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Surface here is educational only; do not use without medical supervision. Our editorial verdict is SKIP-FOR-NOW — current cost / risk / redundancy puts it below the line.
Fluvoxamine
SSRI + sigma-1 receptor agonist | Luvox, Faverin — primary OCD indication, strongest CYP1A2 inhibitor in class, controversial early-COVID-19 repurposing
Aliases (5)
Overview
What is Fluvoxamine?
Fluvoxamine (brand names Luvox, Faverin, Floxyfral, Dumirox) is a selective serotonin reuptake inhibitor (SSRI) FDA-approved for obsessive-compulsive disorder in adults (1994) and pediatric patients aged 8-17 (1997). Marketed for major depressive disorder outside the US. Differentiated from other SSRIs by its strong sigma-1 receptor agonism and the strongest CYP1A2 inhibition in the class — both of which drive most of its distinctive clinical and interaction profile.
Key Benefits
Robust efficacy for OCD across age groups (adult + pediatric), social anxiety, and OCD-spectrum conditions. Sigma-1 agonism gives it a theoretical pro-cognitive and neuroprotective edge vs other SSRIs, with controversial early-COVID-19 outpatient signal in the TOGETHER trial. Half-life ~15 hours, no active metabolite — predictable PK once steady-state reached.
Mechanism of Action
Inhibits the serotonin transporter (SERT) raising synaptic serotonin — standard SSRI mechanism. Distinguishes itself by (1) high-affinity sigma-1 receptor agonism (Ki ~36 nM, highest in class) modulating ER-stress, NMDA tone, BDNF, and neurosteroid signalling; and (2) potent CYP1A2 inhibition plus moderate CYP2C19 inhibition — driving extensive drug interactions with caffeine, melatonin, ramelteon, theophylline, agomelatine, clopidogrel, PPIs, warfarin, clozapine, olanzapine, duloxetine, and tizanidine.
Pharmacokinetics
Research Indications
CYP1A2: strongest inhibitor among SSRIs
substrate examples: caffeine, melatonin, ramelteon, theophylline, agomelatine, tizanidine, mexiletine, clozapine, olanzapine, duloxetine,…
CYP2C19: moderate-strong inhibitor
substrate examples: clopidogrel (active metabolite formation blocked), PPIs, S-warfarin, citalopram/escitalopram, diazepam.
Peptide Interactions
(phenelzine, tranylcypromine, selegiline, linezolid, methylene blue): serotonin syndrome — absolute contraindication, 14-day washout.
tramadol, 5-HTP, MDMA, St John's wort, dextromethorphan (high dose), other SSRIs/SNRIs.
caffeine (effectively contraindicated at any meaningful intake), melatonin (~17× AUC), ramelteon (~190× AUC, FDA contraindication), agomelatine (~60× AUC, EU…
clopidogrel (reduced antiplatelet effect — relevant post-stent), PPIs (modest exposure increase), warfarin (INR rise).
at high cumulative load.
First-line behavioral therapy for OCD; combination outperforms either alone.
(risperidone, aripiprazole) for OCD-resistant cases.
Quality Indicators
Pharmacy-dispensed, intact packaging
Prescription tablets in original sealed blister/bottle from a licensed pharmacy. Generic fluvoxamine maleate is FDA AB-rated and fully bioequivalent.
IR vs CR formulation
Immediate-release and controlled-release fluvoxamine are not interchangeable mg-for-mg. CR avoids BID dosing above 150 mg/day but is more expensive. Confirm formulation when switching.
Generic switching across countries
Fluvoxamine is widely generic (Faverin, Floxyfral, Dumirox, Luvox). International generics can have differing excipients; track if symptoms shift after switching brand.
Unbranded blister or counterfeit risk
Avoid international online pharmacies of unknown provenance. Counterfeit psychiatric medications are a documented issue; verify pharmacy and lot number.
What to Expect
- Day 1-7Sedation prominent (qHS dosing helps), nausea, headache. Often a "thicker" feeling than sertraline — partly sigma-1, partly histamine cross-talk debate.
- Week 2-4Caffeine sensitivity becomes obvious — most users have to drop caffeine entirely. Initial OCD/anxiety response begins.
- Week 4-12Class-typical SSRI emotional blunting; sexual dysfunction (anorgasmia, low libido) often emerges and persists. Y-BOCS responders see meaningful symptom drop.
Side Effects & Safety
- Common (>10%): Nausea (especially first weeks), somnolence, headache, insomnia (paradoxical), dry mouth, dizziness, asthenia, sexual dysfunction (30-60%).
- Less common (1-10%): Sweating, anorexia/weight changes (variable), tremor, palpitations, anorgasmia, ejaculation delay.
- Rare-serious (<1%): Serotonin syndrome, hyponatremia (especially elderly), suicidal ideation <25 yr (FDA black box, class-wide), hepatotoxicity (rare), bleeding (platelet 5-HT depletion), QT prolongation (lower risk than citalopram).
- Specific watch periods: First 4 weeks for activation/suicidality; long-term for sexual side effects and weight; LFTs if hepatic risk factors present.
References
PMID 29477251
Cipriani et al. 2018, comparative efficacy of 21 antidepressants (Lancet).
View StudyPMID 34717820
Reis et al. 2022, TOGETHER trial fluvoxamine COVID-19 (Lancet Glob Health).
View StudyPMID 20021348
Hashimoto 2009, sigma-1 SSRI review (Cent Nerv Syst Agents Med Chem).
View StudyPMID 12814817
Greenberg et al. 2003, SSRIs in OCD (Psychiatr Clin North Am).
View StudyPMID 11106136
Härtter et al. 2000, fluvoxamine + melatonin AUC (J Clin Psychopharmacol).
View StudyPMID 18213021
Kuo et al. 2008, fluvoxamine + ramelteon contraindication (Pharmacotherapy).
View StudyPMID 11966456
Spinks & Spinks 2002, SSRI pharmacology review (Curr Med Chem).
View StudyHow was your experience with this compound?
Anonymous · one vote per session · results below at 5+ votes.
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