fluvoxamine, Luvox, Luvox CR (cont.)
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
Fluvoxamine may increase the effect of warfarin (Coumadin), leading to excessive bleeding. Warfarin therapy should be monitored more frequently in patients who also are taking fluoxetine.
Combining SSRIs with aspirin, nonsteroidal anti-inflammatory drugs or other drugs that affect bleeding may increase the likelihood of upper gastrointestinal bleeding. Fluvoxamine may increase blood levels of tizanidine (Zanaflex), thioridazine (Mellaril), alosetron (Lotronex), and pimozide (Orap), leading to increased side effects of these drugs.
PREGNANCY: There are no adequate studies of fluvoxamine in pregnant women. Infants exposed to SSRIs in late pregnancy may have an increased risk for persistent pulmonary hypertension of the newborn (PPHN), which can be fatal.
NURSING MOTHERS: Fluvoxamine is excreted into breast milk. There are no adequate studies in lactating women.
SIDE EFFECTS: Side effects of fluvoxamine include anxiety, nervousness, sweating, nausea, decreased appetite, constipation, diarrhea, dry mouth, somnolence (sleepiness), dizziness, insomnia, and sexual disfunction. Fluvoxamine also may cause abnormal bleeding, seizures, and manic episodes. Withdrawal of fluvoxamine may result in withdrawal symptoms. The most common symptoms of withdrawal are dizziness, tiredness, tingling of the extremities, nausea, vivid dreams, irritability, and poor mood. Other symptoms include visual disturbances and headaches.
Withdrawal reactions have been reported after an average of 12 to 36 weeks of treatment, but after as few as 5 weeks. Although most authorities recommend discontinuing treatment by gradually reducing the dose, symptoms still may occur. Symptoms generally appear within a few days of discontinuing medication and persist for an average of 12 days (up to 21 days). They are relieved within 24 hours by re-administering the medication that was discontinued. Antidepressants may increase the risk of suicide in children and adolescents. There are concerns that antidepressants also may increase the risk of suicide in adults. Patients with major depression may experience worsening of depression or suicidal thoughts regardless of whether or not they are treated. Therefore, patients started on antidepressants should be closely observed for signs of worsening suicidal thinking or changes in behavior.
Reference: FDA Prescribing Information
Last Editorial Review: 5/31/2013
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