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Luvox (fluvoxamine): A Synopsis for the Educated Consumer

side effects, dosage, how to take & discontinue, uses, pros & cons, and more
Jerod Poore
Author Information Copyright, Citing and License information Published online 17 March, 2011

Home > Meds > Antidepressants > Luvox (fluvoxamine) Synopsis



Table of Contents (hide)

1. Other brand names & branded generic names1
2. FDA Approved Uses of Luvox (fluvoxamine) / Luvox CR
3. Off-Label Uses of Luvox
4. Luvox / Luvox CR pros and cons
4.1 Pros
4.2 Cons
5. Luvox / Luvox CR Side Effects
5.1 Typical Luvox / Luvox CR Side Effects
5.2 Not So Common fluvoxamine maleate Side Effects
5.3 Luvox / Luvox CR Freaky Rare Side Effects
6. Interesting Stuff Your Doctor Probably Won’t Tell You about Luvox / Luvox CR
7. Luvox / Luvox CR Dosage and How to Take Luvox (fluvoxamine)
7.1 Immediate release
7.2 Controlled Extended release
8. How Long Luvox / Luvox CR Takes to Work
9. How to Stop Taking Luvox / Luvox CR (fluvoxamine maleate)
10. Luvox / Luvox CR Half-Life & Average Time to Clear Out of Your System
11. Days to Reach a Steady State
12. Shelf life
13. Comments
14. Luvox Ratings, Reviews, & Other Sites of Interest
14.1 Rate Luvox
14.2 Rate this article
14.3 Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, check for drug-drug interactions
14.4 Discussion board
15. References
US brand name: Luvox
Generic name: fluvoxamine
Other Forms: Luvox CR extended-release capsules

Class: Antidepressant, because Luvox is one of the first SSRIs.2 As far as approved uses goes, it’s an anxiolytic/anti-anxiety drug.

1.  Other brand names & branded generic names1
Anwu (Taiwan)
Dumirox (Korea, Spain, Uruguay)
Dumyrox (Greece, Portugal)
Faverin (Israel, Australia, Hong Kong, Ireland, Philippines, Singapore, Thailand, Turkey, UK)
Favoxil (Israel)
Fevarin (Bulgaria, Czech Republic, Denmark, Finland, Germany, Hungary, Italy, Netherlands, Norway, Poland, Russia, Sweden, Turkey)
Floxyfral (Austria, Belgium, France, Switzerland)
Fluvohexal (Germany)
Fluvoxin (India)
Lote (Taiwan)
Luvox (Argentina, Australia, Brazil, Canada, Costa Rica, El Salvador, Guatemala, Honduras, Indonesia, Japan, Malaysia, New Zealand, Nicaragua, Panama, Peru, South Africa, Taiwan, Venezuela)
Movox (Australia)
Voxamin (Colombia)
2.  FDA Approved Uses of Luvox (fluvoxamine) / Luvox CR
Obsessive-Compulsive Disorder

3.  Off-Label Uses of Luvox
Depression
Luvox (fluvoxamine) is approved to treat depression pretty much everywhere else in the world.
Panic
Generalized social anxiety
Premenstrual Dysphoric Disorder
Binge eating - two studies, one big and one small indicate that SSRIs just aren’t much good for binge eating.
Combat PTSD
Musical hallucinations in acquired deafness
4.  Luvox / Luvox CR pros and cons
4.1  Pros
Proven as the best med for OCD.
Generally less agitating than other SSRIs.
Tends to work faster than other SSRIs, except Lexapro.
4.2  Cons
The short half-life can make discontinuation difficult.
It doesn’t have as many drug-drug interactions as Provigil or fish oil, but it’s as bad, if not worse than warfarin when it comes to the ones it does have. E.g. Luvox + Cymbalta = effectively tripling your Cymbalta dosage.
5.  Luvox / Luvox CR Side Effects
5.1  Typical Luvox / Luvox CR Side Effects
The usual for SSRIs - headache, nausea, dry mouth, sweating, sleepiness or insomnia, and diarrhea or constipation, weight gain, loss of libido. Most everything will go away after a week or two, but the weight gain and loss of libido might stick around longer. Or permanently.

5.2  Not So Common fluvoxamine maleate Side Effects
Worsening of symptoms, be it anxiety, depression or OCD. Even if you’re taking Luvox for one thing you might get the symptoms of something else.3

5.3  Luvox / Luvox CR Freaky Rare Side Effects
Agoraphobia, fecal incontinence, priapism. Time to stay inside and make the freakiest scat video ever!

6.  Interesting Stuff Your Doctor Probably Won’t Tell You about Luvox / Luvox CR
Mixing caffeine and Luvox (fluvoxamine) can be intensely unpleasant. Your one cup of joe will suddenly become like five cups, and the effects will last six times as long.
The results indicate that intake of caffeine during fluvoxamine treatment may lead to caffeine intoxication. —A fluvoxamine-caffeine interaction study.

This effect was confirmed by pharmacokinetic geek lab tests
And it doesn’t matter if you’re a normal or poor metabolizer of CYP1A2, or if you’re taking just 10mg of fluvoxamine. this study shows how much Luvox can mess with you.
However there is at least one dueling study that explains why people who drink coffee and take Luvox don’t completely flip out.
The increased plasma caffeine concentrations during coadministration with fluvoxamine were not accompanied by enhanced pharmacodynamic activity of caffeine. Several alerting actions of caffeine were observed using tests for mood, sedation, psychomotor performance and EEG, but none were augmented by coadministration of fluvoxamine. The lack of a significant caffeine–fluvoxamine pharmacodynamic interaction might be the result of a number of factors. The subjects who participated in this study, four out of seven of whom consumed caffeine-containing beverages on a regular basis, may have been tolerant to the stimulating effects of higher concentrations of caffeine, even though caffeine alone caused significant improvement in psychomotor performance and decreases in self-rated sedation compared with double-placebo administration. Caffeine doses in excess of 5 mg kg−1 are reportedly required to produce clinically important effects such as mild anxiety, respiratory stimulation, and cardiovascular actions. Caffeine doses in the present study (250 mg, approximately 3.5 mg kg−1) may not have been sufficient to produce adverse effects even after augmentation by fluvoxamine. However, the findings from this single-dose caffeine study predict extensive caffeine accumulation with daily caffeine ingestion and fluvoxamine treatment. Based upon our single dose caffeine data, simulated plasma caffeine concentrations once-daily caffeine ingestion (250 mg) and fluvoxamine treatment over 7 days are predicted to reach a range that might produce untoward CNS effects. Caffeine accumulation could be further augmented with the consumption of caffeine repeatedly throughout a 24-h period. —Fluvoxamine impairs single-dose caffeine clearance without altering caffeine pharmacodynamics

In English: Most regular coffee drinkers can drink one cup of coffee a day while taking Luvox and they probably won’t have a problem.
It’s not just coffee. Luvox can mess with a lot of meds, crazy or otherwise. As with Symbyax, if you take any other med for any reason be sure to talk with your pharmacist (this is exactly the sort of thing they teach in pharmacy school), read the Drug Interactions section of the PI sheet and the PI sheets of all the drugs you take, and enter everything (prescription or otherwise) at Check My Meds’ drug-drug and drug-food interaction site to make sure there is no nasty surprise.
If you smoke you’ll increase the metabolism of Luvox (fluvoxamine) by 25% to 60%. That’s out of the PI sheet, with a study backing it up. So you’ll get less out of it. Somehow that’s ironic for a med that is officially approved only for OCD, as nicotine is an effective treatment for OCD. No, really, nicotine reduces OCD and various anxiety symptoms.
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Fuck OCD



7.  Luvox / Luvox CR Dosage and How to Take Luvox (fluvoxamine)
7.1  Immediate release
The initial dose is 50 mg at bedtime, increased by 50 mg a day every four to seven days as needed until the maximum dose of 300 mg a day is reached. Like any SSRI I suggest starting out with 25mg and then increasing to 50mg after a week. If you don’t feel anything go up to 100mg, but stay there until you’ve given it a try for a month total (about two weeks at 100mg), otherwise it’ll just be a pain in the ass to stop it. Even at 100mg you’ll know after a month if Luvox is going to do something for you.

7.2  Controlled Extended release
Here Abbott & Jazz Pharma’s recommendation:

100 mg at bedtime, with weekly increases of 50 mg as tolerated to maximum therapeutic benefit, not to exceed 300 mg per day.--Luvox CR PI sheet

At least they kept Solvay’s lack of a target dosage. As much as I’d like to suggest starting at 50mg, as James pointed out, Luvox CR comes in only two dosages: 100mg & 150mg. So you’re pretty much stuck with starting at 100mg a day.

8.  How Long Luvox / Luvox CR Takes to Work
Like all SSRIs anywhere from a couple days to over a month. If you don’t feel any positive benefit after a two-three weeks, then you should talk to your doctor about either another SSRI and/or adding an antipsychotic to the mix.

9.  How to Stop Taking Luvox / Luvox CR (fluvoxamine maleate)
Your doctor should be recommending that you reduce your dosage 25–50mg every 4 days if you need to stop taking it.

While you have the option of reducing your dosage by 50mg a day with the CR form, since Jazz Pharma makes Luvox CR only in 100mg and 150mg capsules, that can be both complicated and expensive. A study specific to fluvoxamine withdrawal shows that if you stop taking Luvox abruptly you might wind up with SSRI discontinuation syndrome. Ya think?
So if your discontinuation seems harsh, and because fluvoxamine has such a short half-life and its pharmacokinetics are non-linear, talk to your doctor about getting a prescription for immediate-release fluvoxamine and go for a tapering of 12.5–25mg a day.

10.  Luvox / Luvox CR Half-Life & Average Time to Clear Out of Your System
With a half-life of 15.6 hours, the shortest of all true SSRIs4, Luvox (fluvoxamine) is out of your body in about 80 hours. Luvox CR has a half-life of about 16 hours, so there’s still not much difference.

11.  Days to Reach a Steady State
The steady state for Luvox is non-linear. That means if you change the dosage, the steady state gets hosed. So Solvay doesn’t publish any steady state data. Figure at least a week, maybe two, after your last dosage adjustment.

12.  Shelf life
3 years.

13.  Comments
Note that Luvox (fluvoxamine) is not technically an antidepressant in the US, just everywhere else. Luvox is just one of two meds of which I’m aware that are officially approved only for OCD in the US. And why is it so good for OCD? It’s all about the sigma-1 receptor, and fluvoxamine likes sigma-1. Zoloft is another meds that is especially effective for anxiety disorders, and it is also sigma-1 agonists.

Solvay may have given up on Luvox, but in 2008 Abbott & Jazz Pharma brought brand-name Luvox back to the US market as Luvox CR extended-release capsules. How CR translates to extended release is beyond me. I can understand why they didn’t want to call it Luvox ER, because that looks and sounds too much like Effexor, and Elan Pharma’s fancy Spheroidal Oral Drug Absorption System (or SODAS) must “controlled” and not “extended,” or something like that.

Luvox CR originally had approval to treat social anxiety disorder (SAnD) as well as OCD. Unfortunately some data from the clinical trials were made public and the FDA pressured Jazz to “voluntarily withdraw the indication”.5

We know that nicotine makes you clear Luvox a lot faster and nicotine is an effective treatment for OCD. So what would happen if a poor metabolizer of CYP1A2 substrates with OCD combined Luvox with nicotine. Synergistic effect or just a wash?

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14.  Luvox Ratings, Reviews, & Other Sites of Interest
14.1  Rate Luvox
Give your overall impression of Luvox on a scale of 0 to 5.

Get all critical about Luvox
4 stars Rating 3.7 out of 5 from 137 criticisms.
Vote Distribution: 20 – 1 – 6 – 11 – 40 – 59

0- Sucks Donkey Dong! 1- Meh 2- Worth it if You are Out of Options 3- Sucks Less than What I Have 4- Worth Holding on to 5- Life-Saving
14.2  Rate this article
If you’re still feeling judgmental as well as just mental6, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.

Get all judgmental about the Luvox (fluvoxamine) Synopsis
4 stars Rates 3.6 out of 5 from 70 value judgments.
Vote Distribution: 13 – 0 – 2 – 2 – 23 – 30

0 - Made Me Join Scientology 1 - Sucks More than my Meds 2 - Might not Kill You 3 - Beats a PI Sheet Rehash 4 - Life Sucks Less Now 5 - Ignoble Prize Material
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Team OCD	I <3 Wellbutrin buttons at Straitjacket T-shirts
I <3 Wellbutrin
Pages and Forum Topics Google Thinks are Relevant to Your Mental Health


14.3  Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, check for drug-drug interactions
Luvox’s Full US Prescribing Information / PI Sheet
Luvox CR PI sheet

UK Summary of Product Characteristics (SPC) for Faverin

UK Patient Information Leaflet (PIL) for Faverin

Irish Summary of Product Characteristics (SPC) for Faverin

South African Luvox Package Insert

Canadian Luvox Product Monograph

New Zealand Luvox Medicine Data Sheet

Australian Movox Product Information

Drugs.com’s drug-drug and drug-food interaction checker
It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.



14.4  Discussion board
If you have any questions not answered here, please see the Crazymeds Luvox discussion board.


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15.  References
Luvox (fluvoxamine) Full US Prescribing Information
Culm‐Merdek, Kerry E., Lisa L. Von Moltke, Jerold S. Harmatz, and David J. Greenblatt. “Fluvoxamine impairs single‐dose caffeine clearance without altering caffeine pharmacodynamics.” British journal of clinical pharmacology 60, no. 5 (2005): 486-493.
Ishikawa, Masatomo, and Kenji Hashimoto. “The role of sigma-1 receptors in the pathophysiology of neuropsychiatric diseases.” Journal of Receptor, Ligand and Channel Research 3 (2010): 25-36.
Stahl, Stephen M. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Third edition Cambridge University Press 2008. ISBN:978–0521673761
PDR: Physicians’ Desk Reference 2010 64th edition
Diamond, Ronald J., MD Instant Psychopharmacology 2nd Edition W.W. Norton 2002. ISBN:978–0393703917
Julien, Robert M. Ph.D, Claire D. Advokat, and Joseph Comaty Primer of Drug Action: A comprehensive guide to the actions, uses, and side effects of psychoactive drugs 12th edition Worth Publishers 2011. ISBN:978–1429233439
Drummond, Edward, MD The Complete Guide to Psychiatric Drugs John Wiley & Sons 2000. ISBN:0471353701
Healing Anxiety & Depression Daniel G. Amen, M.D., and Lisa C. Routh, M.D. © 2003. Published by G.P. Putnam’s Sons.
Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series)
1 The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions.
2 DU 23000 - the designation used prior to the assignment of the generic name fluvoxamine - was being tested for depression as far back as 1977. Fevarin was released in Switzerland in 1984, although it wasn't approved in the US until 1993.

3 Which seems to be a common trait with sigma-1 agonists.

4 Paxil CR has a half-life of 15-20 hours, while the immediate-release form has a half-life of 21 hours. No, I don't have those backwards. Yes, it makes no sense to me either, other than drug companies usually do a half-assed job in PK testing.

5 And they had to file the usual shitload of paperwork that accompanies any change to what a medication is prescribed for, or anything else that is in a PI sheet for that matter. Talk about adding insult to injury.

6 Thank you! I'll be here at least 72 hours. Be sure to tip your content provider. And don't try the veal, it's cruelicious!

If you have any questions not answered here, please see the Crazymeds Luvox discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.us)


Last modified on Wednesday, 04 May, 2016 at 17:26:44 by JerodPoore	Page Author Jerod Poore	Date created
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Luvox, and all other drug names on this page and used throughout the site, are a trademark of someone else. Luvox’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.




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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.
* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.