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Pharmacologic class: Selective serotonin reuptake inhibitor (SSRI)
Therapeutic class: Antidepressant, antiobsessive agent
Pregnancy risk category C
Selectively inhibits serotonin reuptake in neurons. This inhibition is thought to relieve depression and reduce behaviors related to obsessive-compulsive disorder (OCD).
Capsules (extended-release): 100 mg, 150 mg
Tablets: 25 mg, 50 mg, 100 mg
Indications and dosages
Adults: Initially, 50 mg P.O. daily at bedtime; may increase by 50 mg q 4 to 7 days until desired effect occurs (not to exceed 300 mg/day). If daily dosage exceeds 100 mg, give in two equally divided doses; if doses aren't equal, give larger dose at bedtime. As needed, adjust dosage periodically to maintain lowest effective dosage that controls symptoms (immediate-release formulation)
Children ages 8 to 17: Initially, 25 mg at bedtime; may increase by 25 mg/day q 4 to 7 days until desired effect occurs (up to 200 mg/day for patients up to age 11 or up to 300 mg for adolescents). If daily dosage exceeds 50 mg, give in divided doses, with larger dose at bedtime (immediate-release formulation).
➣ OCD; social anxiety disorder
Adults: 100 mg P.O. once daily at bedtime; titrate in 50-mg increments weekly, to a maximum of 300 mg/day (extended-release formulation).
• Hepatic impairment
• Elderly patients
• Anxiety disorders
• Hypersensitivity to drug or other SSRIs
• MAO inhibitor use within past 14 days
Use cautiously in:
• cardiovascular disease, hepatic or renal impairment, mania, seizures, suicidal tendency
• elderly patients
• labor and delivery
• pregnant or breastfeeding patients.
• Give with or without food.
• Discontinue 5 weeks before MAO inhibitor therapy is set to begin.
CNS: dizziness, drowsiness, headache, insomnia, nervousness, anxiety, apathy, manic or psychotic reactions, depression, hypokinesia or hyperkinesia, tremor, suicide or suicidal ideation (especially in child or adolescent)
CV: hypertension, orthostatic hypotension, palpitations, tachycardia
GI: nausea, vomiting, diarrhea, constipation, dyspepsia, flatulence, dry mouth, dysphagia, anorexia
GU: decreased libido, sexual dysfunction, anorgasmia
Musculoskeletal: hypertonia, myoclonus, twitching
Respiratory: cough, dyspnea
Other: abnormal taste, tooth disorder, dental caries, edema, weight gain or loss, chills, fever, flulike symptoms, yawning, hot flashes, allergic reactions, hypersensitivity reaction
Drug-drug. Beta-adrenergic blockers (such as propranolol), carbamazepine, lithium, L-tryptophan, methadone, some benzodiazepines, theophylline, tolbutamide, warfarin: decreased fluvoxamine metabolism, increased effects
Clozapine: increased clozapine blood level and risk of toxicity
MAO inhibitors: serotonin syndrome
Tricyclic antidepressants: increased fluvoxamine blood level
Drug-tests. Hepatic enzyme levels: increased
Drug-behaviors. Smoking: decreased fluvoxamine efficacy
☞ Watch closely for signs and symptoms of depression and suicidal ideation (especially in child or adolescent).
• Assess patient's appetite. Report weight gain or loss.
• Monitor liver function test results.
• Monitor cardiovascular status, particularly blood pressure.
• Instruct patient to swallow extended-release capsules whole and not to break, crush, or chew them.
☞ Instruct patient or caregiver (especially with child or adolescent patient) to recognize and immediately report signs of suicidal intent or expressions of suicidal ideation.
• Inform patient that drug may take several weeks to be fully effective.
• Recommend establishing effective bedtime routine to minimize insomnia.
• Instruct female patient to notify prescriber if she becomes or intends to become pregnant. Caution her not to breastfeed.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.