Luvox®
(fluvoxamine)
Brand
names:
Luvox®
Luvox
CR®
Generic
name: fluvoxamine (floo
VOKS a meen)
Medication
class: Selective serotonin reuptake inhibitor (SSRI) antidepressant
All FDA black box
warnings are at the end of this fact sheet. Please review
before taking this medication.
What
is Luvox®
and what does it treat?
Fluvoxamine
is an antidepressant medication that works in the brain. It is
approved for the treatment of major depressive disorder (MDD), social
phobia, and obsessive compulsive disorder (OCD) in adults and
children ages 8 and older.
Symptoms
of depression include:
Depressed
mood - feeling sad, empty, or tearful
Feeling
worthless, guilty, hopeless, and helpless
Loss
of interest or pleasure in your usual activities
Sleep
and eat more or less than usual (for most people it is less)
Low
energy, trouble concentrating, or thoughts of death (suicidal
thinking)
Psychomotor
agitation (‘nervous energy’)
Psychomotor
retardation (feeling like you are moving and thinking in slow
motion)
Suicidal
thoughts or behaviors
Social
phobia/social anxiety disorder is a fear of situations where one may
feel as if they are being judged by others. Symptoms include:
Blushing
Difficulty
talking
Nausea
Sweating
Shaking
Obsessive
Compulsive Disorder (OCD) occurs when a person experiences the
following symptoms at the same time:
Obsessions
(unwanted, recurrent, and disturbing thoughts)
Compulsions
(repetitive, ritualized behaviors that the person feels driven to
perform in order to lessen the anxiety produced by the obsessions)
What
is the most important information I should know about Luvox®?
Do
not stop taking fluvoxamine, even when you feel better. Only your
healthcare provider can determine the length of treatment that is
right for you.
Missing
doses of fluvoxamine may increase your risk for relapse in your
symptoms.
Stopping
fluvoxamine abruptly may result in one or more of the following
withdrawal symptoms: irritability, nausea, dizziness, vomiting,
nightmares, headache, and/or paresthesias (prickling, tingling
sensation on the skin).
Depression
is also a part of bipolar illness. People with bipolar disorder who
take antidepressants may be at risk for "switching" from
depression into mania. Symptoms of mania include "high" or
irritable mood, very high self esteem, decreased need for sleep,
pressure to keep talking, racing thoughts, being easily distracted,
frequently involved in activities with a large risk for bad
consequences (for example, excessive buying sprees).
Are
there specific concerns about Luvox®
and
pregnancy?
If
you are planning on becoming pregnant, notify your healthcare
provider to best manage your medications. People living with MDD who
wish to become pregnant face important decisions. Untreated MDD has
risks to the fetus, as well as the mother. It is important to
discuss the risks and benefits of treatment with your doctor and
caregivers.
For
mothers who have taken SSRIs during their pregnancy, there appears to
be less than a 1% chance of infants developing persistent pulmonary
hypertension. This is a potentially fatal condition that is
associated with use of the antidepressant in the second half of
pregnancy. However, women who discontinued antidepressant therapy
were five times more likely to have a depression relapse than those
who continued their antidepressant. If you are pregnant, please
discuss the risks and benefits of antidepressant use with your
healthcare provider.
Caution
is advised with breastfeeding since fluvoxamine
does
pass into breast milk.
What
should I discuss with my healthcare provider before taking Luvox®?
Symptoms
of your condition that bother you the most
If
you have thoughts of suicide or harming yourself
Medications
you have taken in the past for your condition, whether they were
effective or caused any adverse effects
If
you experience side effects from your medications, discuss them with
your provider. Some side effects may pass with time, but others may
require changes in the medication.
Any
other psychiatric or medical problems you have, including a history
of bipolar disorder
All
other medications you are currently taking (including over the
counter products, herbal and nutritional supplements) and any
medication allergies you have
Other
non-medication treatment you are receiving, such as talk therapy or
substance abuse treatment. Your provider can explain how these
different treatments work with the medication.
If
you are pregnant, plan to become pregnant, or are breast-feeding
If
you drink alcohol or use drugs
How
should I take Luvox®?
Fluvoxamine
is usually taken 2 times per day with or without food. The extended
release formulation may be taken 1 time per day with or without food.
Typically
patients begin at a low dose of medicine and the dose is increased
slowly over several weeks.
The
dose usually ranges from 50 mg to 300 mg. Only
your healthcare provider can determine the correct dose for you.
Consider
using a calendar, pillbox, alarm clock, or cell phone alert to help
you remember to take your medication. You may also ask a family
member or friend to remind you or check in with you to be sure you
are taking your medication.
The
extended-release forms should be swallowed whole. They should not be
chewed, crushed, or broken.
What
happens if I miss a dose of Luvox®?
If
you miss a dose of fluvoxamine,
take it as soon as you remember, unless it is closer to the time of
your next dose. Discuss this with your healthcare provider. Do not
double your next dose or take more than what is prescribed.
What
should I avoid while taking Luvox®?
Avoid
drinking alcohol or using illegal drugs while you are taking
antidepressant medications.
They may decrease the benefits (e.g., worsen your condition) and
increase adverse effects (e.g., sedation) of the medication.
What
happens if I overdose with Luvox®?
If
an overdose occurs, call your doctor or 911. You may need urgent
medical care. You may also contact the poison control center at
1-800-222-1222.
A
specific treatment to reverse the effects of fluvoxamine does not
exist.
What
are the possible side effects of Luvox®?
Common
Side Effects
Headache,
nausea, diarrhea, dry mouth, increased sweating
Feeling
nervous, restless, fatigued, sleepy or having trouble sleeping
(insomnia)
These
will often improve over the first week or two as you continue to take
the medication.
Sexual
side effects, such as problems with orgasm or ejaculatory delay often
do not diminish over time.
Rare
Side Effects
Increased
bleeding (e.g., gums may bleed more easily), low sodium blood levels
(signs of low sodium levels may include headache, weakness,
difficulty concentrating and remembering), teeth grinding
Serious
Side Effects
Seizure
Are
there any risks of taking Luvox®
for long periods of time?
To
date, there are no known problems associated with long term use of
fluvoxamine. It is a safe and effective medication when used as
directed.
What
other medications may interact with Luvox®?
Fluvoxamine
should not be taken with or within 2 weeks of taking monoamine
oxidase inhibitors (MAOIs). These include phenelzine (Nardil®),
tranylcypromine (Parnate®),
isocarboxazid (Marplan®),
rasagiline (Azilect®),
and selegeline (Emsam®).
Although
rare, there is an increased risk of serotonin syndrome when
fluvoxamine is used with other medications that increase serotonin,
such as other antidepressants, migraine medications called “triptans”
(e.g., Imitrex®),
some pain medications (e.g., tramadol (Ultram®),
and the antibiotic linezolid (Zyvox®).
Fluvoxamine
may increase
the levels and effects of:
Warfarin
(Coumadin®)
Theophylline
(Theo-Dur®)
Certain
anticonvulsants: carbamazepine (Tegretol®,
Equetro®),
phenytoin (Dilantin®)
Beta
blockers, such as propranolol (Inderal®)
metoprolol (Lopressor®,
Toprol XL®)
Benzodizapines,
such as alprazolam (Xanax®)
diazepam (Valium®)
Certain
antipsychotics, such as olanzapine (Zyprexa®),
clozapine (Clozaril®),
aripiprazole (Abilify®),
quetiapine (Seroquel®)
Mexiletine
(Mexitil®)
Omeprazole
(Prilosec®)
Methadone
(Dolophine®)
Tricyclic
antidepressants, such as amitriptyline (Elavil®)
Fluvoxamine
may decrease
the effects of clopidogrel
(Plavix®).
Fluvoxamine
may increase
the effects of other medications that can cause bleeding (e.g.,
ibuprofen (Advil®,
Motrin®),
warfarin (Coumadin®),
and aspirin).
Combining
fluvoxamine with ramelteon (RozeremTM),
tizanidine (Zanaflex®),
thioridazine (Mellaril®),
pimozide, or alosetron (Lotronex®)
is not
recommended.
How
long does it take for Luvox®
to
work?
Sleep,
energy, or appetite may show some improvement within the first 1-2
weeks. Improvement in these physical symptoms can be an important
early signal that the medication is working. Depressed mood and lack
of interest in activities may need up to 6-8 weeks to fully improve.
Provided
by the College of Psychiatric and Neurologic Pharmacists
(January
2013)
Summary
of Black Box Warnings
Suicidal
Thoughts or Actions in Children and Adults
Depression
and certain other psychiatric disorders are themselves associated
with increases in the risk of suicide.
Patients
with major depressive disorder (MDD), both adult and pediatric, may
experience worsening of their depression and/or the emergence of
suicidal ideation and behavior (suicidality) or unusual changes in
behavior, whether or not they are taking antidepressant medications.
This risk may persist until significant remission occurs.
In
short-term studies, antidepressants increased the risk of
suicidality in children, adolescents, and young adults when compared
to placebo. Short-term studies did not
show an increase in the risk of suicidality with antidepressants
compared to placebo in adults beyond age 24. Adults age 65 and
older taking antidepressants have a decreased risk of suicidality.
Patients,
their families, and caregivers should be alert to the emergence of
anxiety, restlessness, irritability, aggressiveness and insomnia.
If these symptoms emerge, they should be reported to the patient’s
prescriber or healthcare professional.
All
patients being treated with antidepressants for any indication
should watch for and notify their healthcare provider for worsening
symptoms, suicidality and unusual changes in behavior, especially
during the first few months of treatment.
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