924 | date = November 1993 | pmid = 7507038 | doi = 10.2165/00003495-199346050-00008 | s2cid = 195691900 }}</ref>

The average therapeutic dose for fluvoxamine is 100 to 300&nbsp;mg/day, with 300&nbsp;mg being the upper daily limit normally recommended. [[Obsessive-compulsive disorder]], however, often requires higher doses; doses of up to 450&nbsp;mg/day may be prescribed in this case.<ref name="Seibell-2015">Seibell PJ, Hamblin RJ, Hollander E.

Obsessive-compulsive disorder: Overview and standard treatment strategies. Psychiatric Annals. 2015 Jun 1;45(6):297-302.</ref><ref name="Rivas-1997">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.</ref><ref name="Middleton-2019">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.</ref> The (off-label) upper daily limits for other serotonin-reuptake inhibitors used in the treatment of [[obsessive-compulsive disorder]], by analogy, are 400&nbsp;mg for [[sertraline]],<ref name="pmid16426083">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.</ref> 100&nbsp;mg for [[paroxetine]], 120&nbsp;mg for both [[fluoxetine]] and [[citalopram]], 60&nbsp;mg for [[escitalopram]] and 300&nbsp;mg for [[clomipramine]].<ref>{{Cite web | title = Psychopharmacology Institute | url = https://psychopharmacologyinstitute.com/section/adequate-treatment-trials-in-ocd-fda-approvals-and-maximal-dosing-2523-4887 | website = psychopharmacologyinstitute.com }}</ref><ref name="pmid17849776">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.</ref>

In any case with fluvoxamine, treatment is generally begun at 50&nbsp;mg and increased in 50&nbsp;mg increments every 4 to 7 days until a therapeutic optimum is reached.<ref name="Figgitt-2000">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.</ref>

==Adverse effects== 

Fluvoxamine's side-effect profile is very similar to other SSRIs. [[Gastrointestinal]] side effects are characteristic of those receiving treatment with fluvoxamine.<ref name=LUVOX>{{cite web | title = Product Information Luvox | date = 15 January 2013 | work = TGA eBusiness Services | publisher = Abbott Australasia Pty Ltd | access-date = 21 October 2013 | url = https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-07140-3 | archive-date = 9 October 2017 | archive-url = https://web.archive.org/web/20171009014348/https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-07140-3 | url-status = live }}</ref><ref name=DailyMed>{{cite web | title = Fluvoxamine Maleate tablet, coated prescribing information | date = 14 December 2018 | work = [[DailyMed]] | publisher = U.S. National Library of Medicine | url = https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7ecd83ec-88f5-4f85-9cc2-9068375d8820 | access-date = 28 November 2019 | archive-date = 19 October 2020 | archive-url = https://web.archive.org/web/20201019235438/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7ecd83ec-88f5-4f85-9cc2-9068375d8820 | url-status = live }}</ref><ref name="AMH">{{cite book | veditors = Rossi S | title = Australian Medicines Handbook | year = 2013 | isbn = 978-0-9805790-9-3 | place = Adelaide | publisher = The Australian Medicines Handbook Unit Trust | edition = 2013 }}</ref><ref name="BNF">{{cite book | vauthors = ((Joint Formulary Committee)) | title = British National Formulary (BNF) | year = 2013 | isbn = 978-0-85711-084-8 | publisher = Pharmaceutical Press | location = London, UK | edition = 65th | url-access = registration | url = https://archive.org/details/bnf65britishnati0000unse }}</ref><ref name="Maudsley">{{cite book | vauthors = Taylor D, Paton C, Shitij K | title = The Maudsley prescribing guidelines in psychiatry | year = 2012 | isbn = 978-0-470-97948-8 | publisher = Wiley-Blackwell | location = West Sussex }}</ref><ref name="electronic Medicines Compendium-2013">{{cite web | title = Faverin 100 mg film-coated tablets – Summary of Product Characteristics (SPC) | date = 14 May 2013 | work = electronic Medicines Compendium | publisher = Abbott Healthcare Products Limited | access-date = 21 October 2013 | url-status = live | url = http://www.medicines.org.uk/emc/medicine/22124/SPC/Faverin+100+mg+film-coated+tablets/ | archive-date = 21 October 2013 | archive-url = https://web.archive.org/web/20131021042737/http://www.medicines.org.uk/emc/medicine/22124/SPC/Faverin+100+mg+film-coated+tablets/ }}</ref>

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<ref>{{Cite journal | vauthors = Hosenbocus S, Chahal R | title = SSRIs and SNRIs: A review of the Discontinuation Syndrome in Children and Adolescents | journal = Journal of the Canadian Academy of Child and Adolescent Psychiatry | volume = 20 | issue = 1 | pages = 60–67 | date = February 2011 | pmid = 21286371 | pmc = 3024727 | issn = 2293-6122 }}</ref>

===Common=== 

Common side effects occurring with 1–10% incidence:

{{div col |colwidth=20em}}
* 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

{{div col end}}

===Uncommon=== 

Uncommon side effects occurring with 0.1–1% incidence:

{{div col |colwidth=30em}}
* [[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]]
{{div col end}}

===Rare=== 

Rare side effects occurring with 0.01–0.1% incidence:

{{div col |colwidth=32em}}
* Abnormal hepatic (liver) function
* Galactorrhoea (expulsion of breast milk unrelated to pregnancy or breastfeeding)
* [[Mania]]
* Photosensitivity (being abnormally sensitive to light)
* Seizures

{{div col end}}

===Unknown frequency=== 
{{div col |colwidth=30em}}
* [[Akathisia]]{{snd}} a sense of inner restlessness that presents itself with the inability to stay still
* Bed-wetting
* [[Bone fracture]]s
* [[Dysgeusia]]
* [[Ecchymosis|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.
* Suicidal ideation and behaviour
* [[Syndrome of inappropriate antidiuretic hormone secretion]]
* Urinary incontinence
* Urinary retention
* Violence toward others<ref name = LUVOXTIME>{{cite magazine | vauthors = Szalavitz M | title = Top Ten Legal Drugs Linked to Violence | date = 7 January 2011 | magazine = Time | access-date = 10 September 2014 | url = https://healthland.time.com/2011/01/07/top-ten-legal-drugs-linked-to-violence/ | archive-date = 21 September 2014 | archive-url = https://web.archive.org/web/20140921052039/http://healthland.time.com/2011/01/07/top-ten-legal-drugs-linked-to-violence/ | url-status = live }}</ref>
* Weight changes
* Withdrawal symptoms

{{div col end}}

== Interactions == 
[[File:Luvox.jpg|thumb|Luvox (fluvoxamine) 100&nbsp;mg film-coated scored tablets]]

Fluvoxamine inhibits the following [[cytochrome P450]] enzymes:<ref name=Pharm>{{cite book | vauthors = Ciraulo DA, Shader RI | veditors = Ciraulo DA, Shader RI | title = Pharmacotherapy of Depression | year = 2011 | doi = 10.1007/978-1-60327-435-7 | publisher = Springer | isbn = 978-1-60327-435-7 | page = 49 | edition = 2nd }}</ref><ref name="GG">{{cite book | vauthors = Brunton L, Chabner B, Knollman B | title = Goodman and Gilman's The Pharmacological Basis of Therapeutics | year = 2010 | isbn = 978-0-07-162442-8 | edition = 12th | publisher = McGraw-Hill Professional | location = New York | title-link = Goodman and Gilman's The Pharmacological Basis of Therapeutics }}</ref><ref name="pmid8968657">{{cite journal | vauthors = Baumann P | title = Pharmacokinetic-pharmacodynamic relationship of the selective serotonin reuptake inhibitors | journal = Clinical Pharmacokinetics | volume = 31 | issue = 6 | pages = 444–469 | date = December 1996 | pmid = 8968657 | doi = 10.2165/00003088-199631060-00004 | s2cid = 31923953 }}</ref><ref name="pmid9184622">{{cite journal | vauthors = DeVane CL, Gill HS | title = Clinical pharmacokinetics of fluvoxamine: applications to dosage regimen design | journal = The Journal of Clinical Psychiatry | volume = 58 | issue = Suppl 5 | pages = 7–14 | year = 1997 | pmid = 9184622 }}</ref><ref name="pmid9809216">{{cite journal | vauthors = DeVane CL | title = Translational pharmacokinetics: current issues with newer antidepressants | journal = Depression and Anxiety | volume = 8 | issue = Suppl 1 | pages = 64–70 | year = 1998 | pmid = 9809216 | doi = 10.1002/(SICI)1520-6394(1998)8:1+<64::AID-DA10>3.0.CO;2-S | s2cid = 22297498 | doi-access = free }}</ref><ref name="pmid17278909">{{cite journal | vauthors = Bondy B, Spellmann I | title = Pharmacogenetics of antipsychotics: useful for the clinician? | journal = Current Opinion in Psychiatry | volume = 20 | issue = 2 | pages = 126–130 | date = March 2007 | pmid = 17278909 | doi = 10.1097/YCO.0b013e328017f69f | s2cid = 23859992 }}</ref><ref name="pmid17823102">{{cite journal | vauthors = Kroon LA | title = Drug interactions with smoking | journal = American Journal of Health-System Pharmacy  | volume = 64 | issue = 18 | pages = 1917–1921 | date = September 2007 | pmid = 17823102 | doi = 10.2146/ajhp060414 }}</ref><ref name="Waknine-2007">{{cite web | vauthors = Waknine Y | title = Prescribers Warned of Tizanidine Drug Interactions | date = 13 April 2007 | work = Medscape News | publisher = Medscape | url = http://www.medscape.com/viewarticle/555194_print | access-date = 1 February 2008 | archive-date = 21 February 2013 | archive-url = https://web.archive.org/web/20130221020721/http://www.medscape.com/viewarticle/555194_print | url-status = live }}</ref><ref name="Mayo-Clinic-2018">{{cite web | title = Fluvoxamine (Oral Route) Precautions | url = https://www.mayoclinic.org/drugs-supplements/fluvoxamine-oral-route/precautions/drg-20066874?p=1 | website = Mayo Clinic | access-date = 2 November 2018 | archive-date = 6 March 2019 | archive-url = https://web.archive.org/web/20190306043631/https://www.mayoclinic.org/drugs-supplements/fluvoxamine-oral-route/precautions/drg-20066874?p=1 | url-status = live }}</ref>{{Excessive citations inline|date=April 2024}}<!--there should be citations near the relevant enzymes/substances rather than the whole list of citations with unknown relevance-->
* [[CYP1A2]] (strongly) which metabolizes [[agomelatine]], [[amitriptyline]], [[caffeine]], [[clomipramine]], [[clozapine]], [[duloxetine]], [[haloperidol]], [[imipramine]], [[phenacetin]], [[tacrine]], [[tamoxifen]], [[theophylline]], [[olanzapine]], etc.
* [[CYP3A4]] (moderately) which metabolizes [[alprazolam]], [[aripiprazole]], [[clozapine]], [[haloperidol]], [[quetiapine]], [[pimozide]], [[ziprasidone]], etc.<ref name="pmid11876575">{{cite journal | vauthors = Hemeryck A, Belpaire FM | title = Selective serotonin reuptake inhibitors and cytochrome P-450 mediated drug-drug interactions: an update | journal = Current Drug Metabolism | volume = 3 | issue = 1 | pages = 13–37 | date = February 2002 | pmid = 11876575 | doi = 10.2174/1389200023338017 }}</ref>
* [[CYP2D6]] (weakly) which metabolizes [[aripiprazole]], [[chlorpromazine]], [[clozapine]], [[codeine]], [[fluoxetine]], [[haloperidol]], [[olanzapine]], [[oxycodone]], [[paroxetine]], [[perphenazine]], [[pethidine]], [[risperidone]], [[sertraline]], [[thioridazine]], [[zuclopenthixol]], etc.<ref name="FDA_drug_development">{{cite journal | title = Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers | journal = FDA | date = 26 May 2021 | url = https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and-drug-interactions-table-substrates-inhibitors-and-inducers | access-date = 25 December 2020 | archive-date = 4 November 2020 | archive-url = https://web.archive.org/web/20201104173036/https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and-drug-interactions-table-substrates-inhibitors-and-inducers }}</ref>
* [[CYP2C9]] (moderately) which metabolizes [[nonsteroidal anti-inflammatory drugs]], [[phenytoin]], [[sulfonylureas]], etc.
* [[CYP2C19]] (strongly) which metabolizes [[clonazepam]], [[diazepam]], [[phenytoin]], etc.
* [[CYP2B6]] (weakly) which metabolizes [[bupropion]], [[cyclophosphamide]], [[sertraline]], [[tamoxifen]], [[valproate]], etc.

By so doing, fluvoxamine can increase serum concentration of the substrates of these enzymes.<ref name = Pharm/>

Fluvoxamine may also elevate plasma levels of olanzapine by approximately two times.<ref name="pmid17214606">{{cite journal | vauthors = Spina E, de Leon J | title = Metabolic drug interactions with newer antipsychotics: a comparative review | journal = Basic & Clinical Pharmacology & Toxicology | volume = 100 | issue = 1 | pages = 4–22 | date = January 2007 | pmid = 17214606 | doi = 10.1111/j.1742-7843.2007.00017.x | doi-access = free }}</ref> Combined olanzapine and fluvoxamine, which may cause increased sedation,<ref name="pmid11063782">{{cite journal | vauthors = Bogetto F, Bellino S, Vaschetto P, Ziero S | title = Olanzapine augmentation of fluvoxamine-refractory obsessive-compulsive disorder (OCD): a 12-week open trial | journal = Psychiatry Research | volume = 96 | issue = 2 | pages = 91–98 | date = October 2000 | pmid = 11063782 | doi = 10.1016/s0165-1781(00)00203-1 | s2cid = 43395897 }}</ref> should be used cautiously and controlled clinically and by therapeutic drug monitoring to avoid olanzapine induced adverse effects and/or intoxication.<ref name="pmid12352274">{{cite journal | vauthors = Hiemke C, Peled A, Jabarin M, Hadjez J, Weigmann H, Härtter S, Modai I, Ritsner M, Silver H | title = Fluvoxamine augmentation of olanzapine in chronic schizophrenia: pharmacokinetic interactions and clinical effects | journal = Journal of Clinical Psychopharmacology | volume = 22 | issue = 5 | pages = 502–506 | date = October 2002 | pmid = 12352274 | doi = 10.1097/00004714-200210000-00010 | s2cid = 38073367 }}</ref><ref name="NPS MedicineWise-2020">{{cite web | title = Movox | date = 23 November 2020 | url = https://www.nps.org.au/medicine-finder/movox-tablets | access-date = 4 November 2022 | website = NPS MedicineWise | archive-date = 4 November 2022 | archive-url = https://web.archive.org/web/20221104034758/https://www.nps.org.au/medicine-finder/movox-tablets | url-status = live }}</ref>

The plasma levels of oxidatively metabolized [[benzodiazepine]]s (e.g., [[triazolam]], [[midazolam]], [[alprazolam]], and [[diazepam]]) are likely to be increased when co-administered with fluvoxamine. However, the clearance of [[benzodiazepine]]s metabolized by [[glucuronidation]] (e.g., [[lorazepam]]; [[oxazepam]], which is coincidentally a metabolite of diazepam;<ref name="pmid28903606">{{cite journal | vauthors = Dinis-Oliveira RJ | title = Metabolic profile of oxazepam and related benzodiazepines: clinical and forensic aspects | journal = Drug Metabolism Reviews | volume = 49 | issue = 4 | pages = 451–463 | date = November 2017 | pmid = 28903606 | doi = 10.1080/03602532.2017.1377223 | s2cid = 4528255 }}</ref> [[temazepam]])<ref name="Raouf-2016">{{cite web | vauthors = Raouf M | veditors = Fudin J | title = Benzodiazepine Metabolism and Pharmacokinetics | date = 2016 | url = http://paindr.com/wp-content/uploads/2015/10/Revised-BZD_-9-30.pdf | access-date = 16 September 2018 | archive-date = 12 July 2018 | archive-url = https://web.archive.org/web/20180712232038/http://paindr.com/wp-content/uploads/2015/10/Revised-BZD_-9-30.pdf | url-status = live }}</ref><ref name="pmid8700792">{{cite journal | vauthors = Peppers MP | title = Benzodiazepines for alcohol withdrawal in the elderly and in patients with liver disease | journal = Pharmacotherapy | volume = 16 | issue = 1 | pages = 49–57 | date = 1996 | pmid = 8700792 | doi = 10.1002/j.1875-9114.1996.tb02915.x | s2cid = 1389910 }}</ref> are not affected by fluvoxamine and may be safely taken alongside fluvoxamine should concurrent treatment with a benzodiazepine be necessary.<ref name="fluvoxamine maleate-2016">{{cite web | title = fluvoxamine maleate: PRODUCT MONOGRAPH | date = 2016 | url = http://www.mylan.ca/-/media/mylanca/documents/english/product%20pdf/pdfs%20dec%202015/luvox-pm-2016.01.08.pdf | access-date = 16 September 2018 | archive-date = 16 September 2018 | archive-url = https://web.archive.org/web/20180916130322/http://www.mylan.ca/-/media/mylanca/documents/english/product%20pdf/pdfs%20dec%202015/luvox-pm-2016.01.08.pdf | url-status = live }}</ref> 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.<ref name="Medsafe, New Zealand-2017">{{cite web | title = Luvox Data Sheet | date = 2017 | url = http://www.medsafe.govt.nz/profs/datasheet/l/luvoxtab.pdf | publisher = Medsafe, New Zealand | access-date = 16 September 2018 | archive-date = 29 March 2018 | archive-url = https://web.archive.org/web/20180329045516/http://www.medsafe.govt.nz/profs/datasheet/l/luvoxtab.pdf }}</ref><ref name="NPS MedicineWise-2022">{{cite web | title = Faverin Tablets | date = July 2022 | url = https://www.nps.org.au/medicine-finder/faverin-tablets | access-date = 4 November 2022 | website = NPS MedicineWise | archive-date = 4 November 2022 | archive-url = https://web.archive.org/web/20221104201934/https://www.nps.org.au/medicine-finder/faverin-tablets | url-status = live }}</ref>

Using fluvoxamine and [[alprazolam]] together can increase [[alprazolam]] plasma concentrations.<ref name="pmid12698310">{{cite journal | vauthors = Suzuki Y, Shioiri T, Muratake T, Kawashima Y, Sato S, Hagiwara M, Inoue Y, Shimoda K, Someya T | title = Effects of concomitant fluvoxamine on the metabolism of alprazolam in Japanese psychiatric patients: interaction with CYP2C19 mutated alleles | journal = European Journal of Clinical Pharmacology | volume = 58 | issue = 12 | pages = 829–833 | date = April 2003 | pmid = 12698310 | doi = 10.1007/s00228-003-0563-9 | s2cid = 32559753 }}</ref> If [[alprazolam]] is coadministered with fluvoxamine, the initial [[alprazolam]] dose should be reduced to the lowest effective dose.<ref name="Gerlach-2014">{{cite book | vauthors = Gerlach M, Warnke A, Greenhill L | title = Psychiatric Drugs in Children and Adolescents: Basic Pharmacology and Practical Applications | page = 131 | year = 2014 | url = https://books.google.com/books?id=AmQlBAAAQBAJ&pg=PA131 | publisher = Springer-Verlag Wien | isbn = 978-3-7091-1500-8 | access-date = 21 May 2020 | archive-date = 10 January 2023 | archive-url = https://web.archive.org/web/20230110041817/https://books.google.com/books?id=AmQlBAAAQBAJ&pg=PA131 | url-status = live }}</ref><ref name="pmid8005185">{{cite journal | vauthors = Fleishaker JC, Hulst LK | title = A pharmacokinetic and pharmacodynamic evaluation of the combined administration of alprazolam and fluvoxamine | journal = European Journal of Clinical Pharmacology | volume = 46 | issue = 1 | pages = 35–39 | date = 1994 | pmid = 8005185 | doi = 10.1007/bf00195913 | s2cid = 2161450 }}</ref>

As with all [[Selective serotonin reuptake inhibitor|SSRI]] medications, using fluvoxamine with [[Nonsteroidal anti-inflammatory drug|NSAIDs]] like ibuprofen may increase the risk of bleeding, particularly in the GI tract.<ref>{{cite journal | vauthors = Alam SM, Qasswal M, Ahsan MJ, Walters RW, Chandra S | title = Selective serotonin reuptake inhibitors increase risk of upper gastrointestinal bleeding when used with NSAIDs: a systemic review and meta-analysis | journal = Scientific Reports | volume = 12 | issue = 1 | article-number = 14452 | date = August 2022 | pmid = 36002638 | doi = 10.1038/s41598-022-18654-2 | pmc = 9402708 | bibcode = 2022NatSR..1214452A }}</ref>

Fluvoxamine is contraindicated with other medications that increase serotonin ([[Dextromethorphan]],  [[ondansetron]], [[Adderall|ampetamine]], [[sumatriptan]], [[Tramadol]], [[Hypericum perforatum]], etc.).<ref>{{cite journal | vauthors = Scotton WJ, Hill LJ, Williams AC, Barnes NM | title = Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions | journal = International Journal of Tryptophan Research | volume = 12 | article-number = 1178646919873925 | date = 2019 | pmid = 31523132 | pmc = 6734608 | doi = 10.1177/1178646919873925 }}</ref> Combining these medications may rarely lead to a life-threatening complication known as [[Serotonin syndrome]].

Fluvoxamine and [[ramelteon]] coadministration is not indicated.<ref name="pmid20478852">{{cite journal | vauthors = Obach RS, Ryder TF | title = Metabolism of ramelteon in human liver microsomes and correlation with the effect of fluvoxamine on ramelteon pharmacokinetics | journal = Drug Metabolism and Disposition: The Biological Fate of Chemicals | volume = 38 | issue = 8 | pages = 1381–1391 | date = August 2010 | pmid = 20478852 | doi = 10.1124/dmd.110.034009 | s2cid = 8421997 }}</ref><ref name="pmid23861638">{{cite journal | vauthors = Pandi-Perumal SR, Spence DW, Verster JC, Srinivasan V, Brown GM, Cardinali DP, Hardeland R | title = Pharmacotherapy of insomnia with ramelteon: safety, efficacy and clinical applications | journal = Journal of Central Nervous System Disease | volume = 3 | pages = 51–65 | date = 12 April 2011 | pmid = 23861638 | pmc = 3663615 | doi = 10.4137/JCNSD.S1611 }}</ref>

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.<ref name="AnttilaRasanen2001">{{cite journal | vauthors = Anttila AK, Rasanen L, Leinonen EV | title = Fluvoxamine augmentation increases serum mirtazapine concentrations three- to fourfold | journal = The Annals of Pharmacotherapy | volume = 35 | issue = 10 | pages = 1221–1223 | date = October 2001 | pmid = 11675851 | doi = 10.1345/aph.1A014 | s2cid = 44807359 }}</ref> Caution and adjustment of dosage as necessary are warranted when combining fluvoxamine and [[mirtazapine]].<ref name="AnttilaRasanen2001" />

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.<ref name="pmid15060511">{{cite journal | vauthors = Granfors MT, Backman JT, Neuvonen M, Ahonen J, Neuvonen PJ | title = Fluvoxamine drastically increases concentrations and effects of tizanidine: a potentially hazardous interaction | journal = Clinical Pharmacology and Therapeutics | volume = 75 | issue = 4 | pages = 331–341 | date = April 2004 | pmid = 15060511 | doi = 10.1016/j.clpt.2003.12.005 | s2cid = 25781307 }}</ref>

When a beta-blocker is required, [[atenolol]],<ref name="pmid7988100">{{cite journal | vauthors = Perucca E, Gatti G, Spina E | title = Clinical pharmacokinetics of fluvoxamine | journal = Clinical Pharmacokinetics | volume = 27 | issue = 3 | pages = 175–190 | date = September 1994 | pmid = 7988100 | doi = 10.2165/00003088-199427030-00002 | s2cid = 22472247 }}</ref> [[pindolol]]<ref name="pmid11543734">{{cite journal | vauthors = Zanardi R, Serretti A, Rossini D, Franchini L, Cusin C, Lattuada E, Dotoli D, Smeraldi E | title = Factors affecting fluvoxamine antidepressant activity: influence of pindolol and 5-HTTLPR in delusional and nondelusional depression | journal = Biological Psychiatry | volume = 50 | issue = 5 | pages = 323–330 | date = September 2001 | pmid = 11543734 | doi = 10.1016/s0006-3223(01)01118-0 | s2cid = 22692759 }}</ref><ref name="Sluzewska-1996">{{cite journal | vauthors = Sluzewska A, Szczawinska K | title = The effects of pindolol addition to fluvoxamine and buspirone in chronic mild stress model of depression. | journal = Behavioural Pharmacology | volume = 7 | page = 105 | date = May 1996 }}</ref><ref name="pmid9817627">{{cite journal | vauthors = Mundo E, Guglielmo E, Bellodi L | title = Effect of adjuvant pindolol on the antiobsessional response to fluvoxamine: a double-blind, placebo-controlled study | journal = International Clinical Psychopharmacology | volume = 13 | issue = 5 | pages = 219–224 | date = September 1998 | pmid = 9817627 | doi = 10.1097/00004850-199809000-00005 | s2cid = 23946424 }}</ref> and, possibly, [[metoprolol]]<ref name="pmid9681670">{{cite journal | vauthors = Belpaire FM, Wijnant P, Temmerman A, Rasmussen BB, Brøsen K | title = The oxidative metabolism of metoprolol in human liver microsomes: inhibition by the selective serotonin reuptake inhibitors | journal = European Journal of Clinical Pharmacology | volume = 54 | issue = 3 | pages = 261–264 | date = May 1998 | pmid = 9681670 | doi = 10.1007/s002280050456 | s2cid = 28105445 }}</ref><ref name="pmid8904628">{{cite journal | vauthors = Xu ZH, Xie HG, Zhou HH | title = In vivo inhibition of CYP2C19 but not CYP2D6 by fluvoxamine | journal = British Journal of Clinical Pharmacology | volume = 42 | issue = 4 | pages = 518–521 | date = October 1996 | pmid = 8904628 | pmc = 2042705 | doi = 10.1046/j.1365-2125.1996.45319.x | doi-broken-date = 17 July 2025 }}</ref><ref name="pmid11876575"/><ref name="Belpaire-1997">{{cite journal | vauthors = Belpaire FM, Wijnant P, Tammerman A, Bogaert M, Rasmussen B, Brosen K | title = Inhibition of the oxidative metabolism of metoprolol by selective serotonin reuptake inhibitors in human liver microsomes. | journal = Fundamental and Clinical Pharmacology | volume = 2 | issue = 11 | page = 147 | date = 1997 }}</ref> may be safer choices than [[propranolol]], as the latter's metabolism is seriously, potentially dangerously, inhibited by fluvoxamine.<ref name="pmid8846617">{{cite journal | vauthors = van Harten J | title = Overview of the pharmacokinetics of fluvoxamine | journal = Clinical Pharmacokinetics | volume = 29 | issue = Suppl 1 | pages = 1–9 | date = 1995 | pmid = 8846617 | doi = 10.2165/00003088-199500291-00003 | s2cid = 71812133 }}</ref> Indeed, fluvoxamine may increase propranolol blood-levels by five-fold.<ref name="pmid22311403">{{cite journal | vauthors = Muscatello MR, Spina E, Bandelow B, Baldwin DS | title = Clinically relevant drug interactions in anxiety disorders | journal = Human Psychopharmacology | volume = 27 | issue = 3 | pages = 239–253 | date = May 2012 | pmid = 22311403 | doi = 10.1002/hup.2217 | s2cid = 11592004 }}</ref>

[[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]].<ref name="pmid8666564">{{cite journal | vauthors = Szegedi A, Wetzel H, Leal M, Härtter S, Hiemke C | title = Combination treatment with clomipramine and fluvoxamine: drug monitoring, safety, and tolerability data | journal = The Journal of Clinical Psychiatry | volume = 57 | issue = 6 | pages = 257–264 | date = June 1996 | pmid = 8666564}}</ref><ref name="pmid34777510">{{cite journal | vauthors = Hardy NE, Walkup JT | title = Clomipramine in Combination with Fluvoxamine: A Potent Medication Combination for Severe or Refractory Pediatric OCD | journal = Journal of the Canadian Academy of Child and Adolescent Psychiatry | volume = 30 | issue = 4 | pages = 273–277 | date = November 2021 | pmid = 34777510 | pmc = 8561855}}</ref>

==Pharmacology== 

===Pharmacodynamics=== 

{| class="wikitable sortable floatright"

|+Receptor affinity profile<ref name="pmid17662961">{{cite journal | vauthors = Ishikawa M, Ishiwata K, Ishii K, Kimura Y, Sakata M, Naganawa M, Oda K, Miyatake R, Fujisaki M, Shimizu E, Shirayama Y, Iyo M, Hashimoto K | title = High occupancy of sigma-1 receptors in the human brain after single oral administration of fluvoxamine: a positron emission tomography study using [11C]SA4503 | journal = Biological Psychiatry | volume = 62 | issue = 8 | pages = 878–883 | date = October 2007 | pmid = 17662961 | doi = 10.1016/j.biopsych.2007.04.001 | s2cid = 728565 }}</ref><ref name="Schatzberg-2009">{{cite book | vauthors = Schatzberg AF, Nemeroff CB | title = The American Psychiatric Publishing textbook of psychopharmacology | page = 354 | year = 2009 | publisher = American Psychiatric Pub. | isbn = 978-1-58562-386-0 | edition = 4th | location = Arlington, VA | oclc = 320111564 }}</ref><ref name="pmid28501470">{{cite journal | vauthors = Yahata M, Chiba K, Watanabe T, Sugiyama Y | title = 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 = Journal of Pharmaceutical Sciences | volume = 106 | issue = 9 | pages = 2345–2356 | date = September 2017 | pmid = 28501470 | doi = 10.1016/j.xphs.2017.05.007 | bibcode = 2017JPhmS.106.2345Y | doi-access = free }}</ref>
|-

! Site !! K<sub>i</sub> (nM)

|-
| {{abbrlink|SERT|Serotonin transporter}} || 2.5
|-
| {{abbrlink|NET|Norepinephrine transporter}} || 1427
|-
| [[5-HT2C receptor|5-HT<sub>2C</sub>]] || 5786
|-
| [[Alpha-1 adrenergic receptor|α<sub>1</sub>-adrenergic]] || 1288
|-
| [[Sigma-1 receptor|σ<sub>1</sub>]] || 36
|}

Fluvoxamine is a potent [[selective serotonin reuptake inhibitor]] with around 100-fold affinity for the [[serotonin transporter]] over the [[norepinephrine transporter]].<ref name = GG/> It has negligible affinity for the [[dopamine transporter]] or any other site, with the sole exception of the [[sigma-1 receptor|σ<sub>1</sub> receptor]].<ref name = sig>{{cite journal | vauthors = Hashimoto K | title = Sigma-1 receptors and selective serotonin reuptake inhibitors: clinical implications of their relationship | journal = Central Nervous System Agents in Medicinal Chemistry | volume = 9 | issue = 3 | pages = 197–204 | date = September 2009 | pmid = 20021354 | doi = 10.2174/1871524910909030197 }}</ref><ref name = "Westenberg_2006" /> It behaves as a potent [[agonist]] at this receptor and has the highest affinity (36&nbsp;nM) of any SSRI for doing so.<ref name = sig/> This may contribute to its antidepressant and [[anxiolytic]] effects and may also afford it some efficacy in treating the cognitive symptoms of depression.<ref name = cog>{{cite journal | vauthors = Hindmarch I, Hashimoto K | title = Cognition and depression: the effects of fluvoxamine, a sigma-1 receptor agonist, reconsidered | journal = Human Psychopharmacology | volume = 25 | issue = 3 | pages = 193–200 | date = April 2010 | pmid = 20373470 | doi = 10.1002/hup.1106 | s2cid = 26491662 }}</ref> It increases concentrations of the [[neurosteroid]] [[allopregnanolone]], which may also contribute to its anxiolytic effects.<ref name="pmid9501247">{{cite journal | vauthors = Uzunova V, Sheline Y, Davis JM, Rasmusson A, Uzunov DP, Costa E, Guidotti A | title = Increase in the cerebrospinal fluid content of neurosteroids in patients with unipolar major depression who are receiving fluoxetine or fluvoxamine | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 95 | issue = 6 | pages = 3239–3244 | date = March 1998 | pmid = 9501247 | pmc = 19726 | doi = 10.1073/pnas.95.6.3239 | doi-access = free | bibcode = 1998PNAS...95.3239U }}</ref> Unlike some other SSRIs, fluvoxamine's metabolites are pharmacologically neutral.<ref name="pmid1931931">{{cite journal | vauthors = Hrdina PD | title = Pharmacology of serotonin uptake inhibitors: focus on fluvoxamine | journal = Journal of Psychiatry & Neuroscience | volume = 16 | issue = 2 Suppl 1 | pages = 10–18 | date = July 1991 | pmid = 1931931 | pmc = 1188307 }}</ref>

===Pharmacokinetics=== 
[[Literature review]]s have stated that fluvoxamine is [[drug metabolism|metabolized]] primarily by [[CYP2D6]] and to a minor extent by [[CYP1A2]].<ref name="AltamuraCaldiroliBuoli2015">{{cite journal | vauthors = Altamura AC, Caldiroli A, Buoli M | title = Pharmacokinetic evaluation of fluvoxamine for the treatment of anxiety disorders | journal = Expert Opinion on Drug Metabolism & Toxicology | volume = 11 | issue = 4 | pages = 649–660 | date = April 2015 | pmid = 25728382 | doi = 10.1517/17425255.2015.1021331}}</ref><ref name="Wyska2019">{{cite journal | vauthors = Wyska E | title = Pharmacokinetic considerations for current state-of-the-art antidepressants | journal = Expert Opinion on Drug Metabolism & Toxicology | volume = 15 | issue = 10 | pages = 831–847 | date = October 2019 | pmid = 31526279 | doi = 10.1080/17425255.2019.1669560 | url = https://ruj.uj.edu.pl/xmlui/handle/item/256191 }}</ref> However, CYP2D6 [[poor metabolizer]]s do not have considerably higher fluvoxamine levels than [[extensive metabolizer]]s.<ref name="AltamuraCaldiroliBuoli2015" />  Fluvoxamine inhibits oxidative drug metabolising enzymes (particularly CYP1A2, and less potently CYP3A4 and CYP2D6)<ref>{{Cite journal | vauthors = van Harten J | title = Overview of the pharmacokinetics of fluvoxamine | journal = Clinical Pharmacokinetics | volume = 29 Suppl 1 | pages = 1–9 | date = 1995 | pmid = 8846617 | doi = 10.2165/00003088-199500291-00003 | issn = 0312-5963 }}</ref>  The mean plasma half-life of fluvoxamine after multiple oral doses of 100&nbsp;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.<ref name=":0">{{Cite web | title = FDA prescribing information | url = https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/022235lbl.pdf | archive-url = https://web.archive.org/web/20131019125207/http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/022235lbl.pdf | archive-date = 19 October 2013 }}</ref>  Steady-state plasma fluvoxamine concentrations were 2-3 fold higher in children than in adolescents.

==History== 

Fluvoxamine was developed by Kali-Duphar,<ref name="Sittig"/> part of [[Solvay (company)|Solvay Pharmaceuticals]], Belgium, now [[Abbott Laboratories]], and introduced as Floxyfral in Switzerland in 1983.<ref name=Sittig>{{cite book | title = Sittig's Pharmaceutical Manufacturing Encyclopedia | year = 2008 | publisher = William Andrew | isbn = 978-0-8155-1526-5 | page = 1699 | url = http://www.armchairpatriot.com/Encyclopedias/Encyclopedia-Pharmaceutical%20Manufacturing%20%283rd%20edition%29/15265_v02_04.pdf | edition = 3rd | access-date = 17 October 2013 | archive-date = 14 October 2013 | archive-url = https://web.archive.org/web/20131014042521/http://www.armchairpatriot.com/Encyclopedias/Encyclopedia-Pharmaceutical%20Manufacturing%20%283rd%20edition%29/15265_v02_04.pdf }}</ref> It was approved by the U.S. [[Food and Drug Administration]] (FDA) in 1994, and introduced as Luvox in the US.<ref name="pmid15995053">{{cite journal | vauthors = Leslie LK, Newman TB, Chesney PJ, Perrin JM | title = The Food and Drug Administration's deliberations on antidepressant use in pediatric patients | journal = Pediatrics | volume = 116 | issue = 1 | pages = 195–204 | date = July 2005 | pmid = 15995053 | pmc = 1550709 | doi = 10.1542/peds.2005-0074 }}</ref> In India, it is available, among several other brands, as Uvox by Abbott.<ref name=India>{{cite web | title = Brand Index―Fluvoxamine India | url = http://www.drugsupdate.com/brand/showavailablebrands/184 | access-date = 18 October 2013 | archive-url = https://web.archive.org/web/20131019151123/http://www.drugsupdate.com/brand/showavailablebrands/184 | archive-date = 19 October 2013 }}</ref> It was one of the first SSRI antidepressants to be launched, and is prescribed in many countries to patients with major depression.<ref name="Cochrane 2010/2013">{{cite journal | vauthors = Omori IM, Watanabe N, Nakagawa A, Cipriani A, Barbui C, McGuire H, Churchill R, Furukawa TA | title = Fluvoxamine versus other anti-depressive agents for depression | journal = The Cochrane Database of Systematic Reviews | volume = 2013 | issue = 3 | article-number = CD006114 | date = March 2010 | pmid = 20238342 | pmc = 4171125 | doi = 10.1002/14651858.CD006114.pub2 }}</ref> It was the first SSRI, a non-[[tricyclic antidepressant|TCA]] drug, approved by the U.S. FDA specifically for the treatment of OCD.<ref name="OCD Medication">{{cite web | title = OCD Medication | date = 24 February 2010 | url = http://www.brainphysics.com/medications.php | access-date = 17 October 2013 | archive-url = https://web.archive.org/web/20131014072454/http://www.brainphysics.com/medications.php | archive-date = 14 October 2013 }}</ref> At the end of 1995, more than ten million patients worldwide had been treated with fluvoxamine.<ref name="Fluvoxamine Product Monograph-1999">{{cite web | title = Fluvoxamine Product Monograph | year = 1999 | url = https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/021519s003lbl.pdf | access-date = 15 September 2018 | archive-date = 27 October 2020 | archive-url = https://web.archive.org/web/20201027214646/https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/021519s003lbl.pdf }}</ref>{{failed verification|reason=no discussion of ten million patients|date=November 2019}} Fluvoxamine was the first SSRI to be registered for the treatment of obsessive compulsive disorder in children by the FDA in 1997.<ref name="Luvox Approved For Obsessive Compulsive Disorder in Children and Teens-2009">{{cite web | title = Luvox Approved For Obsessive Compulsive Disorder in Children and Teens | url = http://www.pslgroup.com/dg/2261a.htm | access-date = 8 February 2014 | archive-url = https://web.archive.org/web/20090116004424/http://www.pslgroup.com/dg/2261a.htm | archive-date = 16 January 2009 }}</ref> In Japan, fluvoxamine was the first SSRI to be approved for the treatment of depression in 1999<ref name="pmid19300537">{{cite journal | vauthors = Higuchi T, Briley M | title = Japanese experience with milnacipran, the first serotonin and norepinephrine reuptake inhibitor in Japan | journal = Neuropsychiatric Disease and Treatment | volume = 3 | issue = 1 | pages = 41–58 | date = February 2007 | pmid = 19300537 | pmc = 2654524 | doi = 10.2147/nedt.2007.3.1.41 | doi-access = free }}</ref><ref name="Wishart">{{cite HMDB | title = Showing metabocard for Fluvoxamine (HMDB0014322) | author1-link = David S. Wishart | url = http://www.hmdb.ca/metabolites/HMDB0014322 }}</ref> and was later in 2005 the first drug to be approved for the treatment of social anxiety disorder.<ref name="Solvay-2018">{{cite web | title = Solvay's Fluvoxamine maleate is first drug approved for the treatment of social anxiety disorder in Japan | url = https://www.fdanews.com/articles/81585-solvay-s-fluvoxamine-maleate-is-first-drug-approved-for-treatment-of-social-anxiety-disorder-in-japan | access-date = 15 September 2018 | archive-date = 15 September 2018 | archive-url = https://web.archive.org/web/20180915122310/https://www.fdanews.com/articles/81585-solvay-s-fluvoxamine-maleate-is-first-drug-approved-for-treatment-of-social-anxiety-disorder-in-japan | url-status = live }}</ref> Fluvoxamine was the first SSRI approved for clinical use in the United Kingdom.<ref name="Churchill Livingstone Elsevier-2007">{{cite book | veditors = Walker R, Whittlesea C | title = Clinical Pharmacy and Therapeutics | year = 2007 | isbn = 978-0-7020-4293-5 | orig-date = 1994 | publisher = Churchill Livingstone Elsevier | location = Edinburgh | edition = 4th }}</ref>  Manufacturers include BayPharma, [[Synthon (company)|Synthon]], and [[Teva Pharmaceuticals|Teva]], among others.<ref name="www.drugbank.ca-2019">{{cite web | title = Fluvoxamine | url = https://www.drugbank.ca/drugs/DB00176 | website = www.drugbank.ca | access-date = 22 October 2019 | archive-date = 4 November 2019 | archive-url = https://web.archive.org/web/20191104161742/https://www.drugbank.ca/drugs/DB00176 | url-status = live }}</ref>

== 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.<ref name="pmid36103313">{{cite journal | vauthors = Nyirenda JL, Sofroniou M, Toews I, Mikolajewska A, Lehane C, Monsef I, Abu-Taha A, Maun A, Stegemann M, Schmucker C | title = Fluvoxamine for the treatment of COVID-19 | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 9 | article-number = CD015391 | date = September 2022 | pmid = 36103313 | pmc = 9473347 | doi = 10.1002/14651858.CD015391 | type = Systematic review }}</ref> 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.<ref name="pmid35383578">{{cite journal | vauthors = Bhuta S, Khokher W, Kesireddy N, Iftikhar S, Beran A, Mhanna M, Patel NJ, Patel M, Burmeister C, Assaly R | title = 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 | journal = American Journal of Therapeutics | volume = 29 | issue = 3 | pages = e298–e304 | date = 2022 | pmid = 35383578 | doi = 10.1097/MJT.0000000000001496 | s2cid = 247978477 | doi-access = free }}</ref><ref name="pmid36532776">{{cite journal | vauthors = Asadi Anar M, Foroughi E, Sohrabi E, Peiravi S, Tavakoli Y, Kameli Khouzani M, Behshood P, Shamshiri M, Faridzadeh A, Keylani K, Langari SF, Ansari A, Khalaji A, Garousi S, Mottahedi M, Honari S, Deravi N | title = Selective serotonin reuptake inhibitors: New hope in the fight against COVID-19 | journal = Frontiers in Pharmacology | volume = 13 | issue = | article-number = 1036093 | date = 2022 | pmid = 36532776 | pmc = 9748354 | doi = 10.3389/fphar.2022.1036093 | doi-access = free }}</ref> A cytokine storm refers to an excessive immune response characterized by a release of large amounts of pro-inflammatory cytokines.<ref name="pmid32592501">{{cite journal | vauthors = Hu B, Huang S, Yin L | title = The cytokine storm and COVID-19 | journal = Journal of Medical Virology | volume = 93 | issue = 1 | pages = 250–256 | date = January 2021 | pmid = 32592501 | pmc = 7361342 | doi = 10.1002/jmv.26232 }}</ref>

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.<ref name="Reuters-2022">{{cite news | title = FDA declines to authorize common antidepressant as COVID treatment | date = 16 May 2022 | url = https://www.reuters.com/business/healthcare-pharmaceuticals/fda-declines-authorize-common-antidepressant-covid-treatment-2022-05-16/ | access-date = 18 May 2022 | work = Reuters | archive-date = 17 May 2022 | archive-url = https://web.archive.org/web/20220517202625/https://www.reuters.com/business/healthcare-pharmaceuticals/fda-declines-authorize-common-antidepressant-covid-treatment-2022-05-16/ | url-status = live }}</ref><ref name="Food and Drug Administration-2022">{{cite tech report | title = Memorandum Explaining Basis for Declining Request for Emergency Use Authorization of Fluvoxamine Maleate | date = 16 May 2022 | type = Memorandum | id = 4975580 | institution = Food and Drug Administration | url = https://www.accessdata.fda.gov/drugsatfda_docs/nda/2020/EUA%20110%20Fluvoxamine%20Decisional%20Memo_Redacted.pdf | archive-url = https://web.archive.org/web/20220517001646/https://www.accessdata.fda.gov/drugsatfda_docs/nda/2020/EUA%20110%20Fluvoxamine%20Decisional%20Memo_Redacted.pdf | archive-date = 17 May 2022 | url-status = live }} {{Source-attribution}}</ref>

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&nbsp;mg or more daily.<ref name="pmid38148036">{{cite journal | vauthors = Deng J, Moskalyk M, Zuo QK, Garcia C, Abbas U, Ramaraju HB, Rayner D, Park YJ, Heybati K, Zhou F, Lohit S | title = Evaluating fluvoxamine for the outpatient treatment of COVID-19: A systematic review and meta-analysis | journal = Reviews in Medical Virology | volume = 34 | issue = 1 | article-number = e2501 | date = January 2024 | pmid = 38148036 | doi = 10.1002/rmv.2501 | doi-access = free }}</ref><ref name="pmid38862591">{{cite journal | vauthors = Prasanth MI, Wannigama DL, Reiersen AM, Thitilertdecha P, Prasansuklab A, Tencomnao T, Brimson S, Brimson JM | title = A systematic review and meta-analysis, investigating dose and time of fluvoxamine treatment efficacy for COVID-19 clinical deterioration, death, and Long-COVID complications | journal = Scientific Reports | volume = 14 | issue = 1 | article-number = 13462 | date = June 2024 | pmid = 38862591 | pmc = 11166997 | doi = 10.1038/s41598-024-64260-9 | bibcode = 2024NatSR..1413462P}}</ref><ref name="pmid38753761">{{cite journal | vauthors = Zhou Q, Zhao G, Pan Y, Zhang Y, Ni Y | title = The efficacy and safety of fluvoxamine in patients with COVID-19: A systematic review and meta-analysis from randomized controlled trials | journal = PLOS ONE | volume = 19 | issue = 5 | article-number = e0300512 | date = 2024 | pmid = 38753761 | pmc = 11098472 | doi = 10.1371/journal.pone.0300512 | doi-access = free | bibcode = 2024PLoSO..1900512Z}}</ref>

==Environment== 

Fluvoxamine is a common finding in waters near human settlement.<ref name="Runoff" /> Christensen ''et al.'' 2007 finds it is "very toxic to aquatic organisms" by [[European Union]] standards.<ref name="Runoff">

   {{Unbulleted list citebundle

      |{{*}} {{cite journal | vauthors = Chia MA, Lorenzi AS, Ameh I, Dauda S, Cordeiro-Araújo MK, Agee JT, Okpanachi IY, Adesalu AT | title = Susceptibility of phytoplankton to the increasing presence of active pharmaceutical ingredients (APIs) in the aquatic environment: A review | journal = Aquatic Toxicology (Amsterdam, Netherlands) | volume = 234 | article-number = 105809 | date = May 2021 | pmid = 33780670 | doi = 10.1016/j.aquatox.2021.105809 | publisher = [[Elsevier]] | bibcode = 2021AqTox.23405809C | s2cid = 232419482 }}
      |{{*}} {{cite journal | vauthors = Christensen AM, Faaborg-Andersen S, Ingerslev F, Baun A | title = Mixture and single-substance toxicity of selective serotonin reuptake inhibitors toward algae and crustaceans | journal = Environmental Toxicology and Chemistry | volume = 26 | issue = 1 | pages = 85–91 | date = January 2007 | pmid = 17269464 | doi = 10.1897/06-219R.1 | publisher = [[John Wiley & Sons, Inc.]] ([[Society of Environmental Toxicology and Chemistry]] (SETAC)) | s2cid = 6562531 | doi-access = free | bibcode = 2007EnvTC..26...85C }}

   }}

</ref>

== References == 
{{Reflist}}

{{Antidepressants}}
{{Anxiolytics}}
{{OCD pharmacotherapies}}
{{Monoamine reuptake inhibitors}}
{{Sigma receptor modulators}}
{{Portal bar | Medicine}}

[[Category:Amines]]
[[Category:Antidepressants]]
[[Category:CYP1A2 inhibitors]]
[[Category:CYP2B6 inhibitors]]
[[Category:CYP2C19 inhibitors]]
[[Category:CYP2C9 inhibitors]]
[[Category:CYP2D6 inhibitors]]
[[Category:CYP3A4 inhibitors]]
[[Category:Drugs developed by AbbVie]]
[[Category:Ethers]]
[[Category:Ketoxime ethers]]
[[Category:Selective serotonin reuptake inhibitors]]
[[Category:Sigma agonists]]
[[Category:Trifluoromethyl compounds]]