Fluvoxamine

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Fluvoxamine
Fluvoxamine2DACS.svg
Fluvoxamine ball-and-stick.png
Systematic (IUPAC) name
2-{[(E)-{5-Methoxy-1-[4-(trifluoromethyl)phenyl]pentylidene}amino]oxy}ethanamine[1]
Clinical data
Trade names Faverin, Fevarin, Floxyfral, Luvox
AHFS/Drugs.com monograph
MedlinePlus a682275
Pregnancy
category
  • C
Legal status
Routes of
administration
Oral
Pharmacokinetic data
Bioavailability 53% (90% confidence interval: 44-62%)[2]
Protein binding 80%[2]
Metabolism Hepatic (via cytochrome P450 enzymes. Mostly via oxidative demethylation)[2]
Biological half-life 12-13 hours (single dose), 22 hours (repeated dosing)[2]
Excretion Renal (98%; 94% as metabolites, 4% as unchanged drug)[2]
Identifiers
CAS Number 54739-18-3 YesY
ATC code N06AB08 (WHO)
PubChem CID: 5324346
IUPHAR/BPS 7189
DrugBank DB00176 N
ChemSpider 4481878 YesY
UNII O4L1XPO44W YesY
KEGG D07984 YesY
ChEBI CHEBI:5138 YesY
ChEMBL CHEMBL814 YesY
Chemical data
Formula C15H21F3N2O2
Molecular mass 318.335
 NYesY (what is this?)  (verify)

Fluvoxamine (brand names: Faverin, Fevarin, Floxyfral, and Luvox) is a medication which functions as a selective serotonin reuptake inhibitor (SSRI) and σ1 receptor agonist. Fluvoxamine is used primarily for the treatment of obsessive-compulsive disorder (OCD),[3] and is also used to treat major depressive disorder (MDD), and anxiety disorders such as panic disorder and post-traumatic stress disorder (PTSD).[4] Fluvoxamine CR (controlled release) is approved to treat social anxiety disorder.[5]

The FDA has added a black box warning for this drug in reference to increased risks of suicidal thinking and behavior in young adults and children.

Medical uses

Fluvoxamine's only FDA approved indication is in the treatment of OCD,[6] although in other countries (e.g. Australia,[7] UK[8] and Russian Federation[9]) it has indications for MDD, as well. Fluvoxamine has been found to be useful in the treatment of MDD, and anxiety disorders such as panic disorder, social anxiety disorder, post-traumatic stress disorder (PTSD), and obsessive-compulsive spectrum disorders. Fluvoxamine is indicated for children and adolescents with OCD.[10] The drug works long-term, and retains its therapeutic efficacy for at least a year.[11] It has also been found to possess some analgesic properties in line with other SSRIs and tricyclic antidepressants.[12][13][14]

Some evidence shows fluvoxamine may be a helpful adjunct in the treatment of schizophrenia, improving the depressive, negative, and cognitive symptoms of the disorder.[15] Its actions at the sigma receptor may afford it a unique advantage among antidepressants in treating the cognitive symptoms of schizophrenia.[16]

Adverse effects

Gastrointestinal side effects are more common in those receiving fluvoxamine than with other SSRIs.[17] Otherwise, fluvoxamine's side-effect profile is very similar to other SSRIs.[2][6][7][8][18][19]

Common (1-10% incidence) adverse effects
  • Nausea
  • Vomiting
  • Anorexia (weight loss)
  • Agitation
  • Nervousness
  • Anxiety
  • Insomnia
  • Somnolence
  • Tremor
  • Headache
  • Dizziness
  • Palpitations
  • Tachycardia (high heart rate)
  • Abdominal pain
  • Dyspepsia (indigestion)
  • Diarrhoea
  • Constipation
  • Dry mouth
  • Hyperhidrosis (excess sweating)
  • Asthenia (weakness)
  • Malaises
  • Sexual dysfunction (including delayed ejaculation, erectile dysfunction, decreased libido, etc.)
Uncommon (0.1-1% incidence) adverse effects
  • Hallucination
  • Confusional state
  • Extrapyramidal side effects (e.g. dystonia, parkinsonism, tremor, etc.)
  • Orthostatic hypotension
  • Cutaneous hypersensitivity reactions (e.g. oedema [buildup of fluid in the tissues], rash, pruritus)
  • Arthralgia
Rare (0.01-0.1% incidence) adverse effects
  • Mania
  • Seizures
  • Abnormal hepatic (liver) function
  • Photosensitivity (being abnormally sensitive to light)
  • Galactorrhoea (expulsion of breast milk unrelated to pregnancy or breastfeeding)
Unknown frequency adverse effects

Interactions

Fluvoxamine inhibits the following cytochrome P450 enzymes:[21][22][23][24][25][26][27][28]

By so doing, fluvoxamine can increase serum concentration of the substrates of these enzymes.[21]

Pharmacology

Fluvoxamine is a potent and selective serotonin reuptake inhibitor with around 100-fold affinity for the serotonin transporter over the norepinephrine transporter.[22] It has negligible affinity for the dopamine transporter or any other receptor, with the sole exception of the σ1 receptor.[29] It behaves as a potent agonist at this receptor and has the highest affinity of any SSRI for doing so.[29] This may contribute to its antidepressant and anxiolytic effects and may also afford it some efficacy in treating the cognitive symptoms of depression.[16]

History

Fluvoxamine was developed by Kali-Duphar,[30] part of Solvay Pharmaceuticals, Belgium, now Abbott Laboratories, and introduced as Floxyfral in Switzerland and Solvay in West Germany in 1983.[30] It was approved by the FDA on 5 Dec, 1994 and introduced as Luvox in the US.[31] In India, it is available, among several other brands, as Uvox by Abbott.[32] It was one of the first SSRI antidepressants to be launched, and is prescribed in many countries to patients with major depression.[33] It was the first SSRI, a nonTCA drug, approved by the U.S. FDA specifically for the treatment of OCD.[34] At the end of 1995, more than ten million patients worldwide had been treated with fluvoxamine.[35] Fluvoxamine was the first SSRI to be registered for the treatment of obsessive compulsive disorder in children by the FDA in 1997.[36] In Japan, fluvoxamine was the first SSRI to be approved for the treatment of depression in 1999[37] and was later in 2005 the first drug to be approved for the treatment of social anxiety disorder.[38] Fluvoxamine was the first SSRI approved for clinical use in the United Kingdom.[39]

See also

References

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  2. 2.0 2.1 2.2 2.3 2.4 2.5 "PRODUCT INFORMATION LUVOX®". TGA eBusiness Services. Abbott Australasia Pty Ltd. 15 January 2013. Retrieved 21 October 2013.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  3. "FDA Advisory Committee Recommends Luvox (Fluvoxamine) Tablets for Obsessive Compulsive Disorder," PRNewswire, 10/18/93
  4. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  5. Stahl, S. Stahl's Essential Psychopharmacology: The Prescriber's Guide. Cambridge University Press. New York, NY. 2009. pp.215
  6. 6.0 6.1 "Fluvoxamine Maleate (fluvoxamine maleate) Tablet, Coated [Genpharm Inc.]". DailyMed. Genpharm Inc. October 2007. Retrieved 21 October 2013.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  7. 7.0 7.1 Rossi, S, ed. (2013). Australian Medicines Handbook (2013 ed.). Adelaide: The Australian Medicines Handbook Unit Trust. ISBN 978-0-9805790-9-3.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
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  12. Kwasucki, J; Stepień A; Maksymiuk G; Olbrych-Karpińska B (2002). "Evaluation of analgesic action of fluvoxamine compared with efficacy of imipramine and tramadol for treatment of sciatica—open trial". Wiadomości Lekarskie. 55 (1–2): 42–50. PMID 12043315.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  13. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  14. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
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  17. Brayfield, A, ed. (13 August 2013). Fluoxetine Hydrochloride. Martindale: The Complete Drug Reference. London, UK: Pharmaceutical Press. Retrieved 24 November 2013.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  18. Taylor, D; Paton, C; Shitij, K (2012). The Maudsley prescribing guidelines in psychiatry. West Sussex: Wiley-Blackwell. ISBN 978-0-470-97948-8. <templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  19. "Faverin 100 mg film-coated tablets - Summary of Product Characteristics (SPC)". electronic Medicines Compendium. Abbott Healthcare Products Limited. 14 May 2013. Retrieved 21 October 2013.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  20. "Top Ten Legal Drugs Linked to Violence". Time Inc. 7 January 2011. Retrieved 10 September 2014.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
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  22. 22.0 22.1 Brunton, L; Chabner, B; Knollman, B (2010). Goodman and Gilman's The Pharmacological Basis of Therapeutics (12th ed.). New York: McGraw-Hill Professional. ISBN 978-0-07-162442-8. <templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  23. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  24. Gill HS, DeVane CL; Gill, HS (1997). "Clinical Pharmacokinetics of Fluvoxamine: applications to dosage regime design". Journal of Clinical Psychiatry. 58 (Suppl 5): 7–14. PMID 9184622.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  25. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  26. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  27. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
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  33. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
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  35. Fluvoxamine Product Monograph. 1999. Missing or empty |title= (help)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  36. "Luvox Approved For Obsessive Compulsive Disorder in Children and Teens". http://www.pslgroup.com/dg/2261a.htm. External link in |journal= (help)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  37. Lua error in Module:Citation/CS1/Identifiers at line 47: attempt to index field 'wikibase' (a nil value).
  38. "Solvay's Fluvoxamine maleate is first drug approved for the treatment of social anxiety disorder in Japan". http://www.solvaypress.com/pressreleases/0,,33713-2-83,00.htm. External link in |journal= (help)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  39. Walker, R; Whittlesea, C, ed. (2007) [1994]. Clinical Pharmacy and Therapeutics (4th ed.). Edinburgh: Churchill Livingstone Elsevier. ISBN 978-0-7020-4293-5. <templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>

External links