fluvoxamine

Adjunctive therapy

Brands: Luvox

Last reviewed 2025-10-05

Reviewed by PsychMed Editorial Team.

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Quick answers

What is fluvoxamine?
Fluvoxamine (brand Luvox) is a selective serotonin reuptake inhibitor approved for obsessive-compulsive disorder (1994) and social anxiety disorder (2008). It is frequently selected for OCD when psychotic disorders or clozapine therapy coexist, provided its interaction profile is managed carefully.
What is Luvox?
Luvox is a brand name for fluvoxamine.
What is Luvox (fluvoxamine) used for?
Label indications include: Obsessive-compulsive disorder; social anxiety disorder.
What drug class is Luvox (fluvoxamine)?
Selective serotonin reuptake inhibitor (SSRI).
What strengths does Luvox (fluvoxamine) come in?
Immediate-release tablets: 25 mg, 50 mg, 100 mg.

Snapshot

Class: Adjunctive therapy
Common US brands: Luvox
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-10-05

Label indications

Obsessive-compulsive disorder; social anxiety disorder.

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Clinical Highlights

Fluvoxamine (brand Luvox) is a selective serotonin reuptake inhibitor approved for obsessive-compulsive disorder (1994) and social anxiety disorder (2008). It is frequently selected for OCD when psychotic disorders or clozapine therapy coexist, provided its interaction profile is managed carefully. The drug is a strong CYP1A2 and CYP2C19 inhibitor, so it can markedly elevate concentrations of clozapine, olanzapine, theophylline, caffeine, and warfarin—useful when deliberate but hazardous without monitoring.

Immediate-release tablets (25 mg, 50 mg, 100 mg) and extended-release capsules (100 mg, 150 mg) allow once-nightly or divided dosing. IR tablets are widely generic; ER capsules remain largely branded. Bedtime dosing and food can mitigate nausea and somnolence.
The compare view and the fluvoxamine evidence feed can support balancing activation and interaction trade-offs when adjusting complex regimens.
In complex regimens, fluvoxamine is sometimes used to raise clozapine levels; this approach typically involves dose reductions, therapeutic drug monitoring (TDM) when available, and counseling about caffeine or smoking changes that can shift exposure.
Mania/hypomania screening can be coordinated via the bipolar disorder hub, and the schizophrenia hub can support clozapine augmentation coordination; counseling aids can be shared via the fluvoxamine print page.
Obsessive-compulsive disorder (FDA 1994)
Social anxiety disorder (FDA 2008)

Dosing & Formulations

Immediate-release tablets: 25 mg, 50 mg, 100 mg. Extended-release capsules: 100 mg, 150 mg (do not crush or open).

Adults (IR): typical start is 50 mg at bedtime; increase by 50 mg every 4–7 days based on response. Usual range 100–300 mg/day (divide doses above 150 mg/day).
Extended-release capsules: typical start is 100 mg nightly; titrate by 50 mg weekly to 300 mg/day for OCD (200 mg/day for SAD).
Pediatrics (≥8 years, IR): typical start is 25 mg at bedtime; titration is no faster than weekly to a maximum of 200 mg/day with divided dosing over 50 mg.
In hepatic impairment or geriatric patients, lower initial doses (often 25 mg daily) and slower titration are commonly used.

Monitoring & Risks

Boxed warning: Like all antidepressants, fluvoxamine carries an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults—closer monitoring is common during initiation and dose adjustments. Nausea and dyspepsia: Most frequent adverse effect; bedtime dosing with a snack often helps.

Somnolence or fatigue: Larger dose is often given at night; divided dosing is considered if daytime sedation persists.
Activation/insomnia: Slow titration and morning dosing of smaller portions are often used to mitigate early activation.
Sweating and tremor: Usually dose-related; reassess if persistent.
Sexual dysfunction: Expectations and management options can be discussed upfront.
Hyponatremia/SIADH and mania/hypomania monitoring is common; labs and specialty-hub coordination are typically arranged if symptoms emerge.

Drug Interactions

Contraindicated with MAOIs (including linezolid or IV methylene blue); appropriate washouts are required (commonly 14 days). Strong CYP1A2/CYP2C19 inhibition markedly raises levels of clozapine, olanzapine, theophylline, caffeine, tizanidine, and warfarin—dose reductions and monitoring of serum levels or clinical response are often needed.

Moderate inhibition of CYP3A4/CYP2D6 can elevate benzodiazepines, beta-blockers, and TCAs; dose adjustment and monitoring may be needed.
Combined serotonergic therapy (SSRIs/SNRIs, triptans, tramadol) increases serotonin syndrome risk—caution is common and symptom monitoring is important.
Changes in smoking status alter CYP1A2 activity; interacting drug levels are reassessed when smoking status changes.

Practice Notes

Caffeine intake counseling is common; fluvoxamine can more than double caffeine exposure, worsening anxiety and insomnia. Coordination with prescribers managing clozapine or theophylline is common, including serum monitoring (TDM) when fluvoxamine is initiated or discontinued.

Weight, sleep quality, GI symptoms, and serum sodium are commonly monitored in higher-risk populations, and patient handouts can be shared via the fluvoxamine print page.

References

Fluvoxamine maleate tablets prescribing information — DailyMed (2025)
APA Clinical Practice Guideline FOR THE Treatment OF Patients With Obsessive Compulsive Disorder — American Psychiatric Association (2020)
Efficacy OF Fluvoxamine IN Obsessive Compulsive Disorder: A Double Blind Comparison With Placebo — Archives of General Psychiatry (1989)
CANMAT 2024 Clinical Guidelines for Major Depressive Disorder — Canadian Journal of Psychiatry (2024)
Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology: Update 2017 — Pharmacopsychiatry (2018)
Fluvoxamine markedly increases clozapine levels — PubMed (1996)