ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -4 مورد

Fluvoxamine: Pediatric drug information

Fluvoxamine: Pediatric drug information
2025© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Fluvoxamine: Drug information" and "Fluvoxamine: Patient drug information"

For abbreviations, symbols, and age group definitions show table
ALERT: US Boxed Warning
Suicidality and antidepressant drugs:

Antidepressants increased the risk compared with placebo of suicidal thinking and behavior (suicidality) in short-term studies in children, adolescents, and young adults with major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of fluvoxamine in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared with placebo in adults older than 24 years; there was a reduction in risk with antidepressants compared with placebo in adults 65 years and older. Depression and certain other psychiatric disorders are associated with increases in the risk of suicide. Closely observe and appropriately monitor patients of all ages who are started on therapy for clinical worsening, suicidality, or unusual changes in behavior. Advise families and caregivers of the need for close observation and communication with the health care provider. Fluvoxamine immediate release is not approved for use in pediatric patients, except for patients with obsessive-compulsive disorder (OCD). Fluvoxamine extended release (ER) has not been evaluated in pediatric patients.

Brand Names: Canada
  • APO-Fluvoxamine;
  • Luvox;
  • RIVA-Fluvox [DSC];
  • TEVA Fluvoxamine
Therapeutic Category
  • Antidepressant, Selective Serotonin Reuptake Inhibitor (SSRI)
Dosing: Pediatric
Major depressive disorder

Major depressive disorder (unipolar): Limited data available:

Note: In the management of pediatric depression in adolescents, if pharmacotherapy deemed necessary with/without psychotherapeutic interventions, a selective serotonin reuptake inhibitor (SSRI) is recommended first line; fluvoxamine is not recommended first line due to the availability of 2 SSRIs with FDA approval for pediatric depression (fluoxetine, escitalopram) and the need for multiple doses a day. Fluvoxamine clinical trial evidence in adolescents is sparse; dosing based on expert recommendations (Ref).

Adolescents: Immediate release: Oral: Initial: 25 to 50 mg once daily at bedtime; titrate in 50 mg increments (if initial daily dose 25 mg/day used, smaller titration increments may be necessary initially) at 1- to 2-week intervals; usual effective daily dose: 150 mg/day; maximum daily dose: 300 mg/day; daily doses >50 mg should be divided into 2 doses; if applicable, administer larger portion of daily dose at bedtime (Ref).

Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD):

Note: In the management of OCD in children and adolescents, if pharmacotherapy deemed necessary, it should be in combination with cognitive behavioral therapy (CBT) and an SSRI should be used first line; a preferred agent has not been identified (Ref).

Immediate release:

Children 8 to 12 years: Note : Pharmacokinetic age-related and gender-related differences may affect doses at which therapeutic benefit is observed (see "Pharmacokinetics: Additional Considerations").

Oral: Initial: 12.5 to 25 mg once daily at bedtime; titrate in 25 mg increments at 7- to 14-day intervals to therapeutic effect; longer titration intervals may be necessary in some patients to minimize risk of behavior activation. Usual daily dosage range: 50 to 200 mg/day; daily doses >50 mg should be divided into 2 doses; if applicable, administer larger portion of daily dose at bedtime. Maximum daily dose: Children: 8 to 11 years: 200 mg/day; Children 12 years of age: 300 mg/day (Ref).

Adolescents: Oral: Initial: 25 to 50 mg once daily at bedtime; titrate in 25 mg increments at 7- to 14-day intervals to therapeutic effect; longer titration intervals may be necessary in some patients to minimize risk of behavior activation. Usual daily dosage range: 50 to 200 mg/day; daily doses >50 mg should be divided into 2 doses; if applicable, administer larger portion of daily dose at bedtime. Maximum daily dose: Adolescents: 300 mg/day (Ref).

Extended release: Limited data available: Children ≥8 years and Adolescents: Oral: Not for initial therapy; use the immediate-release formulation to initiate and titrate therapy; once patient is on a stable daily dose, convert to the extended-release formulation at same total daily dose and administer once daily if an appropriate mg-strength dosage form is available (Ref).

Discontinuation of therapy:

Consider planning discontinuation of therapy during lower-stress times, recognizing nonillness-related factors could cause stress or anxiety and be misattributed to treatment discontinuation (Ref). Upon discontinuation of antidepressant therapy, gradually taper the dose to minimize the incidence of discontinuation syndromes (withdrawal) and allow for the detection of reemerging disease state symptoms (eg, relapse). Evidence supporting ideal taper rates after illness remission is limited. APA and NICE guidelines suggest tapering therapy over at least several weeks, with consideration given to the half-life of the antidepressant; antidepressants with a shorter half-life may need to be tapered more conservatively. After long-term (years) antidepressant treatment, WFSBP guidelines recommend tapering over 4 to 6 months, with close monitoring during and for 6 months after discontinuation. If intolerable discontinuation symptoms occur following a dose reduction, consider resuming the previously prescribed dose and/or decrease dose at a more gradual rate (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling. Limited data suggest fluvoxamine does not accumulate in patients with renal impairment.

Dosing: Liver Impairment: Pediatric

Children ≥8 years and Adolescents: There are no dosage adjustments provided in the manufacturer's labeling. Limited data suggest fluvoxamine clearance is reduced in patients with hepatic impairment. Some experts recommend a maximum daily dose of 150 mg/day in adult patients with moderate-severe hepatic impairment (Ref).

Dosing: Adult

(For additional information see "Fluvoxamine: Drug information")

Dosage guidance:

Dosing: Some experts suggest a lower starting dose of 25 mg daily and gradual titration in increments of ≤25 mg, particularly in patients with anxiety who are sensitive to antidepressant-associated overstimulation effects (eg, anxiety, insomnia) (Ref).

Dosage form information: Fluvoxamine IR and ER formulations are interchangeable on a mg-to-mg basis. For the IR formulation, divide total daily doses >100 mg into twice-daily dosing.

Binge eating disorder

Binge eating disorder (off-label use): Oral: Immediate release: Initial: 50 mg once daily; increase dose based on response and tolerability up to 300 mg/day (Ref). Divide total daily doses >100 mg into twice-daily dosing (Ref); dosing frequencies of 3 times daily have also been used in a clinical trial with total daily doses of 300 mg/day (Ref).

Body dysmorphic disorder

Body dysmorphic disorder (off-label use): Oral: Immediate release: Initial: 50 mg once daily; may increase dose gradually based on response and tolerability in increments of 50 mg every 2 to 3 weeks to a usual dose of 300 mg/day by week 6 to 10 (Ref). Doses up to 450 mg/day, if tolerated, may be necessary in some patients for optimal response (Ref). Note: An adequate trial for assessment of effect is 12 to 16 weeks, including a dose of 300 mg for at least 4 of those weeks, if needed and tolerated (Ref).

Bulimia nervosa

Bulimia nervosa (off-label use): Oral: Immediate release: Initial: 50 mg once daily; increase dose based on response and tolerability up to 300 mg/day, dividing total daily doses >100 mg into twice-daily dosing (Ref).

Generalized anxiety disorder

Generalized anxiety disorder (off-label use):

Immediate release: Oral: Initial: 50 mg once daily; may increase daily dose in 25 to 50 mg increments based on response and tolerability every ≥3 days up to a therapeutic dose of 100 mg/day; after 4 to 6 weeks, may continue increasing dose in 50 mg increments every 1 to 2 weeks up to a maximum dose of 300 mg/day. Divide total daily doses >100 mg/day into 2 divided doses (Ref). Some experts maintain the initial therapeutic dose for 4 to 6 weeks to assess for efficacy before increasing further (Ref).

Extended release: Oral: Use IR tablets to determine a stable daily dose and then convert to once daily extended release at same total daily dose.

Major depressive disorder

Major depressive disorder (off-label use): Oral: Immediate release: Initial: 50 mg once daily; increase dose based on response and tolerability to usual dosage range of 100 to 200 mg/day, dividing total daily doses >100 mg into twice-daily dosing; doses as high as 300 mg/day have been studied (Ref).

Obsessive-compulsive disorder

Obsessive-compulsive disorder:

Immediate release: Oral: Initial: 50 mg once daily at bedtime; may increase in 50 mg increments at 4- to 7-day intervals, as tolerated; usual dose range: 100 to 300 mg/day, dividing total daily doses >100 mg into twice-daily dosing; maximum dose: 300 mg/day. Some experts recommend doses as high as 450 mg/day when lower doses are well-tolerated but ineffective (Ref).

Extended release: Oral: Initial: 100 mg once daily at bedtime; may increase in 50 mg increments at intervals of at least 1 week; usual dosage range: 100 to 300 mg/day; maximum dose: 300 mg/day. Some experts recommend doses as high as 450 mg/day when lower doses are well-tolerated but ineffective (Ref).

Panic disorder

Panic disorder (off-label use): Oral: Immediate release: Initial: 25 to 50 mg once daily; titrate gradually based on response and tolerability; usual dosage range: 100 to 200 mg/day, dividing total daily doses >100 mg into twice-daily dosing (Ref). Some experts maintain dose at 100 mg for 4 weeks before considering further dose increases. May require 6 weeks at maximally tolerated dose for adequate treatment trial (Ref).

Posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) (off-label use): Oral: Immediate release: 75 mg twice daily (Ref).

Social anxiety disorder

Social anxiety disorder (off-label use): Oral:

Immediate release: Initial: 50 mg once daily; after 4 to 6 weeks at this dose, may increase in 50 mg increments at intervals of at least 1 week, dividing total daily doses >100 mg into twice-daily dosing; usual dosage range: 100 to 300 mg/day (Ref).

Extended release: Initial: 100 mg once daily at bedtime; after 4 to 6 weeks at this dose, may increase in 50 mg increments at intervals of at least 1 week; usual dosage range: 100 to 300 mg daily; maximum dose: 300 mg/day (Ref)

Discontinuation of therapy:When discontinuing antidepressant treatment that has lasted for ≥4 weeks, gradually taper the dose (eg, over 2 to 4 weeks) to minimize withdrawal symptoms and detect reemerging symptoms (Ref). For brief treatment (eg, 2 to 3 weeks) may taper over 1 to 2 weeks; <2 weeks treatment generally does not warrant tapering (Ref). Reasons for a slower taper (eg, over 4 weeks) include prior history of antidepressant withdrawal symptoms or high doses of antidepressants (Ref). If intolerable withdrawal symptoms occur, resume the previously prescribed dose and/or decrease dose at a more gradual rate (Ref). Select patients (eg, those with a history of discontinuation syndrome) on long-term treatment (>6 months) may benefit from tapering over >3 months (Ref). Evidence supporting ideal taper rates is limited (Ref).

Switching antidepressants: Evidence for ideal antidepressant switching strategies is limited; strategies include cross-titration (gradually discontinuing the first antidepressant while at the same time gradually increasing the new antidepressant) and direct switch (abruptly discontinuing the first antidepressant and then starting the new antidepressant at an equivalent dose or lower dose and increasing it gradually). Cross-titration (eg, over 1 to 4 weeks depending upon sensitivity to discontinuation symptoms and adverse effects) is standard for most switches, but is contraindicated when switching to or from a monoamine oxidase inhibitor (MAOI). A direct switch may be an appropriate approach when switching to another agent in the same or similar class (eg, when switching between 2 selective serotonin reuptake inhibitors), when the antidepressant to be discontinued has been used for <1 week, or when the discontinuation is for adverse effects. When choosing the switch strategy, consider the risk of discontinuation symptoms, potential for drug interactions, other antidepressant properties (eg, half-life, adverse effects, pharmacodynamics), and the degree of symptom control desired (Ref).

Switching to or from an MAOI:

Allow 14 days to elapse between discontinuing an MAOI and initiation of fluvoxamine.

Allow 14 days to elapse between discontinuing fluvoxamine and initiation of an MAOI.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Altered kidney function: Oral: No dosage adjustment necessary for any degree of kidney impairment (limited excretion of unchanged drug by the kidney) (Ref).

Hemodialysis, intermittent (thrice weekly): Slightly dialyzable (~22%) (Ref): Oral: No supplemental dose or dosage adjustment necessary (Ref).

Peritoneal dialysis: Unlikely to be significantly dialyzed (large volume of distribution): Oral: No dosage adjustment necessary (Ref).

CRRT: Oral: No dosage adjustment necessary (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): Oral: No dosage adjustment necessary (Ref).

Dosing: Liver Impairment: Adult

Use lower initial doses and titrate slowly; use with caution. Some experts recommend a maximum dose of 150 mg in patients with moderate to severe hepatic impairment (Ref).

Adverse Reactions (Significant): Considerations
Activation of mania or hypomania

Antidepressants (when used as monotherapy) may precipitate a mixed/manic episode in patients with bipolar disorder. Treatment-emergent manic reaction or hypomania have been reported in adult patients with obsessive compulsive disorder and/or unipolar major depressive disorder (MDD) (many cases of bipolar disorder present in episodes of MDD) (Ref).

Mechanism: Non–dose-related; idiosyncratic. Unclear to what extent mood switches represent an uncovering of unrecognized bipolar disorder or a more direct pharmacologic effect independent of diagnosis (Ref).

Onset: Varied; a systematic review observed that the risk of switching increased significantly within the initial 2 years of antidepressant treatment in patients with unipolar MDD receiving an antidepressant as monotherapy, but not thereafter (up to 4.6 years) (Ref).

Risk factors:

• Family history of bipolar disorder (Ref)

• Depressive episode with psychotic symptoms (Ref)

• Younger age at onset of depression (Ref)

• Antidepressant resistance (Ref)

• Females (Ref)

Bleeding risk

Selective serotonin reuptake inhibitors (SSRIs), including fluvoxamine, may increase the risk of bleeding in adults and pediatric patients, particularly if used concomitantly with antiplatelets and/or anticoagulants. Multiple observational studies have found an association with SSRI use and a variety of bleeding complications, ranging from bruising, hematomas, petechiae, purpuric disease and epistaxis, to cerebrovascular accident, upper gastrointestinal hemorrhage, intracranial hemorrhage, abnormal uterine bleeding, and intraoperative bleeding, although conflicting evidence also exists (Ref).

Mechanism: Possibly via inhibition of serotonin-mediated platelet activation and subsequent platelet dysfunction. Fluvoxamine is considered to display moderate affinity for the serotonin reuptake receptor (Ref). SSRIs may also increase gastric acidity, which can increase the risk of GI bleeding (Ref).

Onset: Varied; bleeding risk is likely delayed for several weeks until SSRI-induced platelet depletion becomes clinically significant (Ref); although the onset of bleeding may be more unpredictable if patients are taking concomitant antiplatelets, anticoagulants, or nonsteroidal anti-inflammatory drugs (NSAIDs). For upper GI bleeding, some studies have found risk to be the highest in the first 28 to 30 days (Ref); whereas, another study reported a median time of onset of 25 weeks (Ref).

Risk factors:

• Concomitant use of anticoagulants and/or antiplatelets (Ref)

• Preexisting platelet dysfunction or coagulation disorders (eg, von Willebrand factor) (Ref)

• Concomitant use of NSAIDs increases the risk for upper GI bleeding (Ref)

Fragility fractures

Limited data from observational studies involving mostly adults ≥50 years suggest selective serotonin reuptake inhibitors (SSRIs) are associated with an increased risk of bone fractures (Ref).

Mechanism: Time-related; mechanism not fully elucidated; postulated to be through a direct effect by SSRIs on bone metabolism via interaction with 5-HT and osteoblast, osteocyte, and/or osteoclast activity (Ref). An increased tendency for falls may also contribute to the increased risk of fractures associated with SSRIs (Ref).

Onset: Delayed; risk appears to increase after initiation and may continue to increase with long-term use. A meta-analysis found risk of fracture increased from 2.9% over 1 year to 5.4% over 2 years; within 5 years, risk increased to 13.4% (Ref).

Risk factors:

• Long-term use may be a risk factor (Ref)

Hyponatremia

Selective serotonin reuptake inhibitors are associated with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and/or hyponatremia (including severe cases), predominantly in the elderly (Ref). Hyponatremia is reversible with discontinuation of therapy (Ref).

Mechanism: May cause SIADH via release of antidiuretic hormone (ADH) (Ref) or may cause nephrogenic SIADH by increasing the sensitivity of the kidney to ADH (Ref).

Onset: Intermediate; usually develops within the first few weeks of treatment (Ref).

Risk factors:

• Older age (Ref)

• Females (Ref)

• Concomitant use of diuretics (Ref)

• Low body weight (Ref)

• Lower baseline serum sodium concentration (Ref)

• Volume depletion (Ref)

• History of hyponatremia (potential risk factor) (Ref)

• Symptoms of psychosis (potential risk factor) (Ref)

Ocular effects

Selective serotonin reuptake inhibitors (SSRIs) are associated with acute angle-closure glaucoma (AACG) in case reports and a case-controlled study. AACG may cause symptoms including eye pain, changes in vision, swelling, and redness, which can rapidly lead to permanent blindness if not treated (Ref). In addition, SSRIs may be associated with mydriasis and an increased risk of cataract development (Ref).

Mechanism: AACG: Unclear; hypothesized SSRIs may increase the intraocular pressure via serotonergic effects on ciliary body muscle activation and pupil dilation (Ref).

Risk factors:

For AACG:

Females (Ref)

≥50 years of age (slight increase) (Ref)

Hyperopia (slight increase) (Ref)

Personal or family history of AACG (Ref)

Inuit or Asian descent (Ref)

Serotonin syndrome

Serotonin syndrome has been reported and typically occurs with coadministration of multiple medications that increase synaptic serotonin, but may also occur with a single agent at therapeutic doses (Ref). Serotonin syndrome may result in a spectrum of symptoms, such as anxiety, agitation, confusion, delirium, hyperreflexia, muscle rigidity, myoclonus, tachycardia, tachypnea, and tremor. Severe cases may cause hyperthermia, significant autonomic instability (ie, rapid and severe changes in blood pressure and pulse), coma, and seizures (Ref).

Mechanism: Dose-related; overstimulation of serotonin receptors by medications that increase synaptic serotonin (Ref).

Onset: Rapid; in the majority of cases (74%), onset occurred within 24 hours of treatment initiation, overdose, or change in dose (Ref).

Risk factors:

• Concomitant use of drugs that increase serotonin synthesis, block serotonin reuptake and/or impair serotonin metabolism (eg, monamine oxidase inhibitors [MAOIs]). Of note, concomitant use of some serotonergic agents, such as MAOIs, are contraindicated.

Sexual dysfunction

Selective serotonin reuptake inhibitors (SSRIs) are commonly associated with sexual disorder in both men and women. The following adverse reactions have been associated with SSRI use: Ejaculatory disorder, orgasm disturbance, anorgasmia, erectile dysfunction, decreased libido, and loss of libido (Ref). Priapism and decreased genital sensation have also been reported with SSRIs (Ref).

Mechanism: Increases in serotonin may affect other hormones and neurotransmitters involved in sexual function; in particular, testosterone's effect on sexual arousal and dopamine's role in achieving orgasm (Ref). Elevated serotonin levels may also decrease nitrous oxide levels (due to inhibition of nitrous oxide synthase), resulting in impaired penile blood vessel relaxation and erectile dysfunction (Ref).

Onset: Varied; one study observed an onset of sexual dysfunction within the first 2 to 4 weeks of treatment with fluvoxamine (Ref).

Risk factors:

• Depression (sexual dysfunction is commonly associated with depression; SSRI-associated sexual dysfunction may be difficult to differentiate in treated patients) (Ref)

Suicidal thinking and behavior

Antidepressants are associated with an increased risk of suicidal ideation and suicidal tendencies in pediatric and young adult patients (18 to 24 years of age) in short-term studies. In adults ≥24 years of age, short-term studies did not show an increased risk of suicidal thinking and behavior, and in older adults (≥65 years of age) a decreased risk was observed. Although data have yielded inconsistent results regarding the association of antidepressants and risk of suicide, particularly among adults, collective evidence shows a trend of an elevated risk of suicidality in younger age groups (Ref). Of note, the risk of a suicide attempt is inherent in major depression and may persist until remission occurs.

Mechanism: Not established; one of several postulated mechanisms is antidepressants may energize suicidal patients to act on impulses; another suggests that antidepressants may transiently worsen depressive symptoms leading to the emergence of suicidal thoughts and actions (Ref).

Onset: Varied; increased risk observed in short-term studies (ie, <4 months) in pediatric and young adults; it is unknown whether this risk extends to long-term use (ie, >4 months).

Risk factors:

• Children and adolescents (Ref)

• Depression (risk of suicide is associated with major depression and may persist until remission occurs)

Withdrawal syndrome

Withdrawal syndrome, consisting of both somatic symptoms (eg, dizziness, chills, light-headedness, vertigo, shock-like sensations, paresthesia, fatigue, headache, nausea, tremor, diarrhea, visual disturbances) and psychological symptoms (eg, anxiety, agitation, confusion, insomnia, irritability, mania), have been reported in adult and pediatric patients, primarily following abrupt discontinuation (Ref). Withdrawal symptoms may also occur following gradual tapering (Ref)

Mechanism: Withdrawal; due to reduced availability of serotonin in the CNS with decreasing levels of the selective serotonin reuptake inhibitor. Other neurotransmission systems, including increased glutamine and dopamine, may also be affected as well as the hypothalamic-pituitary-adrenal axis (Ref).

Onset: Intermediate; expected onset is 1 to 10 days (following either abrupt or tapered discontinuation) (Ref); in one study, withdrawal symptoms were most frequently reported on day 5 following fluvoxamine discontinuation (Ref).

Risk factors:

• Abrupt discontinuation (rather than gradual dosage reduction) of an antidepressant treatment that has lasted >3 weeks, particularly a drug with a half-life <24 hours (eg, paroxetine, venlafaxine) (Ref)

• Prior history of antidepressant withdrawal symptoms (Ref)

• High dose (Ref)

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Reported adverse reactions are for adults, adolescents, and children. Frequency varies by dosage form (extended release and immediate release) and indication. Adverse reactions reported as a composite of all indications including off-label uses.

>10%:

Gastrointestinal: Anorexia (6% to 13%), diarrhea (11% to 18%), nausea (34% to 40%), xerostomia (10% to 14%)

Nervous system: Asthenia (14% to 26%), dizziness (11% to 12%), drowsiness (22% to 27%; literature suggests incidence occurs more frequently in adults compared to children and adolescents [Safer 2006]), headache (22% to 32%), insomnia (21% to 35%), nervousness (12%)

1% to 10%:

Cardiovascular: Edema (≥1%), hypertension (2%), hypotension (≥1%), palpitations (3%), syncope, vasodilation (3%; including feeling hot and flushing sensation)

Dermatologic: Acne vulgaris (2%), diaphoresis (7%), ecchymoses (4%)

Endocrine & metabolic: Decreased libido (2% to 10%; incidence higher in males), heavy menstrual bleeding (3%), weight gain (≥1%), weight loss (2%)

Gastrointestinal: Constipation (4% to 10%), dental caries (2% to 3%; including tooth abscess, toothache, and tooth loss), dysgeusia (2% to 3%), dyspepsia (8% to 10%), dysphagia (2%), flatulence (4%), gingivitis (2%), vomiting (5% to 6%; literature suggests prevalence is higher in adolescents compared to adults and is two- to threefold more prevalent in children compared to adults [Safer 2006])

Genitourinary: Anorgasmia (2% to 5%) (table 1), ejaculatory disorder (8% to 10%; including delayed ejaculation and ejaculation failure) (table 2), erectile dysfunction (2%) (table 3), polyuria (2%), sexual disorder (2% to 4%), urinary frequency (3%), urinary retention (1%)

Fluvoxamine: Adverse Reaction: Anorgasmia

Drug (Fluvoxamine)

Placebo

Population

Dosage Form

Indication

Number of Patients (Fluvoxamine)

Number of Patients (Placebo)

5%

0%

Adults

Extended-release capsules

Obsessive compulsive disorder

124

124

2%

0%

Adults

Immediate-release tablets

Obsessive compulsive disorder or depression

892

778

Fluvoxamine: Adverse Reaction: Ejaculatory Disorder

Drug (Fluvoxamine)

Placebo

Population

Dosage Form

Indication

Number of Patients (Fluvoxamine)

Number of Patients (Placebo)

10%

0%

Adults

Extended-release capsules

Obsessive compulsive disorder

N/A

N/A

8%

1%

Adults

Immediate-release tablets

Obsessive compulsive disorder or depression

N/A

N/A

Fluvoxamine: Adverse Reaction: Erectile Dysfunction

Drug (Fluvoxamine)

Placebo

Population

Dosage Form

Indication

Number of Patients (Fluvoxamine)

Number of Patients (Placebo)

2%

1%

Adults

Immediate-release tablets

Obsessive compulsive disorder or depression

N/A

N/A

Infection: Viral infection (2%)

Nervous system: Agitation (2%), amnesia (≥1%), anxiety (5% to 6%), apathy (3%), central nervous system stimulation (2%; including activation syndrome), changes in thinking (3%), chills (2%), depression (2%), hypertonia (2%), malaise, manic reaction (≥1%), myoclonus (≥1%), neurosis (2%), pain (10%), psychotic reaction (≥1%), tremor (5% to 6%), twitching (2%), yawning (2%)

Neuromuscular & skeletal: Hyperkinetic muscle activity (≥1%), hypokinesia (≥1%), myalgia (5%)

Ophthalmic: Amblyopia (2% to 3%; including blurred vision)

Respiratory: Dyspnea (2%), epistaxis (2%) (table 4), flu-like symptoms (3%), increased cough (≥1%), laryngitis (3%), pharyngitis (6%), sinusitis (≥1%), upper respiratory tract infection (9%)

Fluvoxamine: Adverse Reaction: Epistaxis

Drug (Fluvoxamine)

Placebo

Population

Dosage Form

Indication

Number of Patients (Fluvoxamine)

Number of Patients (Placebo)

2%

0%

Adults

Extended-release capsules

Obsessive compulsive disorder

124

124

<1%:

Cardiovascular: Acute myocardial infarction, angina pectoris, atrioventricular block, bradycardia, cardiac conduction delay, cardiac fibrillation, cardiomyopathy, cold extremity, embolism, irregular pulse, pericarditis, phlebitis, ST segment changes on ECG, supraventricular extrasystole

Dermatologic: Alopecia, eczema, exfoliative dermatitis, furunculosis, pallor, seborrhea, skin discoloration, skin photosensitivity, urticaria, xeroderma

Endocrine & metabolic: Dehydration, diabetes mellitus, goiter, hypercholesterolemia, hyperglycemia, hyperlipidemia, hypoglycemia, hypokalemia, hypothyroidism, increased lactate dehydrogenase, increased libido, menopause, premenstrual syndrome, suppressed menstruation

Gastrointestinal: Ageusia, biliary colic, cholecystitis, cholelithiasis, colitis, eructation, esophagitis, fecal incontinence, gastritis, gastrointestinal hemorrhage, gastrointestinal ulcer, glossitis, hematemesis, hemorrhoids, hiccups, intestinal obstruction, melena, rectal hemorrhage, sialorrhea, stomatitis

Genitourinary: Abnormal uterine bleeding, anuria, cystitis, dysuria, hematuria, hemospermia, lactation, nocturia, oliguria, urination disorder (impaired urination), vaginal hemorrhage, vaginitis

Hematologic & oncologic: Anemia, leukocytosis, leukopenia, lymphadenopathy, purpuric disease, thrombocytopenia

Hepatic: Jaundice

Hypersensitivity: Hypersensitivity reaction

Nervous system: Abnormal dreams, agoraphobia, akathisia, akinesia, altered sense of smell, ataxia, central nervous system depression, cerebrovascular accident, coma, confusion, delirium, depersonalization, emotional lability, euphoria, extrapyramidal reaction, hallucination, hemiplegia, hostility, hypersomnia, hypochondriasis, hyporeflexia, hypotonia, hysteria, mutism, myasthenia, paralysis, paranoid ideation, phobia, psychosis, seizure, sleep disorder, slurred speech, stupor, suicidal tendencies (including suicidal ideation), trismus, unsteady gait, vertigo, withdrawal syndrome

Neuromuscular & skeletal: Arthralgia, arthritis, bursitis, dyskinesia, dystonia, muscle spasm, myopathy, neck pain, neck stiffness, tardive dyskinesia, torticollis

Ophthalmic: Accommodation disturbance, conjunctivitis, corneal ulcer, diplopia, dry eye syndrome, eye pain, mydriasis, visual field defect

Renal: Nephrolithiasis

Respiratory: Apnea, asthma, hemoptysis, hoarseness, hyperventilation, laryngismus, obstructive pulmonary disease, pneumonia, pulmonary infarct, respiratory congestion (upper airway)

Frequency not defined: Genitourinary: Priapism

Postmarketing:

Cardiovascular: Prolonged QT interval on ECG, Raynaud disease (Khouri 2016; Peiró 2007), shock, tachycardia, vasculitis, ventricular arrhythmia, ventricular tachycardia (including torsades de pointes)

Dermatologic: Bullous skin disease, Stevens-Johnson syndrome, toxic epidermal necrolysis (Wolkenstein 1993)

Endocrine & metabolic: Amenorrhea, hyponatremia (Gabriel 2009), porphyria, SIADH (Arinzon 2022)

Gastrointestinal: Bruxism, gastroesophageal reflux disease, glossalgia, pancreatitis

Hematologic & oncologic: Agranulocytosis, aplastic anemia, decreased white blood cell count, Henoch-Schonlein purpura

Hepatic: Hepatitis

Hypersensitivity: Anaphylaxis, angioedema

Nervous system: Abnormal gait, aggressive behavior, dysarthria, fatigue, hyperactive behavior (including agitation, hyperactivation, hyperkinesis, and restlessness occurring in children at a two- to threefold higher incidence compared to adolescents; it is more prevalent in adolescents compared to adults) (Safer 2006), homicidal ideation, hypomania (Rihmer 1996), impulsivity, intoxicated feeling, irritability, jitteriness, lethargy, loss of consciousness, neuroleptic malignant syndrome (Stevens 2008), outbursts of anger, parkinsonism, serotonin syndrome (Bastani 1996)

Neuromuscular & skeletal: Rhabdomyolysis (Zhang 2022)

Renal: Acute kidney injury, kidney impairment

Respiratory: Interstitial lung disease

Miscellaneous: Crying, fever

Contraindications

Concurrent use with alosetron, pimozide, thioridazine, or tizanidine; use of monoamine oxidase inhibitors (MAOIs) intended to treat psychiatric disorders (concurrently or within 14 days of discontinuing either fluvoxamine or the MAO inhibitor); initiation of fluvoxamine in a patient receiving IV methylene blue.

Note: Although fluvoxamine is contraindicated per the manufacturer labeling when used in combination with linezolid, new evidence suggests that the combination is unlikely to cause serotonin syndrome (0.06% to 3% risk), and therefore these agents can be administered concomitantly when necessary. Monitor patients on this combination; average duration of serotonin toxicity is ~4 days; however, risks may be greater with longer durations of concurrent therapy. Educate patients on the signs and symptoms of serotonin syndrome (Bai 2022; Butterfield 2012; Karkow 2017; Kufel 2023; Narita 2007; Taylor 2006a).

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to fluvoxamine or any component of the formulation; concurrent use with astemizole, cisapride, mesoridazine, ramelteon, or terfenadine.

Warnings/Precautions

Concerns related to adverse effects:

• CNS depression: Has a low potential to impair cognitive or motor performance; caution operating hazardous machinery or driving.

Disease-related concerns:

• Bariatric surgery: Presurgical assessment of the indication for use, symptoms, and goals of therapy should be documented to enable postsurgical assessment. Monitor for continued efficacy after bariatric surgery and consider switching to an alternate medication if symptoms worsen.

• Cardiovascular disease: Use with caution in patients with cardiovascular disease; fluvoxamine has not been systemically evaluated in patients with a recent history of MI or unstable heart disease.

• Hepatic impairment: Use with caution in patients with hepatic impairment; clearance is decreased and half-life and plasma concentrations are increased; a lower dosage may be needed. However, selective serotonin reuptake inhibitors such as fluvoxamine are considered the safest antidepressants to use in chronic liver disease because of their relative lack of side effects and high therapeutic index (Mullish 2014).

• Seizure disorder: Use with caution in patients with a previous seizure disorder and avoid use with unstable seizure disorder. Discontinue use if seizures occur or if seizure frequency increases.

Concurrent drug therapy issues:

• Smokers: Fluvoxamine levels may be lower in patients who smoke.

Warnings: Additional Pediatric Considerations

Due to limited long-term studies, the clinical usefulness of fluvoxamine should be periodically reevaluated in patients receiving the drug for extended intervals; effects of long-term use of fluvoxamine on pediatric growth, development, and maturation have not been directly assessed.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule Extended Release 24 Hour, Oral, as maleate:

Generic: 100 mg, 150 mg

Tablet, Oral, as maleate:

Generic: 25 mg, 50 mg, 100 mg

Generic Equivalent Available: US

Yes

Pricing: US

Capsule ER 24 Hour Therapy Pack (fluvoxaMINE Maleate ER Oral)

100 mg (per each): $10.18

150 mg (per each): $10.93

Tablets (fluvoxaMINE Maleate Oral)

25 mg (per each): $2.30

50 mg (per each): $2.57

100 mg (per each): $2.63 - $2.64

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral, as maleate:

Luvox: 50 mg, 100 mg

Generic: 50 mg, 100 mg

Administration: Pediatric

Oral: May be administered without regard to meals. Do not chew or crush extended-release capsule; swallow whole.

Administration: Adult

Oral: May be administered with or without food. Do not crush, open, or chew ER capsules.

Bariatric surgery: Fluvoxamine is available as an ER formulation and the release characteristics may be significantly altered in an unknown manner in patients who have undergone bariatric surgery; providers should determine if the condition being treated can be safely monitored or if a switch to an alternative formulation is necessary (Ref). Fluvoxamine is also available as an IR formulation.

Storage/Stability

Protect from high humidity and store at controlled room temperature 25°C (77°F); excursions are permitted between 15°C and 30°C (59°F and 86°F).

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and as follows, must be dispensed with this medication:

Luvox CR capsule: http://www.accessdata.fda.gov/drugsatfda_docs/label/2017/022033s011lbl.pdf#page=26

Fluvoxamine tablet: https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/021519s026lbl.pdf#page=32

Use

Treatment of obsessive-compulsive disorder (OCD) (Immediate release: FDA approved in ages ≥8 years and adults; extended release: FDA approved in adults).

Medication Safety Issues
Sound-alike/look-alike issues:

FluvoxaMINE may be confused with flavoxATE, FLUoxetine, fluPHENAZine

Luvox may be confused with Lasix, Levoxyl, Lovenox

Older Adult: High-Risk Medication:

Beers Criteria: Selective Serotonin Reuptake Inhibitors (SSRIs) are identified in the Beers Criteria as potentially inappropriate medications to be used with caution in patients 65 years and older due to the potential to cause or exacerbate syndrome of inappropriate antidiuretic hormone secretion (SIADH) or hyponatremia; monitor sodium concentration closely when initiating or adjusting the dose in older adults (Beers Criteria [AGS 2023]).

Metabolism/Transport Effects

Substrate of CYP1A2 (Minor), CYP2D6 (Minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential; Inhibits CYP1A2 (Strong), CYP2C19 (Moderate), CYP2C9 (Weak), CYP2D6 (Weak), CYP3A4 (Weak);

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program

Abciximab: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Abrocitinib: Agents with Antiplatelet Effects may increase antiplatelet effects of Abrocitinib. Risk X: Avoid

Acalabrutinib: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Agents with Blood Glucose Lowering Effects: Selective Serotonin Reuptake Inhibitor may increase hypoglycemic effects of Agents with Blood Glucose Lowering Effects. Risk C: Monitor

Agomelatine: CYP1A2 Inhibitors (Strong) may increase serum concentration of Agomelatine. Risk X: Avoid

Alcohol (Ethyl): May increase adverse/toxic effects of Selective Serotonin Reuptake Inhibitor. Specifically, the risk of psychomotor impairment may be enhanced. Management: Patients receiving selective serotonin reuptake inhibitors should be advised to avoid alcohol. Monitor for increased psychomotor impairment in patients who consume alcohol during treatment with selective serotonin reuptake inhibitors. Risk D: Consider Therapy Modification

Almotriptan: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Alosetron: FluvoxaMINE may decrease metabolism of Alosetron. Risk X: Avoid

ALPRAZolam: CYP3A4 Inhibitors (Weak) may increase serum concentration of ALPRAZolam. Risk C: Monitor

Amphetamines: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability). Initiate amphetamines at lower doses, monitor frequently, and adjust doses as needed. Risk C: Monitor

Anagrelide: CYP1A2 Inhibitors (Strong) may increase serum concentration of Anagrelide. CYP1A2 Inhibitors (Strong) may increase active metabolite exposure of Anagrelide. Risk C: Monitor

Anagrelide: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Anticoagulants (Miscellaneous Agents): Antidepressants with Antiplatelet Effects may increase anticoagulant effects of Anticoagulants (Miscellaneous Agents). Risk C: Monitor

Antiemetics (5HT3 Antagonists): May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Antiplatelet Agents (P2Y12 Inhibitors): Agents with Antiplatelet Effects may increase antiplatelet effects of Antiplatelet Agents (P2Y12 Inhibitors). Risk C: Monitor

Antipsychotic Agents: Serotonergic Agents (High Risk) may increase adverse/toxic effects of Antipsychotic Agents. Specifically, serotonergic agents may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotic Agents may increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Risk C: Monitor

Asenapine: CYP1A2 Inhibitors (Strong) may increase serum concentration of Asenapine. Risk C: Monitor

Aspirin: Selective Serotonin Reuptake Inhibitor may increase antiplatelet effects of Aspirin. Risk C: Monitor

Belzutifan: CYP2C19 Inhibitors (Moderate) may increase serum concentration of Belzutifan. Risk C: Monitor

Bendamustine: CYP1A2 Inhibitors (Strong) may increase serum concentration of Bendamustine. Concentrations of the active metabolites of bendamustine may be decreased. Management: Consider alternatives to strong CYP1A2 inhibitors during therapy with bendamustine due to the potential for increased bendamustine plasma concentrations and increased bendamustine toxicity. Risk D: Consider Therapy Modification

Brexanolone: Selective Serotonin Reuptake Inhibitor may increase CNS depressant effects of Brexanolone. Risk C: Monitor

Brivaracetam: CYP2C19 Inhibitors (Moderate) may increase serum concentration of Brivaracetam. Risk C: Monitor

Bromazepam: CYP1A2 Inhibitors (Strong) may increase serum concentration of Bromazepam. Risk C: Monitor

Bromopride: May increase adverse/toxic effects of Selective Serotonin Reuptake Inhibitor. Risk X: Avoid

BuPROPion: May increase adverse/toxic effects of FluvoxaMINE. Risk C: Monitor

BusPIRone: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Caffeine and Caffeine Containing Products: CYP1A2 Inhibitors (Strong) may increase serum concentration of Caffeine and Caffeine Containing Products. Risk C: Monitor

Caplacizumab: Agents with Antiplatelet Effects may increase adverse/toxic effects of Caplacizumab. Specifically, the risk of bleeding may be increased. Risk C: Monitor

CarBAMazepine: CYP3A4 Inhibitors (Weak) may increase serum concentration of CarBAMazepine. Risk C: Monitor

Carisoprodol: CYP2C19 Inhibitors (Moderate) may decrease active metabolite exposure of Carisoprodol. CYP2C19 Inhibitors (Moderate) may increase serum concentration of Carisoprodol. Risk C: Monitor

Cilostazol: CYP2C19 Inhibitors (Moderate) may increase serum concentration of Cilostazol. CYP2C19 Inhibitors (Moderate) may increase active metabolite exposure of Cilostazol. Management: Reduce the cilostazol dose to 50 mg twice daily in patients who are also receiving moderate inhibitors of CYP2C19. Monitor clinical response to cilostazol closely. Risk D: Consider Therapy Modification

Cisapride: FluvoxaMINE may increase serum concentration of Cisapride. Management: Avoid this combination when possible. The combination is specifically contraindicated in at least some non-US labeling. Risk X: Avoid

Citalopram: May increase serotonergic effects of FluvoxaMINE. This could result in serotonin syndrome. Citalopram may increase antiplatelet effects of FluvoxaMINE. FluvoxaMINE may increase serum concentration of Citalopram. Management: Limit citalopram dose to a maximum of 20 mg/day. Monitor for signs and symptoms of bleeding, QTc prolongation, or serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor) if combined. Risk D: Consider Therapy Modification

CloBAZam: CYP2C19 Inhibitors (Moderate) may increase active metabolite exposure of CloBAZam. CYP2C19 Inhibitors (Moderate) may increase serum concentration of CloBAZam. Risk C: Monitor

Clopidogrel: CYP2C19 Inhibitors (Moderate) may decrease active metabolite exposure of Clopidogrel. Risk C: Monitor

CloZAPine: CYP1A2 Inhibitors (Strong) may increase serum concentration of CloZAPine. Management: Reduce the dose of clozapine to one-third of the original dose when adding a strong CYP1A2 inhibitor and monitor patient response closely. Return to the original clozapine dose when the strong CYP1A2 inhibitor is discontinued. Risk D: Consider Therapy Modification

Collagenase (Systemic): Agents with Antiplatelet Effects may increase adverse/toxic effects of Collagenase (Systemic). Specifically, the risk of injection site bruising and or bleeding may be increased. Risk C: Monitor

Cyclobenzaprine: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

CycloSPORINE (Systemic): CYP3A4 Inhibitors (Weak) may increase serum concentration of CycloSPORINE (Systemic). Risk C: Monitor

CYP2D6 Inhibitors (Strong): May increase serum concentration of FluvoxaMINE. Risk C: Monitor

Cyproheptadine: May decrease therapeutic effects of Selective Serotonin Reuptake Inhibitor. Risk C: Monitor

Dapoxetine: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Do not use serotonergic agents (high risk) with dapoxetine or within 7 days of serotonergic agent discontinuation. Do not use dapoxetine within 14 days of monoamine oxidase inhibitor use. Dapoxetine labeling lists this combination as contraindicated. Risk X: Avoid

Dasatinib: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Deoxycholic Acid: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Desmopressin: Hyponatremia-Associated Agents may increase hyponatremic effects of Desmopressin. Risk C: Monitor

Dexlansoprazole: CYP2C19 Inhibitors (Moderate) may increase serum concentration of Dexlansoprazole. Risk C: Monitor

Dexmethylphenidate-Methylphenidate: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Dextromethorphan: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

DiazePAM: CYP2C19 Inhibitors (Moderate) may increase serum concentration of DiazePAM. Risk C: Monitor

Diazoxide Choline: CYP1A2 Inhibitors (Strong) may increase serum concentration of Diazoxide Choline. Risk D: Consider Therapy Modification

Direct Oral Anticoagulants (DOACs): Antidepressants with Antiplatelet Effects may increase anticoagulant effects of Direct Oral Anticoagulants (DOACs). Risk C: Monitor

Dofetilide: CYP3A4 Inhibitors (Weak) may increase serum concentration of Dofetilide. Risk C: Monitor

DULoxetine: May increase serotonergic effects of FluvoxaMINE. This could result in serotonin syndrome. DULoxetine may increase antiplatelet effects of FluvoxaMINE. FluvoxaMINE may increase serum concentration of DULoxetine. Risk X: Avoid

Eletriptan: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Epinephrine (Racemic): Selective Serotonin Reuptake Inhibitor may increase adverse/toxic effects of Epinephrine (Racemic). Risk X: Avoid

Ergot Derivatives: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Erlotinib: FluvoxaMINE may increase serum concentration of Erlotinib. Management: Avoid use of this combination when possible. When the combination must be used, monitor the patient closely for the development of severe adverse reactions, and if such severe reactions occur, reduce the erlotinib dose (in 50 mg decrements). Risk D: Consider Therapy Modification

Etizolam: FluvoxaMINE may increase serum concentration of Etizolam. Risk C: Monitor

Etravirine: CYP2C19 Inhibitors (Moderate) may increase serum concentration of Etravirine. Risk C: Monitor

Fenfluramine: CYP1A2 Inhibitors (Strong) may increase serum concentration of Fenfluramine. Management: Limit fenfluramine dose to 20 mg/day without concurrent stiripentol or to 17 mg/day with concomitant stiripentol and clobazam when used with a strong CYP1A2 inhibitor. Risk D: Consider Therapy Modification

Fezolinetant: CYP1A2 Inhibitors (Strong) may increase serum concentration of Fezolinetant. Risk X: Avoid

Finerenone: CYP3A4 Inhibitors (Weak) may increase serum concentration of Finerenone. Risk C: Monitor

Flibanserin: CYP2C19 Inhibitors (Moderate) may increase serum concentration of Flibanserin. Risk C: Monitor

Flibanserin: CYP3A4 Inhibitors (Weak) may increase serum concentration of Flibanserin. Risk C: Monitor

Fondaparinux: Antidepressants with Antiplatelet Effects may increase anticoagulant effects of Fondaparinux. Risk C: Monitor

Fosphenytoin-Phenytoin: CYP2C19 Inhibitors (Moderate) may increase serum concentration of Fosphenytoin-Phenytoin. Risk C: Monitor

Gepirone: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Risk C: Monitor

Gilteritinib: May decrease therapeutic effects of Selective Serotonin Reuptake Inhibitor. Management: Avoid use of this combination if possible. If the combination cannot be avoided, monitor closely for evidence of reduced response to the selective serotonin reuptake inhibitor. Risk D: Consider Therapy Modification

Glycoprotein IIb/IIIa Inhibitors: Agents with Antiplatelet Effects may increase antiplatelet effects of Glycoprotein IIb/IIIa Inhibitors. Risk C: Monitor

Grapefruit Juice: May increase serum concentration of FluvoxaMINE. Risk C: Monitor

Haloperidol: FluvoxaMINE may increase serum concentration of Haloperidol. Risk C: Monitor

Heparin: Antidepressants with Antiplatelet Effects may increase anticoagulant effects of Heparin. Risk C: Monitor

Heparins (Low Molecular Weight): Antidepressants with Antiplatelet Effects may increase anticoagulant effects of Heparins (Low Molecular Weight). Risk C: Monitor

Herbal Products with Anticoagulant/Antiplatelet Effects: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Ibritumomab Tiuxetan: Agents with Antiplatelet Effects may increase antiplatelet effects of Ibritumomab Tiuxetan. Risk C: Monitor

Ibrutinib: Agents with Antiplatelet Effects may increase adverse/toxic effects of Ibrutinib. Specifically, the risk of bleeding and hemorrhage may be increased. Risk C: Monitor

Inotersen: Agents with Antiplatelet Effects may increase adverse/toxic effects of Inotersen. Specifically, the risk of bleeding may be increased. Risk C: Monitor

Ioflupane I 123: Coadministration of Selective Serotonin Reuptake Inhibitor and Ioflupane I 123 may alter diagnostic results. Risk C: Monitor

Ixabepilone: CYP3A4 Inhibitors (Weak) may increase serum concentration of Ixabepilone. Risk C: Monitor

Lansoprazole: CYP2C19 Inhibitors (Moderate) may increase serum concentration of Lansoprazole. Risk C: Monitor

Lasmiditan: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Lemborexant: CYP3A4 Inhibitors (Weak) may increase serum concentration of Lemborexant. Management: The maximum recommended dosage of lemborexant is 5 mg, no more than once per night, when coadministered with weak CYP3A4 inhibitors. Risk D: Consider Therapy Modification

Levobupivacaine: CYP1A2 Inhibitors (Strong) may increase serum concentration of Levobupivacaine. Risk C: Monitor

Levomethadone: May increase serotonergic effects of FluvoxaMINE. This could result in serotonin syndrome. FluvoxaMINE may increase serum concentration of Levomethadone. Management: Monitor for increased methadone effects/toxicities if combined with fluvoxamine. Also monitor for signs and symptoms of serotonin syndrome/serotonin toxicity if these agents are combined. Risk C: Monitor

Lidocaine (Systemic): CYP1A2 Inhibitors (Strong) may increase serum concentration of Lidocaine (Systemic). Risk C: Monitor

Limaprost: May increase adverse/toxic effects of Agents with Antiplatelet Effects. Specifically, the risk of bleeding may be increased. Risk C: Monitor

Linezolid: May increase serotonergic effects of Selective Serotonin Reuptake Inhibitor. This could result in serotonin syndrome. Risk X: Avoid

Lomitapide: CYP3A4 Inhibitors (Weak) may increase serum concentration of Lomitapide. Management: Patients on lomitapide 5 mg/day may continue that dose. Patients taking lomitapide 10 mg/day or more should decrease the lomitapide dose by half. The lomitapide dose may then be titrated up to a max adult dose of 30 mg/day. Risk D: Consider Therapy Modification

Lumateperone: FluvoxaMINE may increase serum concentration of Lumateperone. Risk C: Monitor

Mavacamten: CYP2C19 Inhibitors (Moderate) may increase serum concentration of Mavacamten. Management: For patients on stable therapy with a moderate CYP2C19 inhibitor initiate mavacamten at 2.5 mg daily. For patients initiating a moderate CYP2C19 inhibitor during mavacamten therapy, dose reductions are recommended. See full mono for details. Risk D: Consider Therapy Modification

Melatonin: CYP1A2 Inhibitors (Strong) may increase serum concentration of Melatonin. Risk X: Avoid

Metaxalone: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Methadone: May increase serotonergic effects of FluvoxaMINE. This could result in serotonin syndrome. FluvoxaMINE may increase serum concentration of Methadone. Management: Monitor for increased methadone effects/toxicities if combined with fluvoxamine. Also monitor for signs and symptoms of serotonin syndrome/serotonin toxicity if these agents are combined. Risk C: Monitor

Methylene Blue: Selective Serotonin Reuptake Inhibitor may increase serotonergic effects of Methylene Blue. This could result in serotonin syndrome. Risk X: Avoid

Methysergide: FluvoxaMINE may increase serum concentration of Methysergide. Risk X: Avoid

Metoclopramide: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Consider monitoring for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Mexiletine: CYP1A2 Inhibitors (Strong) may increase serum concentration of Mexiletine. Risk C: Monitor

Midazolam: CYP3A4 Inhibitors (Weak) may increase serum concentration of Midazolam. Risk C: Monitor

Miscellaneous Antiplatelets: Agents with Antiplatelet Effects may increase antiplatelet effects of Miscellaneous Antiplatelets. Risk C: Monitor

Mivacurium: Selective Serotonin Reuptake Inhibitor may increase serum concentration of Mivacurium. Risk C: Monitor

Monoamine Oxidase Inhibitors (Antidepressant): Selective Serotonin Reuptake Inhibitor may increase serotonergic effects of Monoamine Oxidase Inhibitors (Antidepressant). This could result in serotonin syndrome. Risk X: Avoid

Nefazodone: May increase serotonergic effects of Selective Serotonin Reuptake Inhibitor. This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

NiMODipine: CYP3A4 Inhibitors (Weak) may increase serum concentration of NiMODipine. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective): Selective Serotonin Reuptake Inhibitor may increase antiplatelet effects of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective). Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective) may decrease therapeutic effects of Selective Serotonin Reuptake Inhibitor. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents (Nonselective): Selective Serotonin Reuptake Inhibitor may increase antiplatelet effects of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Nonsteroidal Anti-Inflammatory Agents (Nonselective) may decrease therapeutic effects of Selective Serotonin Reuptake Inhibitor. Management: Consider alternatives to NSAIDs. Monitor for evidence of bleeding and diminished antidepressant effects. It is unclear whether COX-2-selective NSAIDs reduce risk. Risk D: Consider Therapy Modification

Nonsteroidal Anti-Inflammatory Agents (Topical): May increase antiplatelet effects of Selective Serotonin Reuptake Inhibitor. Risk C: Monitor

Obinutuzumab: Agents with Antiplatelet Effects may increase adverse/toxic effects of Obinutuzumab. Specifically, the risk of bleeding may be increased. Management: Consider avoiding coadministration of obinutuzumab and agents with antiplatelet effects, especially during the first cycle of obinutuzumab therapy. Risk D: Consider Therapy Modification

OLANZapine: CYP1A2 Inhibitors (Strong) may increase serum concentration of OLANZapine. Risk C: Monitor

Omeprazole: CYP2C19 Inhibitors (Moderate) may increase serum concentration of Omeprazole. Risk C: Monitor

Ondansetron: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Opioid Agonists (metabolized by CYP3A4 and CYP2D6): May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Opioid Agonists (metabolized by CYP3A4): May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Opioid Agonists: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Opipramol: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Oxitriptan: Serotonergic Agents (High Risk) may increase serotonergic effects of Oxitriptan. This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

OxyCODONE: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Pentosan Polysulfate Sodium: Agents with Antiplatelet Effects may increase adverse/toxic effects of Pentosan Polysulfate Sodium. Specifically, the risk of hemorrhage may be increased. Risk C: Monitor

Pentoxifylline: CYP1A2 Inhibitors (Strong) may increase serum concentration of Pentoxifylline. Risk C: Monitor

PHENobarbital: CYP2C19 Inhibitors (Moderate) may increase serum concentration of PHENobarbital. Risk C: Monitor

Pimozide: CYP3A4 Inhibitors (Weak) may increase serum concentration of Pimozide. Risk X: Avoid

Pimozide: Selective Serotonin Reuptake Inhibitor may increase adverse/toxic effects of Pimozide. Risk X: Avoid

Pirfenidone: CYP1A2 Inhibitors (Strong) may increase serum concentration of Pirfenidone. Management: Avoid concomitant use of pirfenidone and strong CYP1A2 inhibitors whenever possible. If combined, decrease the pirfenidone dose to 801 mg per day (267 mg three times daily) and monitor for increased pirfenidone toxicities. Risk D: Consider Therapy Modification

Pirtobrutinib: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Pomalidomide: CYP1A2 Inhibitors (Strong) may increase serum concentration of Pomalidomide. Management: Avoid when possible. If coadministration is necessary, reduce the pomalidomide dose to 2 mg and monitor for increased pomalidomide effects/toxicities. Risk D: Consider Therapy Modification

Primidone: CYP2C19 Inhibitors (Moderate) may increase active metabolite exposure of Primidone. Specifically, concentrations of phenobarbital may be increased. Risk C: Monitor

Proguanil: CYP2C19 Inhibitors (Moderate) may increase serum concentration of Proguanil. CYP2C19 Inhibitors (Moderate) may decrease active metabolite exposure of Proguanil. Risk C: Monitor

Propranolol: CYP1A2 Inhibitors (Strong) may increase serum concentration of Propranolol. Management: Use a lower initial propranolol dose and be more cautious during propranolol dose titration when combined with strong CYP1A2 inhibitors. Risk D: Consider Therapy Modification

Psilocybin: Antidepressants may decrease therapeutic effects of Psilocybin. Risk C: Monitor

QT-prolonging Agents (Highest Risk): QT-prolonging Agents (Indeterminate Risk - Caution) may increase QTc-prolonging effects of QT-prolonging Agents (Highest Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

QuiNIDine: FluvoxaMINE may increase serum concentration of QuiNIDine. QuiNIDine may increase serum concentration of FluvoxaMINE. Risk C: Monitor

Ramelteon: CYP1A2 Inhibitors (Strong) may increase serum concentration of Ramelteon. Risk X: Avoid

Ramosetron: May increase serotonergic effects of FluvoxaMINE. This could result in serotonin syndrome. FluvoxaMINE may increase serum concentration of Ramosetron. Management: Monitor for increased ramosetron effects/toxicities, including signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability) when these drugs are combined. Risk C: Monitor

Rasagiline: FluvoxaMINE may increase serotonergic effects of Rasagiline. This could result in serotonin syndrome. FluvoxaMINE may increase serum concentration of Rasagiline. Risk X: Avoid

Riluzole: CYP1A2 Inhibitors (Strong) may increase serum concentration of Riluzole. Risk C: Monitor

Roflumilast-Containing Products: FluvoxaMINE may increase serum concentration of Roflumilast-Containing Products. FluvoxaMINE may increase active metabolite exposure of Roflumilast-Containing Products. Risk C: Monitor

ROPINIRole: CYP1A2 Inhibitors (Strong) may increase serum concentration of ROPINIRole. Risk C: Monitor

ROPivacaine: CYP1A2 Inhibitors (Strong) may increase serum concentration of ROPivacaine. Risk C: Monitor

Safinamide: May increase serotonergic effects of Selective Serotonin Reuptake Inhibitor. This could result in serotonin syndrome. Risk X: Avoid

Selective Serotonin Reuptake Inhibitor: May increase serotonergic effects of Selective Serotonin Reuptake Inhibitor. This could result in serotonin syndrome. Selective Serotonin Reuptake Inhibitor may increase antiplatelet effects of Selective Serotonin Reuptake Inhibitor. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, mental status changes) when these agents are combined. In addition, monitor for signs and symptoms of bleeding. Risk C: Monitor

Selegiline: Selective Serotonin Reuptake Inhibitor may increase serotonergic effects of Selegiline. This could result in serotonin syndrome. Risk X: Avoid

Selumetinib: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Serotonergic Agents (High Risk, Miscellaneous): May increase serotonergic effects of Selective Serotonin Reuptake Inhibitor. This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Serotonergic Non-Opioid CNS Depressants: Selective Serotonin Reuptake Inhibitor may increase serotonergic effects of Serotonergic Non-Opioid CNS Depressants. This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Serotonergic Opioids (High Risk): May increase serotonergic effects of Selective Serotonin Reuptake Inhibitor. This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) if these agents are combined. Risk C: Monitor

Serotonin 5-HT1D Receptor Agonists (Triptans): May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Serotonin/Norepinephrine Reuptake Inhibitor: Selective Serotonin Reuptake Inhibitor may increase serotonergic effects of Serotonin/Norepinephrine Reuptake Inhibitor. This could result in serotonin syndrome. Selective Serotonin Reuptake Inhibitor may increase antiplatelet effects of Serotonin/Norepinephrine Reuptake Inhibitor. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, mental status changes) when these agents are combined. In addition, monitor for signs and symptoms of bleeding. Risk C: Monitor

Simvastatin: CYP3A4 Inhibitors (Weak) may increase serum concentration of Simvastatin. CYP3A4 Inhibitors (Weak) may increase active metabolite exposure of Simvastatin. Risk C: Monitor

Sirolimus (Conventional): CYP3A4 Inhibitors (Weak) may increase serum concentration of Sirolimus (Conventional). Risk C: Monitor

Sirolimus (Protein Bound): CYP3A4 Inhibitors (Weak) may increase serum concentration of Sirolimus (Protein Bound). Management: Reduce the dose of protein bound sirolimus to 56 mg/m2 when used concomitantly with a weak CYP3A4 inhibitor. Risk D: Consider Therapy Modification

St John's Wort: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. St John's Wort may decrease serum concentration of Serotonergic Agents (High Risk). Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Syrian Rue: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Risk C: Monitor

Tacrolimus (Systemic): CYP3A4 Inhibitors (Weak) may increase serum concentration of Tacrolimus (Systemic). Risk C: Monitor

Talazoparib: May increase serum concentration of FluvoxaMINE. Risk C: Monitor

Tasimelteon: CYP1A2 Inhibitors (Strong) may increase serum concentration of Tasimelteon. Risk X: Avoid

Theophylline Derivatives: CYP1A2 Inhibitors (Strong) may increase serum concentration of Theophylline Derivatives. Management: Consider avoidance of this combination. If coadministration is necessary, consider an empiric theophylline dose reduction to one-third of the original theophylline dose. Monitor for increased theophylline serum concentrations and toxicities when combined. Risk D: Consider Therapy Modification

Thiazide and Thiazide-Like Diuretics: Selective Serotonin Reuptake Inhibitor may increase hyponatremic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Thioridazine: FluvoxaMINE may increase serum concentration of Thioridazine. Risk X: Avoid

Thrombolytic Agents: Agents with Antiplatelet Effects may increase adverse/toxic effects of Thrombolytic Agents. Specifically, the risk of bleeding may be increased. Risk C: Monitor

Thyroid Products: Selective Serotonin Reuptake Inhibitor may decrease therapeutic effects of Thyroid Products. Thyroid product dose requirements may be increased. Risk C: Monitor

Tilidine: CYP2C19 Inhibitors (Moderate) may increase serum concentration of Tilidine. CYP2C19 Inhibitors (Moderate) may increase active metabolite exposure of Tilidine. Risk C: Monitor

Tipranavir: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

TiZANidine: CYP1A2 Inhibitors (Strong) may increase serum concentration of TiZANidine. Risk X: Avoid

Tobacco (Smoked): May decrease serum concentration of FluvoxaMINE. Risk C: Monitor

TOLBUTamide: CYP2C9 Inhibitors (Weak) may increase serum concentration of TOLBUTamide. Risk C: Monitor

TraMADol: May increase adverse/toxic effects of Selective Serotonin Reuptake Inhibitor. Specifically, the risk for serotonin syndrome/serotonin toxicity and seizures may be increased. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) and seizures when these agents are combined. Risk C: Monitor

Triazolam: CYP3A4 Inhibitors (Weak) may increase serum concentration of Triazolam. Risk C: Monitor

Tricyclic Antidepressants: FluvoxaMINE may increase serotonergic effects of Tricyclic Antidepressants. FluvoxaMINE may increase serum concentration of Tricyclic Antidepressants. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) and increased TCA concentrations/effects if these agents are combined. Risk C: Monitor

Ubrogepant: FluvoxaMINE may increase serum concentration of Ubrogepant. Management: Use an initial ubrogepant dose of 50 mg and consider avoiding a second dose for 24 hours when used with fluvoxamine. Risk D: Consider Therapy Modification

Vasopressin: Drugs Suspected of Causing SIADH may increase therapeutic effects of Vasopressin. Specifically, the pressor and antidiuretic effects of vasopressin may be increased. Risk C: Monitor

Venlafaxine: Selective Serotonin Reuptake Inhibitor may increase antiplatelet effects of Venlafaxine. Selective Serotonin Reuptake Inhibitor may increase serotonergic effects of Venlafaxine. This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, mental status changes) when these agents are combined. In addition, monitor for signs and symptoms of bleeding. Risk C: Monitor

Vitamin E (Systemic): May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Vitamin K Antagonists: FluvoxaMINE may increase anticoagulant effects of Vitamin K Antagonists. FluvoxaMINE may increase serum concentration of Vitamin K Antagonists. Risk C: Monitor

Volanesorsen: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Vorasidenib: CYP1A2 Inhibitors (Strong) may increase serum concentration of Vorasidenib. Risk X: Avoid

Voriconazole: CYP2C19 Inhibitors (Moderate) may increase serum concentration of Voriconazole. Risk C: Monitor

Vortioxetine: May increase serotonergic effects of Selective Serotonin Reuptake Inhibitor. This could result in serotonin syndrome. Vortioxetine may increase antiplatelet effects of Selective Serotonin Reuptake Inhibitor. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, mental status changes) when these agents are combined. In addition, monitor for signs and symptoms of bleeding. Risk C: Monitor

Zanubrutinib: May increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor

Ziprasidone: May increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Risk C: Monitor

Zolpidem: FluvoxaMINE may increase CNS depressant effects of Zolpidem. FluvoxaMINE may increase serum concentration of Zolpidem. Risk C: Monitor

Reproductive Considerations

Evaluate pregnancy status prior to initiating treatment in patients who could become pregnant. Treatment should not be withheld, but pharmacologic management may vary based on reproductive status, severity of illness, and history of antidepressant response (ACOG 2023; WFSBP [Dodd 2018]). When treating depression, anxiety, obsessive-compulsive disorder, or post-traumatic stress disorder, selective serotonin reuptake inhibitors (SSRIs) are preferred for use prior to conception in patients who are treatment naive or who do not have a history of effective treatment. Patients effectively treated may continue their current medication when planning a pregnancy unless contraindications exist (BAP [McAllister-Williams 2017]). Management of mental health conditions in patients who could become pregnant should be based on a shared decision-making process that considers the possibility of pregnancy during treatment (ACOG 2023; BAP [McAllister-Williams 2017]; CANMAT [MacQueen 2016]).

Dysmenorrhea has been reported following use of fluvoxamine. SSRI use may cause hyperprolactinemia and, rarely, changes in thyroid function, both of which can be associated with menstrual irregularities. Depression is also associated with menstrual changes (Padda 2021).

Some studies suggest SSRIs may impair semen parameters, including the motility of spermatozoa; use of other treatments may be preferred in male patients planning a pregnancy (ISSM [Althof 2014]; Sylvester 2019). SSRIs are associated with an increased risk of sexual dysfunction (Tarchi 2023).

Pregnancy Considerations

Fluvoxamine crosses the human placenta (Matsuoka 2017; Monfort 2023).

As a class, selective serotonin reuptake inhibitors (SSRIs) have been evaluated extensively in pregnant patients. Studies focusing on newborn outcomes following first trimester exposure often have inconsistent results due to differences in study design and confounders (ACOG 2023; Anderson 2020; BAP [McAllister-Williams 2017]; Biffi 2020; Fitton 2020; Gao 2018; Lebin 2022). Adverse effects in the newborn following SSRI exposure in the third trimester include neonatal adaptation syndrome and persistent pulmonary hypertension of the newborn (PPHN). Neonatal adaptation syndrome can occur shortly after birth and typically resolves within 2 weeks. Mechanisms of neonatal adaptation syndrome are not well understood but may be due to either SSRI toxicity or withdrawal. Reducing the dose or discontinuing the SSRI prior to delivery to reduce the risk of neonatal adaptation syndrome is not recommended (ACOG 2023). Symptoms can include apnea, constant crying, cyanosis, feeding difficulty, hyperreflexia, hypo- or hypertonia, hypoglycemia, irritability, jitteriness, respiratory distress, seizures, temperature instability, tremor, and vomiting. Prolonged hospitalization, respiratory support, or tube feedings may be required.

PPHN is a rare complication of SSRI use during pregnancy with symptoms of respiratory distress within the first hours of life and an increased risk of neonatal mortality (ACOG 2023). Monitoring of infants exposed to SSRIs late in pregnancy is recommended (Masarwa 2019; Ng 2019). Data related to the long-term effects of in utero SSRI exposure on infant neurodevelopment and behavior are limited (CANMAT [MacQueen 2016]; Lebin 2022).

SSRIs may increase the risk of bleeding; exposure late in pregnancy is associated with less than a 2-fold increase in postpartum hemorrhage. The clinical significance of this is uncertain (BAP [McAllister-Williams 2017]; Lebin 2022)

Due to pregnancy-induced physiologic changes, some pharmacokinetic parameters of fluvoxamine may be altered. Based on limited data, maternal serum concentrations may be decreased in the third trimester. Close clinical monitoring as pregnancy progresses and therapeutic drug monitoring to detect patterns of changing plasma concentrations are recommended to assist dose adjustment when needed (Schoretsanitis 2020; Westin 2017). Untreated and undertreated mental health conditions are associated with adverse pregnancy outcomes. Untreated or undertreated depression is associated with preterm birth, low birth weight (LBW), preeclampsia, postpartum depression, and impaired infant attachment (associated with long-term developmental effects). Anxiety disorders during pregnancy are associated with LBW, preterm birth, and adverse behavioral outcomes in the offspring (ACOG 2023). Patients effectively treated for depression, anxiety, obsessive-compulsive disorder (OCD) or post-traumatic stress disorder (PTSD) in the past may use that medication during pregnancy unless contraindications exist (ACOG 2023; BAP [McAllister-Williams 2017]; CANMAT [MacQueen 2016]). Treatment should not be withheld or discontinued based only on pregnancy status (ACOG 2023).

SSRIs are preferred for use in pregnant patients who are treatment naïve or who do not have a history of effective treatment in the past. An SSRI other than fluvoxamine may be preferred for pregnant patients with no prior medication history (ACOG 2023). SSRI dosing should be initiated with half the lowest recommended dose and titrated gradually over 4 to 10 days. Dose adjustments may be required as pregnancy progresses to keep symptoms in remission (ACOG 2023).

When medications are used, the lowest effective dose of a single agent is recommended. Optimize dosing prior to changing a medication or adding additional agents whenever possible. Monthly monitoring for symptom improvement with a validated screening tool during pregnancy is recommended. Manage side effects as needed (ACOG 2023).

Data collection to monitor pregnancy and infant outcomes following exposure to antidepressant medications is ongoing. Pregnant patients 45 years of age and younger with a history of psychiatric illness are encouraged to enroll in the National Pregnancy Registry for Antidepressants (1-866-961-2388 or https://womensmentalhealth.org/research/pregnancyregistry/antidepressants).

Monitoring Parameters

Evaluate mental status, suicidal ideation (especially at the beginning of therapy or when doses are increased or decreased), anxiety, social functioning, mania, panic attacks, or other unusual changes in behavior; signs/symptoms of serotonin syndrome; akathisia; weight and BMI (particularly in pediatric patients); hepatic function (baseline and as clinically indicated).

Mechanism of Action

Inhibits CNS neuron serotonin uptake; minimal or no effect on reuptake of norepinephrine or dopamine; does not significantly bind to alpha-adrenergic, histamine or cholinergic receptors

Pharmacokinetics (Adult Data Unless Noted)

Onset of action:

Anxiety disorders (obsessive-compulsive, panic, and posttraumatic stress disorder): Initial effects may be observed within 2 weeks of treatment, with continued improvements through 4 to 6 weeks (Issari 2016; Varigonda 2016; WFSBP [Bandelow 2023a]); some experts suggest up to 12 weeks of treatment may be necessary for response, particularly in patients with obsessive-compulsive disorder and posttraumatic stress disorder (BAP [Baldwin 2014]; Katzman 2014; WFSBP [Bandelow 2023a]; WFSBP [Bandelow 2023b]).

Depression: Initial effects may be observed within 1 to 2 weeks of treatment, with continued improvements through 4 to 6 weeks (Papakostas 2006; Posternak 2005; Szegedi 2009; Taylor 2006b).

Distribution: Vd: ~25 L/kg

Protein binding: ~80%, primarily to albumin

Metabolism: Extensively hepatic via oxidative demethylation and deamination

Bioavailability: Immediate release: 53%; Extended release: 84%; not significantly affected by food.

Half-life elimination: ~14 to 16 hours; ~17 to 26 hours in the elderly

Time to peak, plasma: 3 to 8 hours

Excretion: Urine (~85% as metabolites; ~2% as unchanged drug)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Hepatic function impairment: For the IR tablets, a 30% decrease in clearance has been observed in patients with hepatic impairment compared with healthy subjects. Half-life and AUC increased by ~50% following a single dose of immediate release fluvoxamine in patients with alcoholic liver cirrhosis (van Harten 1993).

Pediatric: For the immediate-release tablets, area under the curve (AUC) and Cmax were 1.5- and 2.7-fold higher, respectively, in children 6 to 11 years of age. Female children had significantly higher AUC and Cmax compared with males. AUC and Cmax in adolescents 12 to 17 years of age were similar to adults and there were no gender differences.

Older adult: For the immediate-release tablets, compared with younger subjects, clearance is reduced by 50% and mean max plasma concentrations are 40% higher in the elderly.

Sex: For the extended-release capsules, the AUC and Cmax were increased by approximately 60% in healthy women compared with men.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Apo fluvoxamine | Faverin;
  • (AR) Argentina: Luvox;
  • (AT) Austria: Felixsan | Floxyfral;
  • (AU) Australia: Apo fluvoxamine | Faverin | Fluvoxamine an | Fluvoxamine ga | Luvox | Movox | Voxam;
  • (BD) Bangladesh: Florest | Relafin;
  • (BE) Belgium: Dumirox | Floxyfral | Fluvoxamine eg | Fluvoxamine sandoz | Fluvoxamine teva generics belgium;
  • (BG) Bulgaria: Fevarin;
  • (BR) Brazil: Luvox | Revoc;
  • (CH) Switzerland: Flox-ex | Floxyfral bruchrille | Floxyfral m bruchrille | Floxyfral ohne bruchrill | Floxyfral ohne bruchrille;
  • (CL) Chile: Luvox;
  • (CN) China: Luvox;
  • (CO) Colombia: Fluvoxamina maleato | Luvox;
  • (CZ) Czech Republic: Fevarin;
  • (DE) Germany: Desifluvoxamin | Fevarin | Fluvohexal | Fluvoxadura | Fluvoxamin al | Fluvoxamin beta | Fluvoxamin Ratiopharm | Fluvoxamin stada | Fluvoxamin Synthon | Fluvoxamin Teva;
  • (EE) Estonia: Fevarin;
  • (EG) Egypt: Faverin | Fluvoxamine | Fluxamine | Statomain;
  • (ES) Spain: Dumirox | Fluvoxamina Sandoz;
  • (FI) Finland: Fevarin | Fluvosol;
  • (FR) France: Floxyfral | Fluvoxamine Actavis | Fluvoxamine eg | Fluvoxamine merck | Fluvoxamine sandoz | Fluvoxamine teva;
  • (GB) United Kingdom: Faverin | Fluvoxamine | Fluvoxamine arrow | Fluvoxamine cox | Fluvoxamine kent;
  • (GR) Greece: Dumyrox | Faverin;
  • (HK) Hong Kong: Apo fluvoxamine | Faverin;
  • (HR) Croatia: Fevarin;
  • (HU) Hungary: Fevarin;
  • (ID) Indonesia: Luvox;
  • (IE) Ireland: Faverin;
  • (IL) Israel: Favoxil;
  • (IN) India: Cererest | Defluvox | Fluoxa | Fluvaris | Fluvator | Fluvo | Fluvoxin | Frext | Ocdox | Ocivox | Oxvun | Psyvoxin | Revilife | Sorest | Uvamat | Uvox | Voxaday | Voxamin | Voxidep;
  • (IT) Italy: Dumirox | Fevarin | Fluvoxamina EG | Maveral;
  • (JO) Jordan: Faverin;
  • (JP) Japan: Depromel | Fluvoxamine maleate mylan | Fluvoxamine maleate np | Fluvoxamine maleate teva kowa | Luvox;
  • (KE) Kenya: Faverin;
  • (KR) Korea, Republic of: Dumirox | Luvox;
  • (KW) Kuwait: Apo fluvoxamine | Faverin;
  • (LB) Lebanon: Faverin;
  • (LT) Lithuania: Fevarin;
  • (LU) Luxembourg: Dumirox | Floxyfral;
  • (LV) Latvia: Fevarin;
  • (MX) Mexico: Fluvoxamina synthon | Forezol | Vuminix;
  • (MY) Malaysia: Apo fluvoxamine | Fluvox | Luvox;
  • (NL) Netherlands: Fevarin | Fluvoxamine Maleaat EB | Fluvoxamine-Maleaat A | Fluvoxaminemaleaat | Fluvoxaminemaleaat CF | Fluvoxaminemaleaat Katwijk | Fluvoxaminemaleaat Merck | Fluvoxaminemaleaat PCH | Fluvoxaminemaleaat Sandoz;
  • (NO) Norway: Fevarin;
  • (NZ) New Zealand: Fluvoxamine;
  • (PE) Peru: Luvox;
  • (PH) Philippines: Faverin | Voxamine;
  • (PK) Pakistan: Amvoxa | Faverin | Fluvox | Fulvana | Oxamine | Revilife | Voxamine;
  • (PL) Poland: Fevarin;
  • (PT) Portugal: Dumyrox | Fluvoxamina Generis;
  • (PY) Paraguay: Luvox;
  • (QA) Qatar: Apo-Fluvoxamine | Faverin | Floxyfral;
  • (RO) Romania: Deprivox | Fevarin | Fluvoxamine teva;
  • (RU) Russian Federation: Fevarin | Rokona;
  • (SA) Saudi Arabia: Apo fluvoxamine | Faverin | Fluvoxamine;
  • (SE) Sweden: Fevarin | Fluvosol;
  • (SG) Singapore: Faverin;
  • (SI) Slovenia: Avoxin;
  • (SK) Slovakia: Fevarin;
  • (TH) Thailand: Faverin | Fluvoxin;
  • (TN) Tunisia: Floxyfral;
  • (TR) Turkey: Faverin | Fluvamteva | Revoxin;
  • (TW) Taiwan: Anwu | Fluvoxin | Lote | Luvox;
  • (UA) Ukraine: Fevarin | Fluvoxamine;
  • (UG) Uganda: Faverin;
  • (UY) Uruguay: Dumirox | Fluvoprex;
  • (ZA) South Africa: Faverin | Fluvoxamine oethmaan | Luvox
  1. 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372 [PubMed 37139824]
  2. Althof SE, McMahon CG, Waldinger MD, et al. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). Sex Med. 2014;2(2):60-90. doi:10.1002/sm2.28 [PubMed 25356302]
  3. American Academy of Child and Adolescent Psychiatry (AACAP). Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry. 2012;51(1):98-113. doi:10.1016/j.jaac.2011.09.019 [PubMed 22176943]
  4. American College of Obstetricians and Gynecologists (ACOG) Committee on Clinical Practice Guidelines—Obstetrics. Practice Bulletin No. 5: Treatment and management of mental health conditions during pregnancy and postpartum. Obstet Gynecol. 2023;141(6):1262-1288. doi:10.1097/AOG.0000000000005202 [PubMed 37486661]
  5. American Psychiatric Association (APA). Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/acutestressdisorderptsd.pdf. Published November 2004. Accessed July 20, 2021.
  6. American Psychiatric Association (APA). Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. Published October 2010. Accessed August 4, 2023. http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf
  7. American Psychiatric Association (APA). Practice guideline for the treatment of patients with obsessive-compulsive disorder. July 2007. http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/ocd.pdf
  8. American Psychiatric Association (APA). Practice guideline for the treatment of patients with panic disorder. http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/panicdisorder.pdf. Published January 2009. Accessed March 11, 2015.
  9. American Psychological Association (APA) Guideline Development Panel for the Treatment of Depressive Disorders. Clinical practice guideline for the treatment of depression across three age cohorts. Published February 16, 2019. https://www.apa.org/depression-guideline/guideline.pdf
  10. Anderson KN, Lind JN, Simeone RM, et al. Maternal use of specific antidepressant medications during early pregnancy and the risk of selected birth defects. JAMA Psychiatry. 2020;77(12):1246-1255. doi:10.1001/jamapsychiatry.2020.2453 [PubMed 32777011]
  11. Anderson PO. Antidepressants and breastfeeding. Breastfeed Med. 2021;16(1):5-7. doi:10.1089/bfm.2020.0350 [PubMed 33237799]
  12. Anderson PO, Sauberan JB. Modeling drug passage into human milk. Clin Pharmacol Ther. 2016;100(1):42-52. [PubMed 27060684]
  13. Andrade C, Sandarsh S, Chethan KB, Nagesh KS. Serotonin reuptake inhibitor antidepressants and abnormal bleeding: a review for clinicians and a reconsideration of mechanisms. J Clin Psychiatry. 2010;71(12):1565-1575. doi:10.4088/JCP.09r05786blu [PubMed 21190637]
  14. Anglin R, Yuan Y, Moayyedi P, Tse F, Armstrong D, Leontiadis GI. Risk of upper gastrointestinal bleeding with selective serotonin reuptake inhibitors with or without concurrent nonsteroidal anti-inflammatory use: a systematic review and meta-analysis. Am J Gastroenterol. 2014;109(6):811-819. doi:10.1038/ajg.2014.82 [PubMed 24777151]
  15. Arinzon ZH, Lehman YA, Fidelman ZG, Krasnyansky II. Delayed recurrent SIADH associated with SSRIs. Ann Pharmacother. 2002;36(7-8):1175-1177. doi:10.1345/aph.1A337 [PubMed 12086550]
  16. Asakura S; Tajima O; Koyama T. Fluvoxamine treatment of generalized social anxiety disorder in Japan: a randomized double-blind, placebo-controlled study. Int J Neuropsychopharmacol. 2007;10(2):263-274. [PubMed 16573847]
  17. Asnis GM, Hameedi FA, Goddard AW, et al. Fluvoxamine in the treatment of panic disorder: a multi-center, double-blind, placebo-controlled study in outpatients. Psychiatry Res. 2001;103(1):1-14. [PubMed 11472786]
  18. Auerbach AD, Vittinghoff E, Maselli J, Pekow PS, Young JQ, Lindenauer PK. Perioperative use of selective serotonin reuptake inhibitors and risks for adverse outcomes of surgery. JAMA Intern Med. 2013;173(12):1075-1081. doi:10.1001/jamainternmed.2013.714 [PubMed 23699725]
  19. Bai AD, McKenna S, Wise H, Loeb M, Gill SS. Association of linezolid with risk of serotonin syndrome in patients receiving antidepressants. JAMA Netw Open. 2022;5(12):e2247426. doi:10.1001/jamanetworkopen.2022.47426 [PubMed 36534400]
  20. Bakker S, Burggraaf JLI, Kruip MJHA, van der Meer FJM, Lijfering WM, van Rein N. Selective serotonin reuptake inhibitor use and risk of major bleeding during treatment with vitamin K antagonists: results of a cohort study. Thromb Haemost. 2023;123(2):245-254. doi:10.1055/a-1957-6305 [PubMed 36208621]
  21. Baldessarini RJ, Faedda GL, Offidani E, et al. Antidepressant-associated mood-switching and transition from unipolar major depression to bipolar disorder: a review. J Affect Disord. 2013;148(1):129-135. doi:10.1016/j.jad.2012.10.033 [PubMed 23219059]
  22. Baldwin DS, Anderson IM, Nutt DJ, et al. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol. 2014;28(5):403-439. doi:10.1177/0269881114525674 [PubMed 24713617]
  23. Balon R. Fluvoxamine-induced erectile dysfunction responding to sildenafil. J Sex Marital Ther. 1998;24(4):313-317. doi:10.1080/00926239808403967 [PubMed 9805292]
  24. Bandelow B, Allgulander C, Baldwin DS, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders - version 3. Part I: anxiety disorders. World J Biol Psychiatry. 2023a;24(2):79-117. doi:10.1080/15622975.2022.2086295 [PubMed 35900161]
  25. Bandelow B, Allgulander C, Baldwin DS, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders - version 3. Part II: OCD and PTSD. World J Biol Psychiatry. 2023b;24(2):118-134. doi:10.1080/15622975.2022.2086296 [PubMed 35900217]
  26. Barbuti M, Pacchiarotti I, Vieta E, et al. Antidepressant-induced hypomania/mania in patients with major depression: evidence from the BRIDGE-II-MIX study. J Affect Disord. 2017;219:187-192. doi:10.1016/j.jad.2017.05.035 [PubMed 28558366]
  27. Bartlett D. Drug-induced serotonin syndrome. Crit Care Nurse. 2017;37(1):49-54. doi:10.4037/ccn2017169 [PubMed 28148614]
  28. Bastani JB, Troester MM, Bastani AJ. Serotonin syndrome and fluvoxamine: a case study. Nebr Med J. 1996;81(4):107-109. [PubMed 8628448]
  29. Bauer M, Pfennig A, Severus E, Whybrow PC, Angst J, Möller HJ; World Federation of Societies of Biological Psychiatry; Task Force on Unipolar Depressive Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 1: update 2013 on the acute and continuation treatment of unipolar depressive disorders. World J Biol Psychiatry. 2013;14(5):334-385. [PubMed 23879318]
  30. Bauer M, Severus E, Köhler S, Whybrow PC, Angst J, Möller HJ; WFSBP Task Force on Treatment Guidelines for Unipolar Depressive Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders. Part 2: maintenance treatment of major depressive disorder-update 2015. World J Biol Psychiatry. 2015;16(2):76-95. doi:10.3109/15622975.2014.1001786 [PubMed 25677972]
  31. Bauer M, Whybrow PC, Anst J, et al. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders, Part 2: Maintenance treatment of major depressive disorder and treatment of chronic depressive disorders and subthreshold depressions. World J Biol Psychiatry. 2002;3(2):69-86. [PubMed 12479080]
  32. Benedek DM, Friedman MJ, Zatzick D, Ursano RJ. Guideline watch (March 2009): Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/acutestressdisorderptsd-watch.pdf. Published March 2009. Accessed July 30, 2021.
  33. Benazzi F. Antidepressant-associated hypomania in outpatient depression: a 203-case study in private practice. J Affect Disord. 1997;46(1):73-77. doi:10.1016/s0165-0327(97)00082-7 [PubMed 9387089]
  34. Benazzi F. SSRI discontinuation syndrome related to fluvoxamine. J Psychiatry Neurosci. 1998;23(2):94. [PubMed 9549249]
  35. Berle JO, Spigset O. Antidepressant use during breastfeeding. Curr Womens Health Rev. 2011;7(1):28-34. [PubMed 22299006]
  36. Biffi A, Cantarutti A, Rea F, Locatelli A, Zanini R, Corrao G. Use of antidepressants during pregnancy and neonatal outcomes: an umbrella review of meta-analyses of observational studies. J Psychiatr Res. 2020;124:99-108. doi:10.1016/j.jpsychires.2020.02.023 [PubMed 32135392]
  37. Bixby AL, VandenBerg A, Bostwick JR. Clinical management of bleeding risk with antidepressants. Ann Pharmacother. 2019;53(2):186-194. doi:10.1177/1060028018794005 [PubMed 30081645]
  38. Black DW, Wesner R, Gabel J. The abrupt discontinuation of fluvoxamine in patients with panic disorder. J Clin Psychiatry. 1993;54(4):146-149. [PubMed 8486592]
  39. Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. 2005;352(11):1112-1120. doi:10.1056/NEJMra041867 [PubMed 15784664]
  40. Brambilla F, Draisci A, Peirone A, Brunetta M. Combined cognitive-behavioral, psychopharmacological and nutritional therapy in bulimia nervosa. Neuropsychobiology. 1995;32(2):68-71. [PubMed 7477802]
  41. Butterfield JM, Lawrence KR, Reisman A, Huang DB, Thompson CA, Lodise TP. Comparison of serotonin toxicity with concomitant use of either linezolid or comparators and serotonergic agents: an analysis of phase III and IV randomized clinical trial data. J Antimicrob Chemother. 2012;67(2):494-502. doi:10.1093/jac/dkr467 [PubMed 22139199]
  42. Carvalho AF, Sharma MS, Brunoni AR, Vieta E, Fava GA. The safety, tolerability and risks associated with the use of newer generation antidepressant drugs: a critical review of the literature. Psychother Psychosom. 2016;85(5):270-288. doi:10.1159/000447034 [PubMed 27508501]
  43. Ceylan ME, Maner F. Long-term use of fluoxetine and multiple skeleton fractures. Eur J Clin Pharmacol. 2010;66(12):1279. doi:10.1007/s00228-010-0880-8 [PubMed 20703452]
  44. Chen HY, Lin CL, Lai SW, Kao CH. Association of selective serotonin reuptake inhibitor use and acute angle-closure glaucoma. J Clin Psychiatry. 2016;77(6):e692-e696. doi:10.4088/JCP.15m10038 [PubMed 27135704]
  45. Cheung AH, Kozloff N, Sacks D. Pediatric depression: an evidence-based update on treatment interventions. Curr Psychiatry Rep. 2013;15(8):381. doi:10.1007/s11920-013-0381-4 [PubMed 23881712]
  46. Cheung AH, Zuckerbrot RA, Jensen PS, Laraque D, Stein REK; GLAD-PC Steering Group. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II. Treatment and ongoing management. Pediatrics. 2018;141(3):e20174082. doi:10.1542/peds.2017-4082 [PubMed 29483201]
  47. Chou PH, Chu CS, Chen YH, et al. Antidepressants and risk of cataract development: a population-based, nested case-control study. J Affect Disord. 2017;215:237-244. doi:10.1016/j.jad.2017.03.044 [PubMed 28342338]
  48. Coskuner ER, Culha MG, Ozkan B, Kaleagasi EO. Post-SSRI sexual dysfunction: preclinical to clinical. Is it fact or fiction?. Sex Med Rev. 2018;6(2):217-223. doi:10.1016/j.sxmr.2017.11.004 [PubMed 29463440]
  49. Costagliola C, Parmeggiani F, Semeraro F, Sebastiani A. Selective serotonin reuptake inhibitors: a review of its effects on intraocular pressure. Curr Neuropharmacol. 2008;6(4):293-310. doi:10.2174/157015908787386104 [PubMed 19587851]
  50. Craske M, Bystritsky A. Generalized anxiety disorder in adults: management. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 22, 2023.
  51. Crone C, Fochtmann LJ, Attia E, et al; Guideline Writing Group. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders. 4th ed. American Psychiatric Association. Published 2023. Accessed March 15, 2023. doi:10.1176/appi.books.9780890424865
  52. Csoka AB, Bahrick A, Mehtonen OP. Persistent sexual dysfunction after discontinuation of selective serotonin reuptake inhibitors. J Sex Med. 2008;5(1):227-233. doi:10.1111/j.1743-6109.2007.00630.x [PubMed 18173768]
  53. Dall M, Schaffalitzky de Muckadell OB, Lassen AT, Hansen JM, Hallas J. An association between selective serotonin reuptake inhibitor use and serious upper gastrointestinal bleeding. Clin Gastroenterol Hepatol. 2009;7(12):1314-1321. doi:10.1016/j.cgh.2009.08.019 [PubMed 19716436]
  54. Davidson J, Yaryura-Tobias J, DuPont R, et al. Fluvoxamine-Controlled Release Formulation for the Treatment of Generalized Social Anxiety Disorder. J Clin Psychopharmacol. 2004;24(2):118-125. [PubMed 15206657]
  55. De Picker L, Van Den Eede F, Dumont G, Moorkens G, Sabbe BG. Antidepressants and the risk of hyponatremia: a class-by-class review of literature. Psychosomatics. 2014;55(6):536-547. doi:10.1016/j.psym.2014.01.010 [PubMed 25262043]
  56. De Vries MH, Raghoebar M, Mathlener IS, et al. Single and Multiple Oral Dose Fluvoxamine Kinetics in Young and Elderly Subjects. Ther Drug Monit. 1992;14(6):493-498. [PubMed 1485372]
  57. Diler R, Avci A. Selective Serotonin Reuptake Inhibitor Discontinuation Syndrome in Children: Six Case Reports. Current Therapeutic Research. 2002;63(3):188-197.
  58. Dodd S, Mitchell PB, Bauer M, et al. Monitoring for antidepressant-associated adverse events in the treatment of patients with major depressive disorder: an international consensus statement. World J Biol Psychiatry. 2018;19(5):330-348. doi:10.1080/15622975.2017.1379609 [PubMed 28984491]
  59. Dorevitch A, Davis H. Fluvoxamine-associated sexual dysfunction. Ann Pharmacother. 1994;28(7-8):872-874. doi:10.1177/106002809402800709 [PubMed 7949503]
  60. Dorevitch A, Frankel Y, Bar-Halperin A, Aronzon R, Zilberman L. Fluvoxamine-associated manic behavior: a case series. Ann Pharmacother. 1993;27(12):1455-1457. doi:10.1177/106002809302701207 [PubMed 8305775]
  61. Douros A, Ades M, Renoux C. Risk of intracranial hemorrhage associated with the use of antidepressants inhibiting serotonin reuptake: a systematic review. CNS Drugs. 2018;32(4):321-334. doi:10.1007/s40263-018-0507-7 [PubMed 29536379]
  62. Dunkley EJ, Isbister GK, Sibbritt D, et al. The Hunter Serotonin Toxicity Criteria: Simple and Accurate Diagnostic Decision Rules for Serotonin Toxicity. QJM. 2003;96(9):635-642. [PubMed 12925718]
  63. Dvořáčková E, Pilková A, Matoulek M, Slanař O, Hartinger JM. Bioavailability of orally administered drugs after bariatric surgery. Curr Obes Rep. 2024;13(1):141-153. doi:10.1007/s13679-023-00548-7 [PubMed 38172482]
  64. Ebert D, Albert R, May A, et al. The serotonin syndrome and psychosis-like side-effects of fluvoxamine clinical use--an estimation of incidence. Eur Neuropsychopharmacol. 1997;7(1):71-74. doi:10.1016/s0924-977x(96)00043-0 [PubMed 9088888]
  65. Erie JC, Brue SM, Chamberlain AM, Hodge DO. Selective serotonin reuptake inhibitor use and increased risk of cataract surgery: a population-based, case-control study. Am J Ophthalmol. 2014;158(1):192-197.e1. doi:10.1016/j.ajo.2014.03.006 [PubMed 24631758]
  66. Expert opinion. Senior Renal Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
  67. Fava GA, Gatti A, Belaise C, Guidi J, Offidani E. Withdrawal symptoms after selective serotonin reuptake inhibitor discontinuation: a systematic review. Psychother Psychosom. 2015;84(2):72-81. doi:10.1159/000370338 [PubMed 25721705]
  68. Fenske JN, Schwenk TL. Obsessive compulsive disorder: diagnosis and management. Am Fam Physician. 2009;80(3):239-245. [PubMed 19621834]
  69. Fichter MM, Krüger R, Rief W, Holland R, Döhne J. Fluvoxamine in prevention of relapse in bulimia nervosa: effects on eating-specific psychopathology. J Clin Psychopharmacol. 1996;16(1):9-18 [PubMed 8834413]
  70. Fichter MM, Leibl C, Krüger R, Rief W. Effects of fluvoxamine on depression, anxiety, and other areas of general psychopathology in bulimia nervosa. Pharmacopsychiatry. 1997;30(3):85-92. [PubMed 9211569]
  71. Fitton CA, Steiner MFC, Aucott L, et al. In utero exposure to antidepressant medication and neonatal and child outcomes: a systematic review. Acta Psychiatr Scand. 2020;141(1):21-33. doi:10.1111/acps.13120 [PubMed 31648376]
  72. Fluvoxamine for the Treatment of Anxiety Disorders in Children and Adolescents. The Research Unit on Pediatric Psychopharmacology Anxiety Study Group. N Engl J Med. 2001;344(17):1279-1285. [PubMed 11323729]
  73. Fluvoxamine Maleate extended-release capsules [prescribing information]. Chestnut Ridge, NY: Par Pharmaceutical; August 2021.
  74. Fluvoxamine maleate extended-release capsules [prescribing information]. Parsippany, NJ: Teva Pharmaceuticals; October 2023.
  75. Fluvoxamine maleate tablets [prescribing information]. Baudette, MN: ANI Pharmaceuticals Inc; August 2023.
  76. Fluvoxamine maleate tablets, USP [prescribing information]. Weston, FL: Apotex Corp; November 2021.
  77. Friedlander AH, Mahler ME. Major Depressive Disorder. Psychopathology, Medical Management, and Dental Implications. J Am Dent Assoc. 2001;132(5):629-638. [PubMed 11367967]
  78. Friedman RA, Leon AC. Expanding the black box - depression, antidepressants, and the risk of suicide. N Engl J Med. 2007;356(23):2343-2346. doi:10.1056/NEJMp078015 [PubMed 17485726]
  79. Gabriel A. Serotonin reuptake inhibitor and fluvoxamine-induced severe hyponatremia in a 49-year-old man. Case Rep Med. 2009;2009:585193. doi:10.1155/2009/585193 [PubMed 19829765]
  80. Gao SY, Wu QJ, Sun C, Zhang TN, et al. Selective serotonin reuptake inhibitor use during early pregnancy and congenital malformations: a systematic review and meta-analysis of cohort studies of more than 9 million births. BMC Med. 2018;16(1):205. doi:10.1186/s12916-018-1193-5 [PubMed 30415641]
  81. Gerber PE, Lynd LD. Selective Serotonin Reuptake Inhibitor-induced Movement Disorders. Ann Pharmacother. 1998;32(6):692-698. [PubMed 9640489]
  82. Gill N, Bayes A, Parker G. A review of antidepressant-associated hypomania in those diagnosed with unipolar depression-risk factors, conceptual models, and management. Curr Psychiatry Rep. 2020;22(4):20. doi:10.1007/s11920-020-01143-6 [PubMed 32215771]
  83. Gregorian RS, Golden KA, Bahce A, Goodman C, Kwong WJ, Khan ZM. Antidepressant-induced sexual dysfunction. Ann Pharmacother. 2002;36(10):1577-1589. doi:10.1345/aph.1A195 [PubMed 12243609]
  84. Grimsley SR, Jann MW. Paroxetine, Sertraline, and Fluvoxamine: New Selective Serotonin Reuptake Inhibitors. Clin Pharm. 1992;11(11):930-957. [PubMed 1464219]
  85. Haddad PM. Antidepressant discontinuation syndromes. Drug Saf. 2001;24(3):183-197. [PubMed 11347722]
  86. Halperin D, Reber G. Influence of antidepressants on hemostasis. Dialogues Clin Neurosci. 2007;9(1):47-59. doi:10.31887/DCNS.2007.9.1/dhalperin [PubMed 17506225]
  87. Hammad TA, Laughren T, Racoosin J. Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry. 2006;63(3):332-339. doi:10.1001/archpsyc.63.3.332 [PubMed 16520440]
  88. Hathaway EE, Walkup JT, Strawn JR. Antidepressant Treatment Duration in Pediatric Depressive and Anxiety Disorders: How Long is Long Enough? Curr Probl Pediatr Adolesc Health Care. 2018;48(2):31-39. [PubMed 29337001]
  89. Heller HM, Ravelli ACJ, Bruning AHL, et al. Increased postpartum haemorrhage, the possible relation with serotonergic and other psychopharmacological drugs: a matched cohort study. BMC Pregnancy Childbirth. 2017;17(1):166. doi:10.1186/s12884-017-1334-4 [PubMed 28577352]
  90. Hetrick SE, McKenzie JE, Cox GR, Simmons MB, Merry SN. Newer generation antidepressants for depressive disorders in children and adolescents. Cochrane Database Syst Rev. 2012;11(11):CD004851. doi:10.1002/14651858.CD004851.pub3 [PubMed 23152227]
  91. Himmerich H, Lewis YD, Conti C, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines update 2023 on the pharmacological treatment of eating disorders. World J Biol Psychiatry. doi:10.1080/15622975.2023.2179663 [PubMed 37350265]
  92. Hirsch M, Birnbaum RJ. Discontinuing antidepressant medications in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed January 2, 2024.
  93. Hirsch M, Birnbaum RJ. Selective serotonin reuptake inhibitors: pharmacology, administration, and side effects. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed September 8, 2021.
  94. Hudson JI, McElroy SL, Raymond NC, et al. Fluvoxamine in the treatment of binge-eating disorder: a multicenter placebo-controlled, double-blind trial. Am J Psychiatry. 1998;155(12):1756-1762. doi:10.1176/ajp.155.12.1756 [PubMed 9842788]
  95. Issari Y, Jakubovski E, Bartley CA, Pittenger C, Bloch MH. Early onset of response with selective serotonin reuptake inhibitors in obsessive-compulsive disorder: a meta-analysis. J Clin Psychiatry. 2016;77(5):e605-e611. doi:10.4088/JCP.14r09758 [PubMed 27249090]
  96. Ito S. Drug therapy for breast-feeding women. N Engl J Med. 2000;343(2):118-126. [PubMed 10891521]
  97. Jacob S, Spinler SA. Hyponatremia associated with selective serotonin-reuptake inhibitors in older adults. Ann Pharmacother. 2006;40(9):1618-1622. doi:10.1345/aph.1G293 [PubMed 16896026]
  98. Jefferson JW, Greist JH, Perse TL, Rosenfeld R. Fluvoxamine-associated mania/hypomania in patients with obsessive-compulsive disorder. J Clin Psychopharmacol. 1991;11(6):391-392. doi:10.1097/00004714-199112000-00020 [PubMed 1770160]
  99. Jeong BO, Kim SW, Kim SY, Kim JM, Shin IS, Yoon JS. Use of serotonergic antidepressants and bleeding risk in patients undergoing surgery. Psychosomatics. 2014;55(3):213-220. doi:10.1016/j.psym.2013.08.011 [PubMed 24314591]
  100. Jha MK, Rush AJ, Trivedi MH. When discontinuing SSRI antidepressants is a challenge: management tips. Am J Psychiatry. 2018;175(12):1176-1184. doi:10.1176/appi.ajp.2018.18060692 [PubMed 30501420]
  101. Jiménez-Jiménez FJ, Ortí-Pareja M, Zurdo JM. Aggravation of glaucoma with fluvoxamine. Ann Pharmacother. 2001;35(12):1565-1566. doi:10.1345/aph.1Z440 [PubMed 11793621]
  102. Jing E, Straw-Wilson K. Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: a narrative literature review. Ment Health Clin. 2016;6(4):191-196. doi:10.9740/mhc.2016.07.191 [PubMed 29955469]
  103. Kamo T, Horikawa N, Tsuruta Y, Miyasita M, Hatakeyama H, Maebashi Y. Efficacy and pharmacokinetics of fluvoxamine maleate in patients with mild depression undergoing hemodialysis. Psychiatry Clin Neurosci. 2004;58(2):133-137. doi:10.1111/j.1440-1819.2003.01206.x [PubMed 15009816]
  104. Karkow DC, Kauer JF, Ernst EJ. Incidence of serotonin syndrome with combined use of linezolid and serotonin reuptake inhibitors compared with linezolid monotherapy. J Clin Psychopharmacol. 2017;37(5):518-523. doi:10.1097/JCP.0000000000000751 [PubMed 28796019]
  105. Katzman MA, Bleau P, Blier P, et al; Canadian Anxiety Guidelines Initiative Group. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14(suppl 1):S1. doi: 10.1186/1471-244X-14-S1-S1. [PubMed 25081580]
  106. Khan A, Khan S, Kolts R, Brown WA. Suicide rates in clinical trials of SSRIs, other antidepressants, and placebo: analysis of FDA reports. Am J Psychiatry. 2003;160(4):790-792. doi:10.1176/appi.ajp.160.4.790 [PubMed 12668373]
  107. Khanassov V, Hu J, Reeves D, van Marwijk H. Selective serotonin reuptake inhibitor and selective serotonin and norepinephrine reuptake inhibitor use and risk of fractures in adults: a systematic review and meta-analysis. Int J Geriatr Psychiatry. 2018;33(12):1688-1708. doi:10.1002/gps.4974 [PubMed 30247774]
  108. Khouri C, Blaise S, Carpentier P, Villier C, Cracowski J, Roustit M. Drug-induced Raynaud's phenomenon: beyond beta-blockers. Br J Clin Pharmacol. 2016;82(1):6-16. doi:10.1111/bcp.12912 [PubMed 26949933]
  109. Kirkham J, Seitz D. Evidence of ocular side effects of SSRIs and new warnings. Evid Based Ment Health. 2017;20(1):27. doi:10.1136/eb-2016-102528 [PubMed 27993931]
  110. Kotapati VP, Khan AM, Dar S, et al. The effectiveness of selective serotonin reuptake inhibitors for treatment of obsessive-compulsive disorder in adolescents and children: a systematic review and meta-analysis. Front Psychiatry. 2019;10:523. doi:10.3389/fpsyt.2019.00523 [PubMed 31447707]
  111. Kristensen JH, Hackett LP, Kohan R, Paech M, Ilett KF. The amount of fluvoxamine in milk is unlikely to be a cause of adverse effects in breastfed infants. J Hum Lact. 2002;18(2):139-143. [PubMed 12033075]
  112. Kufel WD, Parsels KA, Blaine BE, Steele JM, Seabury RW, Asiago-Reddy EA. Real-world evaluation of linezolid-associated serotonin toxicity with and without concurrent serotonergic agents. Int J Antimicrob Agents. 2023;62(1):106843. doi:10.1016/j.ijantimicag.2023.106843 [PubMed 37160238]
  113. Labos C, Dasgupta K, Nedjar H, Turecki G, Rahme E. Risk of bleeding associated with combined use of selective serotonin reuptake inhibitors and antiplatelet therapy following acute myocardial infarction. CMAJ. 2011;183(16):1835-1843. doi:10.1503/cmaj.100912 [PubMed 21948719]
  114. Lake MB, Birmaher B, Wassick S, et al. Bleeding and Selective Serotonin Reuptake Inhibitors in Childhood and Adolescence. J Child Adolesc Psychopharmacol. 2000;10(1):35-38. [PubMed 10755580]
  115. Lanza di Scalea T, Wisner KL. Antidepressant medication use during breastfeeding. Clin Obstet Gynecol. 2009;52(3):483-497. doi:10.1097/GRF.0b013e3181b52bd6 [PubMed 19661763]
  116. Lebin LG, Novick AM. Selective serotonin reuptake inhibitors (SSRIs) in pregnancy: an updated review on risks to mother, fetus, and child. Curr Psychiatry Rep. 2022;24(11):687-695. doi:10.1007/s11920-022-01372-x [PubMed 36181572]
  117. Leon AC. The revised warning for antidepressants and suicidality: unveiling the black box of statistical analyses. Am J Psychiatry. 2007;164(12):1786-1789. doi:10.1176/appi.ajp.2007.07050775 [PubMed 18056231]
  118. Leung M, Shore R. Fluvoxamine-associated bleeding. Can J Psychiatry. 1996;41(9):604-605. doi:10.1177/070674379604100919 [PubMed 8946088]
  119. Levy DM, Arush OB, Carmi L, Wetzler AJ, Zohar J. Off-label higher doses of serotonin reuptake inhibitors in the treatment of obsessive-compulsive disorder: safety and tolerability. Compr Psychiatry. 2024;133:152486. doi:10.1016/j.comppsych.2024.152486 [PubMed 38703743]
  120. Lewis JD, Strom BL, Localio AR, et al. Moderate and high affinity serotonin reuptake inhibitors increase the risk of upper gastrointestinal toxicity. Pharmacoepidemiol Drug Saf. 2008;17(4):328-335. doi:10.1002/pds.1546 [PubMed 18188866]
  121. Liu BA, Mittmann N, Knowles SR, Shear NH. Hyponatremia and the syndrome of inappropriate secretion of antidiuretic hormone associated with the use of selective serotonin reuptake inhibitors: a review of spontaneous reports. CMAJ. 1996;155(5):519-527. [PubMed 8804257]
  122. Loke YK, Trivedi AN, Singh S. Meta-analysis: gastrointestinal bleeding due to interaction between selective serotonin uptake inhibitors and non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther. 2008;27(1):31-40. doi:10.1111/j.1365-2036.2007.03541.x [PubMed 17919277]
  123. Luvox (fluvoxamine) [product monograph]. Etobicoke, Ontario, Canada: BGP Pharma ULC; December 2020.
  124. Luvox (fluvoxamine) [product monograph]. Etobicoke, Ontario, Canada: BGP Pharma ULC; July 2021.
  125. MacQueen GM, Frey BN, Ismail Z, et al; CANMAT Depression Work Group. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 6. Special populations: youth, women, and the elderly. Can J Psychiatry. 2016;61(9):588-603. doi:10.1177/0706743716659276 [PubMed 27486149]
  126. Mannesse CK, Jansen PA, Van Marum RJ, et al. Characteristics, prevalence, risk factors, and underlying mechanism of hyponatremia in elderly patients treated with antidepressants: a cross-sectional study. Maturitas. 2013;76(4):357-363. doi:10.1016/j.maturitas.2013.08.010 [PubMed 24094459]
  127. Marshall AM, Nommsen-Rivers LA, Hernandez LL, et al. Serotonin Transport and Metabolism in the Mammary Gland Modulates Secretory Activation and Involution. J Clin Endocrinol Metab. 2010;95(2):837-846. [PubMed 19965920]
  128. Martin A, Young C, Leckman JF, Mukonoweshuro C, Rosenheck R, Leslie D. Age effects on antidepressant-induced manic conversion. Arch Pediatr Adolesc Med. 2004;158(8):773-780. doi:10.1001/archpedi.158.8.773 [PubMed 15289250]
  129. Masarwa R, Bar-Oz B, Gorelik E, Reif S, Perlman A, Matok I. Prenatal exposure to selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors and risk for persistent pulmonary hypertension of the newborn: a systematic review, meta-analysis, and network meta-analysis. Am J Obstet Gynecol. 2019;220(1):57.e1-57.e13. doi:10.1016/j.ajog.2018.08.030 [PubMed 30170040]
  130. Mason PJ, Morris VA, Balcezak TJ. Serotonin syndrome. Presentation of 2 cases and review of the literature. Medicine (Baltimore). 2000;79(4):201-209. doi:10.1097/00005792-200007000-00001 [PubMed 10941349]
  131. Matsuoka S, Hori S, Satoh H, Nagamatsu T, Fujii T, Sawada Y. Quantitative prediction of fetal plasma concentration of fluvoxamine during dosage-tapering to the mother. Placenta. 2017;58:74-81. doi:10.1016/j.placenta.2017.08.010 [PubMed 28962699]
  132. Mauri MC, Fiorentini A, Paletta S, Altamura AC. Pharmacokinetics of antidepressants in patients with hepatic impairment. Clin Pharmacokinet. 2014;53(12):1069-1081. doi:10.1007/s40262-014-0187-5 [PubMed 25248846]
  133. McAllister-Williams RH, Baldwin DS, Cantwell R, et al; British Association for Psychopharmacology. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol. 2017;31(5):519-552. doi:10.1177/0269881117699361 [PubMed 28440103]
  134. Milano W, Siano C, Putrella C, Capasso A. Treatment of bulimia nervosa with fluvoxamine: a randomized controlled trial. Adv Ther. 2005;22(3):278-283. [PubMed 16236688]
  135. Monfort A, Cardoso E, Eap CB, et al. Infant exposure to Fluvoxamine through placenta and human milk: a case series - a contribution from the ConcePTION project. Front Psychiatry. 2023;14:1167870. doi:10.3389/fpsyt.2023.1167870 [PubMed 37275991]
  136. Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. J Clin Psychiatry. 2001;62 suppl 3:10-21. [PubMed 11229449]
  137. Montejo-González AL, Llorca G, Izquierdo JA, et al. SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients. J Sex Marital Ther. 1997;23(3):176-194. doi:10.1080/00926239708403923 [PubMed 9292833]
  138. Moses TEH, Javanbakht A. Resolution of selective serotonin reuptake inhibitor-associated sexual dysfunction after switching from fluvoxamine to fluoxetine. J Clin Psychopharmacol. 2023;43(1):71-73. doi:10.1097/JCP.0000000000001636 [PubMed 36445984]
  139. Movig KL, Janssen MW, de Waal Malefijt J, Kabel PJ, Leufkens HG, Egberts AC. Relationship of serotonergic antidepressants and need for blood transfusion in orthopedic surgical patients. Arch Intern Med. 2003;163(19):2354-2358. doi:10.1001/archinte.163.19.2354 [PubMed 14581256]
  140. Mullen S. Major depressive disorder in children and adolescents. Ment Health Clin. 2018;8(6):275-283. doi:10.9740/mhc.2018.11.275 [PubMed 30397569]
  141. Mullish BH, Kabir MS, Thursz MR, Dhar A. Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation. Aliment Pharmacol Ther. 2014;40(8):880-892. doi:10.1111/apt.12925 [PubMed 25175904]
  142. Nafziger AN, Bertino JS Jr, Goss-Bley AI, Kashuba AD. Incidence of sexual dysfunction in healthy volunteers on fluvoxamine therapy. J Clin Psychiatry. 1999;60(3):187-190. doi:10.4088/jcp.v60n0307 [PubMed 10192595]
  143. Nagler EV, Webster AC, Vanholder R, Zoccali C. Antidepressants for depression in stage 3-5 chronic kidney disease: a systematic review of pharmacokinetics, efficacy and safety with recommendations by European Renal Best Practice (ERBP). Nephrol Dial Transplant. 2012;27(10):3736-3745. doi:10.1093/ndt/gfs295 [PubMed 22859791]
  144. Narita M, Tsuji BT, Yu VL. Linezolid-associated peripheral and optic neuropathy, lactic acidosis, and serotonin syndrome. Pharmacotherapy. 2007;27(8):1189-1197. doi:10.1592/phco.27.8.1189 [PubMed 17655517]
  145. National Collaborating Centre for Mental Health (NCCMH). Depression: The Treatment and Management of Depression in Adults (Updated Edition). National Institute for Health & Clinical Excellence (NICE). 2010. [PubMed 22132433]
  146. National Institute for Health and Care Excellence (NICE). Obsessive-compulsive disorder and body dysmorphic disorder: treatment. https://www.nice.org.uk/guidance/cg31. Published November 2005. Accessed January 10, 2024.
  147. Nevatte T, O'Brien PM, Bäckström T, et al; Consensus Group of the International Society for Premenstrual Disorders. ISPMD consensus on the management of premenstrual disorders. Arch Womens Ment Health. 2013;16(4):279-291. doi:10.1007/s00737-013-0346-y [PubMed 23624686]
  148. Ng QX, Venkatanarayanan N, Ho CYX, Sim WS, Lim DY, Yeo WS. Selective serotonin reuptake inhibitors and persistent pulmonary hypertension of the newborn: an update meta-analysis. J Womens Health (Larchmt). 2019;28(3):331-338. doi:10.1089/jwh.2018.7319 [PubMed 30407100]
  149. Ogle NR, Akkerman SR. Guidance for the discontinuation or switching of antidepressant therapies in adults. J Pharm Pract. 2013;26(4):389-396. doi:10.1177/0897190012467210 [PubMed 23459282]
  150. Omori IM, Watanabe N, Nakagawa A, et al. Fluvoxamine versus other anti-depressive agents for depression. Cochrane Database Syst Rev. 2010;(3):CD006114. doi:10.1002/14651858.CD006114.pub2 [PubMed 20238342]
  151. Opatrny L, Delaney JA, Suissa S. Gastro-intestinal haemorrhage risks of selective serotonin receptor antagonist therapy: a new look. Br J Clin Pharmacol. 2008;66(1):76-81. doi:10.1111/j.1365-2125.2008.03154.x [PubMed 18460039]
  152. Orsolini L, Bellantuono C. Serotonin reuptake inhibitors and breastfeeding: a systematic review. Hum Psychopharmacol. 2015;30(1):4-20. doi:10.1002/hup.2451 [PubMed 25572308]
  153. Padda J, Khalid K, Hitawala G, et al. Depression and its effect on the menstrual cycle. Cureus. 2021;13(7):e16532. doi:10.7759/cureus.16532 [PubMed 34430141]
  154. Papakostas GI, Perlis RH, Scalia MJ, Petersen TJ, Fava M. A meta-analysis of early sustained response rates between antidepressants and placebo for the treatment of major depressive disorder. J Clin Psychopharmacol. 2006;26(1):56-60. doi:10.1097/01.jcp.0000195042.62724.76 [PubMed 16415707]
  155. Pass SE, Simpson RW. Discontinuation and Reinstitution of Medications During the Perioperative Period. Am J Health Syst Pharm. 2004;61(9):899-912. [PubMed 15156966]
  156. Patel R, Reiss P, Shetty H, et al. Do antidepressants increase the risk of mania and bipolar disorder in people with depression? A retrospective electronic case register cohort study. BMJ Open. 2015;5(12):e008341. doi:10.1136/bmjopen-2015-008341 [PubMed 26667012]
  157. Pediatric OCD Treatment Study (POTS) Team. Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: the Pediatric OCD Treatment Study (POTS) randomized controlled trial. JAMA. 2004;292(16):1969-1976. doi:10.1001/jama.292.16.1969 [PubMed 15507582]
  158. Peiró AM, Margarit C, Torra M. Citalopram-induced Raynaud's phenomenon. Rheumatol Int. 2007;27(6):599-601. [PubMed 17103176]
  159. Phillips KA. Body dysmorphic disorder: choosing treatment and prognosis. Connor RF, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed January 9, 2024a.
  160. Phillips KA. Obsessive-compulsive disorder in adults: treatment overview. Connor RF, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 20, 2024b.
  161. Phillips KA, Dwight MM, McElroy SL. Efficacy and safety of fluvoxamine in body dysmorphic disorder. J Clin Psychiatry. 1998;59(4):165-171. doi:10.4088/jcp.v59n0404 [PubMed 9590666]
  162. Phillips KA, Hollander E. Treating body dysmorphic disorder with medication: evidence, misconceptions, and a suggested approach. Body Image. 2008;5(1):13-27. doi:10.1016/j.bodyim.2007.12.003 [PubMed 18325859]
  163. Phillips KA, Susser LC. Body dysmorphic disorder in women. Psychiatr Clin North Am. 2023;46(3):505-525. doi:10.1016/j.psc.2023.04.007 [PubMed 37500247]
  164. Posternak MA, Zimmerman M. Is there a delay in the antidepressant effect? A meta-analysis. J Clin Psychiatry. 2005;66(2):148-158. doi:10.4088/jcp.v66n0201 [PubMed 15704999]
  165. Rabenda V, Nicolet D, Beaudart C, et al. Relationship between use of antidepressants and risk of fractures: a meta-analysis. Osteoporos Int. 2013;24(1):121-137. [PubMed 22638709]
  166. Rausch JL, Hobby HM, Shendarkar N, Johnson ME, Li J. Fluvoxamine treatment of mixed anxiety and depression: evidence for serotonergically mediated anxiolysis. J Clin Psychopharmacol. 2001;21(2):139-142. doi:10.1097/00004714-200104000-00004 [PubMed 11270909]
  167. Reeves RR, Ladner ME. Antidepressant-induced suicidality: an update. CNS Neurosci Ther. 2010;16(4):227-234. doi:10.1111/j.1755-5949.2010.00160.x [PubMed 20553304]
  168. Refer to manufacturer's labeling.
  169. Renoir T. Selective serotonin reuptake inhibitor antidepressant treatment discontinuation syndrome: a review of the clinical evidence and the possible mechanisms involved. Front Pharmacol. 2013;4:45. doi:10.3389/fphar.2013.00045 [PubMed 23596418]
  170. Ricca V, Mannucci E, Mezzani B, et al. Fluoxetine and fluvoxamine combined with individual cognitive-behaviour therapy in binge eating disorder: a one-year follow-up study. Psychother Psychosom. 2001;70(6):298-306. doi:10.1159/000056270 [PubMed 11598429]
  171. Richa S, Yazbek JC. Ocular adverse effects of common psychotropic agents: a review. CNS Drugs. 2010;24(6):501-526. doi:10.2165/11533180-000000000-00000 [PubMed 20443647]
  172. Richards JB, Papaioannou A, Adachi JD, et al. Effect of selective serotonin reuptake inhibitors on the risk of fracture. Arch Intern Med. 2007;167(2):188-194. doi:10.1001/archinte.167.2.188 [PubMed 17242321]
  173. Rihmer Z, Barsi J, Belsõ N, Pestality P, György S. Antidepressant-induced hypomania in obsessive-compulsive disorder. Int Clin Psychopharmacol. 1996;11(3):203-205. doi:10.1097/00004850-199609000-00008 [PubMed 8923100]
  174. Rizzoli R, Cooper C, Reginster JY, et al. Antidepressant medications and osteoporosis. Bone. 2012;51(3):606-613. [PubMed 22659406]
  175. Roose SP, Glassman AH, Attia E, et al. Comparative Efficacy of Selective Serotonin Reuptake Inhibitors and Tricyclics in the Treatment of Melancholia. Am J Psychiatry. 1994;151(12):1735-1739. [PubMed 7977878]
  176. Roy-Byrne PP, Craske M. Panic disorder in adults: Treatment overview. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed December 4, 2023.
  177. Safer DJ and Zito JM. Treatment Emergent Adverse Effects of Selective Serotonin Reuptake Inhibitors by Age Group: Children vs. Adolescents,” J Child Adolesc Psychopharmacol. 2006,16(1/2):159-169. [PubMed 16553536]
  178. Samuel NG, Seifert CF. Risk of bleeding in patients on full-dose enoxaparin with venous thromboembolism and selective serotonin reuptake inhibitors. Ann Pharmacother. 2017;51(3):226-231. doi:10.1177/1060028016677309 [PubMed 27834194]
  179. Schatzberg AF, Blier P, Delgado PL, et al. Antidepressant discontinuation syndrome: consensus panel recommendations for clinical management and additional research. J Clin Psychiatry. 2006;67(suppl 4):27-30. [PubMed 16683860]
  180. Schoretsanitis G, Spigset O, Stingl JC, Deligiannidis KM, Paulzen M, Westin AA. The impact of pregnancy on the pharmacokinetics of antidepressants: a systematic critical review and meta-analysis. Expert Opin Drug Metab Toxicol. 2020;16(5):431‐440. doi:10.1080/17425255.2020.1750598 [PubMed 32238008]
  181. Serretti A, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. J Clin Psychopharmacol. 2009;29(3):259-266. doi:10.1097/JCP.0b013e3181a5233f [PubMed 19440080]
  182. Shelton RC. Steps following attainment of remission: discontinuation of antidepressant therapy. Prim Care Companion J Clin Psychiatry. 2001;3(4):168-174. [PubMed 15014601]
  183. Spigset O, Mjorndal T. The effect of fluvoxamine on serum prolactin and serum sodium concentrations: relation to platelet 5-HT2A receptor status. J Clin Psychopharmacol. 1997;17(4):292-297. doi:10.1097/00004714-199708000-00009 [PubMed 9241009]
  184. Spivak B, Strous RD, Shaked G, Shabash E, Kotler M, Weizman A. Reboxetine versus fluvoxamine in the treatment of motor vehicle accident-related posttraumatic stress disorder: a double-blind, fixed-dosage, controlled trial. J Clin Psychopharmacol. 2006;26(2):153-156. doi:10.1097/01.jcp.0000203195.65710.f0 [PubMed 16633143]
  185. Sriraman NK, Melvin K, Meltzer-Brody S. ABM Clinical Protocol #18: Use of antidepressants in breastfeeding mothers. Breastfeed Med. 2015;10(6):290-299. [PubMed 26204124]
  186. Stahl SM. Mechanism of action of serotonin selective reuptake inhibitors. Serotonin receptors and pathways mediate therapeutic effects and side effects. J Affect Disord. 1998;51(3):215-235. doi:10.1016/s0165-0327(98)00221-3 [PubMed 10333979]
  187. Stein DJ, Westenberg HG, Yang H, et al. Fluvoxamine CR in the Long-Term Treatment of Social Anxiety Disorder: The 12- to 24-Week Extension Phase of a Multicentre, Randomized, Placebo-Controlled Trial. Int J Neuropsychopharmacol. 2003;6(4):317-323. [PubMed 14604447]
  188. Stein MB, Taylor CT. Social anxiety disorder in adults: Treatment overview. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 22, 2023.
  189. Stevens DL. Association between selective serotonin-reuptake inhibitors, second-generation antipsychotics, and neuroleptic malignant syndrome. Ann Pharmacother. 2008;42(9):1290-1297. doi:10.1345/aph.1L066 [PubMed 18628446]
  190. Sun-Edelstein C, Tepper SJ, Shapiro RE. Drug-induced serotonin syndrome: a review. Expert Opin Drug Saf. 2008;7(5):587-596. doi:10.1517/14740338.7.5.587 [PubMed 18759711]
  191. Sylvester C, Menke M, Gopalan P. Selective serotonin reuptake inhibitors and fertility: considerations for couples trying to conceive. Harv Rev Psychiatry. 2019;27(2):108-118. doi:10.1097/HRP.0000000000000204 [PubMed 30676405]
  192. Szegedi A, Jansen WT, van Willigenburg AP, van der Meulen E, Stassen HH, Thase ME. Early improvement in the first 2 weeks as a predictor of treatment outcome in patients with major depressive disorder: a meta-analysis including 6562 patients. J Clin Psychiatry. 2009;70(3):344-353. doi:10.4088/jcp.07m03780 [PubMed 19254516]
  193. Tarchi L, Merola GP, Baccaredda-Boy O, et al. Selective serotonin reuptake inhibitors, post-treatment sexual dysfunction and persistent genital arousal disorder: a systematic review. Pharmacoepidemiol Drug Saf. 2023;32(10):1053-1067. doi:10.1002/pds.5653 [PubMed 37294623]
  194. Targownik LE, Bolton JM, Metge CJ, Leung S, Sareen J. Selective serotonin reuptake inhibitors are associated with a modest increase in the risk of upper gastrointestinal bleeding. Am J Gastroenterol. 2009;104(6):1475-1482. doi:10.1038/ajg.2009.128 [PubMed 19491861]
  195. Taylor JJ, Wilson JW, Estes LL. Linezolid and serotonergic drug interactions: a retrospective survey. Clin Infect Dis. 2006a;43(2):180-187. doi:10.1086/504809 [PubMed 16779744]
  196. Taylor MJ, Freemantle N, Geddes JR, Bhagwagar Z. Early onset of selective serotonin reuptake inhibitor antidepressant action: systematic review and meta-analysis. Arch Gen Psychiatry. 2006b;63(11):1217-1223. doi:10.1001/archpsyc.63.11.1217 [PubMed 17088502]
  197. Tomlin AM, Reith DM, Woods DJ, et al. A pharmacoepidemiology database system for monitoring risk due to the use of medicines by New Zealand primary care patients. Drug Saf. 2017;40(12):1259-1277. doi:10.1007/s40264-017-0579-1 [PubMed 28766108]
  198. Tondo L, Vázquez G, Baldessarini RJ. Mania associated with antidepressant treatment: comprehensive meta-analytic review. Acta Psychiatr Scand. 2010;121(6):404-414. doi:10.1111/j.1600-0447.2009.01514.x [PubMed 19958306]
  199. Uguz F. Gastrointestinal side effects in the baby of a breastfeeding woman treated with low-dose fluvoxamine. J Hum Lact. 2015;31(3):371-373. [PubMed 25896469]
  200. van Geffen EC, Hugtenburg JG, Heerdink ER, van Hulten RP, Egberts AC. Discontinuation symptoms in users of selective serotonin reuptake inhibitors in clinical practice: tapering versus abrupt discontinuation. Eur J Clin Pharmacol. 2005;61(4):303-307. doi:10.1007/s00228-005-0921-x [PubMed 15906018]
  201. van Harten J, Duchier J, Devissaguet JP, van Bemmel P, de Vries MH, Raghoebar M. Pharmacokinetics of fluvoxamine maleate in patients with liver cirrhosis after single-dose oral administration. Clin Pharmacokinet. 1993;24(2):177-182. doi:10.2165/00003088-199324020-00006 [PubMed 8453824]
  202. Varigonda AL, Jakubovski E, Bloch MH. Systematic review and meta-analysis: early treatment responses of selective serotonin reuptake inhibitors and clomipramine in pediatric obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry. 2016;55(10):851-859.e2. doi:10.1016/j.jaac.2016.07.768 [PubMed 27663940]
  203. Vestergaard P, Rejnmark L, Mosekilde L. Selective serotonin reuptake inhibitors and other antidepressants and risk of fracture. Calcif Tissue Int. 2008;82(2):92-101. doi:10.1007/s00223-007-9099-9 [PubMed 18219438]
  204. Wadhwa R, Kumar M, Talegaonkar S, Vohora D. Serotonin reuptake inhibitors and bone health: a review of clinical studies and plausible mechanisms. Osteoporos Sarcopenia. 2017;3(2):75-81. doi:10.1016/j.afos.2017.05.002 [PubMed 30775508]
  205. Waldinger MD. Psychiatric disorders and sexual dysfunction. Handb Clin Neurol. 2015;130:469-489. doi:10.1016/B978-0-444-63247-0.00027-4 [PubMed 26003261]
  206. Warner, CH, Bobo W, Warner C, et al. Antidepressant discontinuation syndrome. Am Fam Physician. 2006;74:449-456. [PubMed 16913164]
  207. Weissman AM, Levy BT, Hartz AJ, et al. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry. 2004;161(6):1066-1078. doi:10.1176/appi.ajp.161.6.1066 [PubMed 15169695]
  208. Westenberg HG, Stein DJ, Yang H, et al. A Double-Blind Placebo-Controlled Study of Controlled Release Fluvoxamine for the Treatment of Generalized Social Anxiety Disorder. J Clin Psychopharmacol. 2004;24(1):49-55. [PubMed 14709947]
  209. Westin AA, Brekke M, Molden E, Skogvoll E, Spigset O. Selective serotonin reuptake inhibitors and venlafaxine in pregnancy: Changes in drug disposition. PLoS One. 2017;12(7):e0181082. doi:10.1371/journal.pone.0181082 [PubMed 28708853]
  210. Williams AJ, Lai Z, Knight S, Kamali M, Assari S, McInnis MG. Risk factors associated with antidepressant exposure and history of antidepressant-induced mania in bipolar disorder. J Clin Psychiatry. 2018;79(3):17m11765. doi:10.4088/JCP.17m11765 [PubMed 29873955]
  211. Wolkenstein P, Revuz J, Diehl JL, Langeron O, Roupie E, Machet L. Toxic epidermal necrolysis after fluvoxamine. Lancet. 1993;342(8866):304-305. doi:10.1016/0140-6736(93)91852-d [PubMed 8101329]
  212. Wylie ME, Miller MD, Shear MK, et al. Fluvoxamine pharmacotherapy of anxiety disorders in later life: preliminary open-trial data. J Geriatr Psychiatry Neurol. 2000;13(1):43-48. doi:10.1177/089198870001300107 [PubMed 10753007]
  213. Wynn RL. New antidepressant medications. Gen Dent. 1997;45(1):24-28. [PubMed 9171475]
  214. Xu J, Hao Q, Qian R, et al. Optimal dose of serotonin reuptake inhibitors for obsessive-compulsive disorder in adults: a systematic review and dose-response meta-analysis. Front Psychiatry. 2021;12:717999. doi:10.3389/fpsyt.2021.717999 [PubMed 34630180]
  215. Xuev S, Ickowicz A. Serotonin syndrome in children and adolescents exposed to selective serotonin reuptake inhibitors - a review of literature. J Can Acad Child Adolesc Psychiatry. 2021;30(3):156-164. [PubMed 34381508]
  216. Zhang F, Gong W, Cui Z, Li J, Lu Y. Rhabdomyolysis in a male adolescent associated with monotherapy of fluvoxamine. Eur J Hosp Pharm. 2022;ejhpharm-2022-003533. doi:10.1136/ejhpharm-2022-003533 [PubMed 36460460]
Topic 13025 Version 480.0