Fluvoxamine

Fluvoxamine stops nerve cells from taking serotonin back up too quickly, so more of it remains between cells. After some weeks mood lifts and the grip of intrusive, repetitive thoughts loosens. Although classed as an antidepressant, it is probably the one most people meet as a treatment for obsessive compulsive disorder, where a fear such as contamination drives rituals like repeated washing or checking.

The UK SmPC allows adults to use it for major depression and for OCD. Children aged 8 and over are covered for OCD only, and it is not recommended for depression under 18. Results are not instant: depression is judged for response after three to four weeks, and treatment continues for six months or more once symptoms have gone.

Pack sizes for 50 mg are 30, 60, 90, 120, 180 and 360; for 100 mg they are 30, 60, 90, 120, 180 and 240. For depression adults begin on 50 or 100 mg in the evening, the SmPC recommending 100 mg. For OCD the start is 50 mg daily, then a range of 100 to 300 mg a day; responders can continue beyond ten weeks provided they are assessed regularly. A single evening dose may be as much as 150 mg. Anything above that is divided into two or three, and 300 mg a day is the adult maximum. Children with OCD start at 25 mg and can reach 200 mg, any amount over 50 mg a day being split into two. Tablets go down with water and are not chewed. Kidney or liver impairment means a lower starting dose.

Tizanidine, pimozide and MAOIs must not be taken alongside it. After an irreversible MAOI there must be a gap of two weeks before fluvoxamine is begun (one day after moclobemide), and a week must pass after the last dose before any MAOI is started. Serotonin syndrome becomes likelier with triptans, tramadol, lithium and St John’s wort. Linezolid works as an MAOI, so its use with fluvoxamine is limited to exceptional circumstances with close monitoring. Fluvoxamine inhibits liver enzymes and can increase levels of theophylline, clozapine, methadone, phenytoin, carbamazepine, ciclosporin, tricyclic antidepressants and caffeine. It can reduce levels of clopidogrel’s active metabolite, so concomitant use is discouraged. Bleeding risk is higher with anticoagulants, antiplatelet drugs and anti-inflammatory painkillers; alcohol is not advised.

Nausea is the most frequent effect and usually settles within a fortnight or so. Possible problems include seizures, a low blood sodium level and bleeding such as bruising, nosebleeds or black stools; epilepsy calls for special care. Some people also report sleepiness, a dry mouth and sweating. During the first weeks people under 25 are especially liable to feel more anxious or to have thoughts of self-harm, so any change in mood or behaviour should be reported at once. Cognitive therapy is often offered with the tablets for OCD. Ending treatment calls for a gradual reduction over one to two weeks at least.

Evening dosing suits people who feel drowsy. Side effects tend to arrive before benefits in the first two weeks, and giving up too soon is a typical reason for treatment to fail. A short diary of rituals or low mood helps the clinic judge progress. Mention herbal remedies, energy drinks rich in caffeine and any plans for pregnancy or breastfeeding at the outset.

Faverin 50 mg and 100 mg film-coated tablets hold the British licence, and a prescription is required for every medicine of this type. The tablets on this page are imported, so the prescriber or pharmacist should check their formulation and product information before confirming a dose. Stopping suddenly can cause dizziness and anxiety, and the interaction list is long. For both reasons any change is agreed with the prescriber, who also decides whether Fluvoxamine is the right choice.