QuickView for Fluvoxamine (compound)

Summary
General Info

PubChem

PubChem Compound 3404

Name:	Fluvoxamine
PubChem Compound ID:	3404
Description:	A selective serotonin reuptake inhibitor. It is effective in the treatment of depression, obsessive-compulsive disorders, anxiety, panic disorders, and alcohol amnestic disorders.
Molecular formula:	C₁₅H₂₁F₃N₂O₂
Molecular weight:	318.335 g/mol
Synonyms:	Prestwick0_000995; Prestwick1_000995; SPBio_002980

DrugBank

Identification

Name:	Fluvoxamine
Name (isomeric):	DB00176
Drug Type:	small molecule
Description:	A selective serotonin reuptake inhibitor. It is effective in the treatment of depression, obsessive-compulsive disorders, anxiety, panic disorders, and alcohol amnestic disorders.
Synonyms:	fluvoxamine-CR; Fluvoxamina [INN-Spanish]; Fluvoxamine maleate; Fluvoxaminum [INN-Latin]
Brand:	Floxyfral, Dumyrox, Maveral, Faverin, Fevarin, Luvox, Dumirox
Category:	Anti-anxiety Agents, Antidepressive Agents, Second-Generation, Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin Uptake Inhibitors, Antidepressive Agents
CAS number:	54739-18-3

Pharmacology

Indication:	For management of depression and for Obsessive Compulsive Disorder (OCD). Has also been used in the management of bulimia nervosa.
Pharmacology:	Fluvoxamine, an aralkylketone-derivative agent, is one of a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) that differs structurally from other SSRIs. It is used to treat the depression associated with mood disorders. It is also used on occassion in the treatment of body dysmorphic disorder and anxiety. The antide... show more » Fluvoxamine, an aralkylketone-derivative agent, is one of a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) that differs structurally from other SSRIs. It is used to treat the depression associated with mood disorders. It is also used on occassion in the treatment of body dysmorphic disorder and anxiety. The antidepressant, antiobsessive-compulsive, and antibulimic actions of Fluvoxamine are presumed to be linked to its inhibition of CNS neuronal uptake of serotonin. In vitro studies show that Fluvoxamine is a potent and selective inhibitor of neuronal serotonin reuptake and has only very weak effects on norepinephrine and dopamine neuronal reuptake. Fluvoxamine has no significant affinity for adrenergic (alpha1, alpha2, beta), cholinergic, GABA, dopaminergic, histaminergic, serotonergic (5HT_1A, 5HT_1B, 5HT₂), or benzodiazepine receptors; antagonism of such receptors has been hypothesized to be associated with various anticholinergic, sedative, and cardiovascular effects for other psychotropic drugs. The chronic administration of Fluvoxamine was found to downregulate brain norepinephrine receptors, as has been observed with other drugs effective in the treatment of major depressive disorder. Fluvoxamine does not inhibit monoamine oxidase. show less «
Mechanism of Action:	The exact mechanism of action of fluvoxamine has not been fully determined, but appears to be linked to its inhibition of CNS neuronal uptake of serotonin. Fluvoxamine blocks the reuptake of serotonin at the serotonin reuptake pump of the neuronal membrane, enhancing the actions of serotonin on 5HT_1A autoreceptors. In-vitro studies sugge... show more » The exact mechanism of action of fluvoxamine has not been fully determined, but appears to be linked to its inhibition of CNS neuronal uptake of serotonin. Fluvoxamine blocks the reuptake of serotonin at the serotonin reuptake pump of the neuronal membrane, enhancing the actions of serotonin on 5HT_1A autoreceptors. In-vitro studies suggest that fluvoxamine is more potent than clomipramine, fluoxetine, and desipramine as a serotonin-reuptake inhibitor. Studies have also demonstrated that fluvoxamine has virtually no affinity for α₁- or α₂-adrenergic, β-adrenergic, muscarinic, dopamine D₂, histamine H₁, GABA-benzodiazepine, opiate, 5-HT₁, or 5-HT₂ receptors. show less «
Absorption:	Well absorbed, bioavailability of fluvoxamine maleate is 53%.
Protein binding:	~77-80% (plasma protein)
Biotransformation:	Hepatic
Route of elimination:	The main human metabolite was fluvoxamine acid which, together with its N-acetylated analog, accounted for about 60% of the urinary excretion products. Approximately 2% of fluvoxamine was excreted in urine unchanged. Following a 14C-labelled oral dose of fluvoxamine maleate (5 mg), an average of 94% of drug-related products was recovered in the urine within 71 hours.
Half Life:	15.6 hours
Toxicity:	Side effects include anorexia, constipation, dry mouth, headache, nausea, nervousness, skin rash, sleep problems, somnolence, liver toxicity, mania, increase urination, seizures, sweating increase, tremors, or Tourette's syndrome.
Affected organisms:	Humans and other mammals

Interactions

Food interaction:

Avoid alcohol.

Avoid high doses of caffeine.

Grapefruit and grapefruit juice should be avoided throughout treatment as grapefruit can significantly increase serum levels of this product.

Take without regard to meals.

Drug interaction:

Phenelzine	Possible severe adverse reaction with this combination
Almotriptan	Increased risk of CNS adverse effects
Duloxetine	Fluvoxamine increases the effect and toxicity of duloxetine
Ropivacaine	Increases the effect and toxicity of ropivacaine
Dicumarol	Fluvoxamine may increase the anticoagulant effect of dicumarol by increasing its serum concentration.

Phenelzine	Possible severe adverse reaction with this combination
Almotriptan	Increased risk of CNS adverse effects
Duloxetine	Fluvoxamine increases the effect and toxicity of duloxetine
Ropivacaine	Increases the effect and toxicity of ropivacaine
Dicumarol	Fluvoxamine may increase the anticoagulant effect of dicumarol by increasing its serum concentration.
Tranylcypromine	Increased risk of serotonin syndrome. Concomitant therapy should be avoided. A significant washout period, dependent on the half-lives of the agents, should be employed between therapies.
Phentermine	Risk of serotoninergic syndrome
Doxepin	The SSRI, fluvoxamine, may increase the serum concentration of the tricyclic antidepressant, doxepin, by decreasing its metabolism. Additive modulation of serotonin activity also increases the risk of serotonin syndrome. Monitor for development of serotonin syndrome during concomitant therapy. Monitor for changes in the therapeutic and adverse effects of doxepin if fluvoxamine is initiated, discontinued or dose changed.
Trimipramine	The strong CYP2C19 inhibitor, fluvoxamine, may decrease the metabolism and clearance of trimipramine, a CYP2C19 substrate. Additive modulation of serotonin activity may also increase the risk of serotonin syndrome. Consider alternate therapy or monitor for serotonin syndrome and changes in therapeutic and adverse effects of trimipramine if fluvoxamine is initiated, discontinued or dose changed.
Oxtriphylline	Fluvoxamine may increase the therapeutic and adverse effects of oxtriphylline.
Isocarboxazid	Possible severe adverse reaction with this combination
Protriptyline	The SSRI, fluvoxamine, may increase the serum concentration of the tricyclic antidepressant, protriptyline, by decreasing its metabolism. Additive modulation of serotonin activity also increases the risk of serotonin syndrome. Monitor for development of serotonin syndrome during concomitant therapy. Monitor for changes in the therapeutic and adverse effects of protriptyline if fluvoxamine is initiated, discontinued or dose changed.
Fenfluramine	Risk of serotoninergic syndrome
Dihydroergotamine	Possible ergotism and severe ischemia with this combination
Dextroamphetamine	Risk of serotoninergic syndrome
Tiaprofenic acid	Additive antiplatelet effects increase the risk of bleeding. Consider alternate therapy or monitor for increased bleeding.
Rasagiline	Possible severe adverse reaction with this combination
Trazodone	Increased risk of serotonin syndrome. Monitor for symptoms of serotonin syndrome.
Fosphenytoin	Fluvoxamine may increase the therapeutic and adverse effects of fosphenytoin.
Naratriptan	Increased risk of CNS adverse effects
Terbinafine	Terbinafine may reduce the metabolism and clearance of Fluvoxamine. Consider alternate therapy or monitor for therapeutic/adverse effects of Fluvoxamine if Terbinafine is initiated, discontinued or dose changed.
Methadone	Fluvoxamine increases the effect and toxicity of methadone
Thioridazine	Increased risk of cardiotoxicity and arrhythmias
Clomipramine	The SSRI, fluvoxamine, may increase the serum concentration of the tricyclic antidepressant, clomipramine, by decreasing its metabolism. Additive modulation of serotonin activity also increases the risk of serotonin syndrome. Monitor for development of serotonin syndrome during concomitant therapy. Monitor for changes in the therapeutic and adverse effects of clomipramine if fluvoxamine is initiated, discontinued or dose changed.
Cilostazol	Fluvoxamine increases the effect of cilostazol
Mephenytoin	Increases the effect of hydantoin
Desipramine	The SSRI, fluvoxamine, may increase the serum concentration of the tricyclic antidepressant, desipramine, by decreasing its metabolism. Additive modulation of serotonin activity also increases the risk of serotonin syndrome. Monitor for development of serotonin syndrome during concomitant therapy. Monitor for changes in the therapeutic and adverse effects of desipramine if fluvoxamine is initiated, discontinued or dose changed.
Astemizole	Increased risk of cardiotoxicity and arrhythmias
Tizanidine	Fluvoxamine inhibits the metabolism and clearance of tizanidine. Concomitant therapy is contraindicated.
Dyphylline	Increases the effect and toxicity of theophylline
Eletriptan	Increased risk of CNS adverse effects
Carbamazepine	Fluvoxamine increases the effect of carbamazepine
Tramadol	Tramadol may increase the risk of serotonin syndrome and seizures.
Rizatriptan	Increased risk of CNS adverse effects
Ginkgo biloba	Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.
Mexiletine	Fluvoxamine may increase the therapeutic and adverse effects of mexiletine.
Zolmitriptan	Use of two serotonin modulators, such as zolmitriptan and fluvoxamine, may increase the risk of serotonin syndrome. Consider alternate therapy or monitor for serotonin syndrome during concomitant therapy.
Warfarin	Fluvoxamine may increase the anticoagulant effect of warfarin by increasing its serum concentration.
Dexfenfluramine	Risk of serotoninergic syndrome
Tacrine	Fluvoxamine, a strong CYP1A2 inhibitor, may decrease the metabolism and clearance of tacrine, a CYP1A2 substrate. Concomitant therapy should be avoided as it could lead to severe toxic effects such as hepatotoxicity. If concomitant therapy is used, monitor for altered efficacy and toxic effects, such as gastrointestinal and hepatic effects, of tacrine.
Clozapine	The antidepressant increases the effect of clozapine
Carisoprodol	Strong CYP2C19 inhibitors such as fluvoxamine may decrease the metabolism of CYP2C19 substrates such as carisoprodol. Consider an alternative for one of the interacting drugs in order to avoid toxicity of the substrate. Some combinations are specifically contraindicated by manufacturers. Suggested dosage adjustments are also offered by some manufacturers. Please review applicable package inserts. Monitor for increased effects of the CYP substrate if a CYP inhibitor is initiated/dose increased, and decreased effects if a CYP inhibitor is discontinued/dose decreased.
Moclobemide	Increased incidence of adverse effects with this association
Mirtazapine	Fluvoxamine may increase the therapeutic and adverse effects of mirtazapine.
Methamphetamine	Risk of serotoninergic syndrome
Imipramine	The SSRI, fluvoxamine, may increase the serum concentration of the tricyclic antidepressant, imipramine, by decreasing its metabolism. Additive modulation of serotonin activity also increases the risk of serotonin syndrome. Monitor for development of serotonin syndrome during concomitant therapy. Monitor for changes in the therapeutic and adverse effects of imipramine if fluvoxamine is initiated, discontinued or dose changed.
Phenytoin	Fluvoxamine may increase the therapeutic effect of phenytoin.
Mazindol	Risk of serotoninergic syndrome
Selegiline	Possible severe adverse reaction with this combination
Ropinirole	Increases the effect and toxicity of ropinirole
Linezolid	Combination associated with possible serotoninergic syndrome
Diethylpropion	Risk of serotoninergic syndrome
Venlafaxine	Increased risk of serotonin syndrome. Monitor for symptoms of serotonin syndrome.
Anisindione	Fluvoxamine may increase the anticoagulant effect of anisindione by increasing its serum concentration.
Benzphetamine	Amphetamines may enhance the adverse/toxic effect of Serotonin Modulators. The risk of serotonin syndrome may be increased. Monitor patients closely for signs and symptoms of serotonin syndrome (e.g., agitation, tremor, tachycardia, etc.) when using amphetamines and serotonin modulators in combination.
Treprostinil	The prostacyclin analogue, Treprostinil, increases the risk of bleeding when combined with the antiplatelet agent, Fluvoxamine. Monitor for increased bleeding during concomitant thearpy.
Amphetamine	Risk of serotoninergic syndrome
Phenylpropanolamine	Risk of serotoninergic syndrome
Nortriptyline	The SSRI, fluvoxamine, may increase the serum concentration of the tricyclic antidepressant, nortriptyline, by decreasing its metabolism. Additive modulation of serotonin activity also increases the risk of serotonin syndrome. Monitor for development of serotonin syndrome during concomitant therapy. Monitor for changes in the therapeutic and adverse effects of nortriptyline if fluvoxamine is initiated, discontinued or dose changed.
Lithium	The SSRI, fluvoxamine, increases serum levels of lithium.
Olanzapine	Fluvoxamine increases the effect and toxicity of olanzapine
Aminophylline	Fluvoxamine may increase the effect and toxicity of aminophylline.
Tolmetin	Increased antiplatelet effects may enhance the risk of bleeding. Alternate therapy may be considered or monitor for inreased bleeding during concomitant therapy.
Desvenlafaxine	Increased risk of serotonin syndrome. Monitor for symptoms of serotonin syndrome.
Mesoridazine	Increased risk of cardiotoxicity and arrhythmias
Oxycodone	Increased risk of serotonin syndrome
Ramelteon	Fluvoxamine may increase the serum level and toxicity of ramelteon.
Acenocoumarol	Fluvoxamine may increase the anticoagulant effect of acenocoumarol by increasing its serum concentration.
Frovatriptan	Increased risk of CNS adverse effects
Terfenadine	Increased risk of cardiotoxicity and arrhythmias
Amoxapine	The SSRI, fluvoxamine, may increase the serum concentration of the tricyclic antidepressant, amoxapine, by decreasing its metabolism. Additive modulation of serotonin activity also increases the risk of serotonin syndrome. Monitor for development of serotonin syndrome during concomitant therapy. Monitor for changes in the therapeutic and adverse effects of amoxapine if fluvoxamine is initiated, discontinued or dose changed.
Amitriptyline	The SSRI, fluvoxamine, may increase the serum concentration of the tricyclic antidepressant, amitriptyline, by decreasing its metabolism. Additive modulation of serotonin activity also increases the risk of serotonin syndrome. Monitor for development of serotonin syndrome during concomitant therapy. Monitor for changes in the therapeutic and adverse effects of amitriptyline if fluvoxamine is initiated, discontinued or dose changed.
Sibutramine	Risk of serotoninergic syndrome
Thiabendazole	The strong CYP1A2 inhibitor, Thiabendazole, may increase the effects and toxicity of Fluvoxamine by decreasing Fluvoxamine metabolism and clearance. Monitor for changes in the therapeutic and adverse effects of Fluvoxamine if Thiabendazole is initiated, discontinued or dose changed.
Thiothixene	The strong CYP1A2 inhibitor, Fluvoxamine, may decrease the metabolism and clearance of Thiothixene, a CYP1A2 substrate. Consider alternate therapy or monitor for changes in Thiothixene therapeutic and adverse effects if Fluvoxamine is initiated, discontinued or dose changed.
Sumatriptan	Increased risk of CNS adverse effects
Phendimetrazine	Risk of serotoninergic syndrome
Triprolidine	The CNS depressants, Triprolidine and Fluvoxamine, may increase adverse/toxic effects due to additivity. Monitor for increased CNS depressant effects during concomitant therapy.
Theophylline	Fluvoxamine may increase the therapeutic and adverse effects of theophylline.
Ergotamine	Possible ergotism and severe ischemia with this combination
Ketoprofen	Concomitant therapy may result in additive antiplatelet effects and increase the risk of bleeding. Monitor for increased risk of bleeding during concomitant therapy.
Ethotoin	Increases the effect of hydantoin
St. John's Wort	St. John's Wort increases the effect and toxicity of the SSRI, fluvoxamine.

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Targets

Sodium-dependent serotonin transporter

Enzymes

Transporters

Multidrug resistance protein 1