Skip to content

Fluvoxamine (Luvox)

SSRI • Last reviewed 2025-09-26

General information

Fluvoxamine is an SSRI approved for OCD and social anxiety disorder; it is used off-label for major depressive disorder when other SSRIs fail.

Tablets (25, 50, 100 mg) are usually dosed twice daily; an extended-release capsule (100, 150 mg) enables once-daily evening dosing.

Strong inhibition of CYP1A2 and CYP2C19 leads to numerous interactions (e.g., theophylline, clozapine, warfarin). Gradual titration minimizes nausea and somnolence.

Fluvoxamine has evidence for reducing intrusive thoughts and anxiety-driven ruminations due to high serotonergic specificity.

Dosing & administration

OCD: start 50 mg at bedtime; increase by 50 mg every 4–7 days as tolerated to 100–300 mg/day (divide doses >100 mg).

Social anxiety disorder: XR 100 mg once daily at bedtime, titrate to 300 mg if needed.

Reduce dose in hepatic impairment; titrate slowly in elderly.

Mechanism of action

Selective serotonin reuptake inhibitor with negligible activity at adrenergic, histamine, or muscarinic receptors.

Metabolism & pharmacokinetics

Extensive first-pass metabolism; peak concentration 3–8 hours post-dose. Metabolized predominantly via CYP1A2 and CYP2D6; elimination half-life ~15 hours after a single dose, extending to ~22 hours at steady state.

Drug interactions

Avoid MAOIs, linezolid, methylene blue (serotonin syndrome).

Strong inhibitor of CYP1A2 and CYP2C19—monitor levels of theophylline, clozapine, warfarin, tizanidine.

CYP1A2 inducers (smoking) may lower concentrations; adjust dose accordingly.

Monitoring & safety checks

Discontinuation guidance

Taper gradually (over ≥2 weeks) to minimize discontinuation symptoms (dizziness, agitation, sensory disturbances).

References

  1. Fluvoxamine maleate tablets prescribing information — DailyMed (2025)
  2. APA Clinical Practice Guideline for the Treatment of Obsessive-Compulsive Disorder — American Psychiatric Association (2020)
  3. CANMAT 2024 Depression Guidelines (2024)

Educational use only — verify details in current prescribing information and authoritative clinical guidelines before making prescribing decisions.