Drug Name
Generic Name : fluvoxamine maleate
Brand Name: Apo-Fluvoxamine (CAN), ratio-Fluvoxamine (CAN)
Classification: SSRI
Pregnancy Category C
Dosage & Route
Available forms : Tablets—25, 50, 100 mg
ADULTS
- Initially, 50 mg PO hs. Increase in 50-mg increments at 4–7 day intervals. Usual range, 100–300 mg/day. Divide doses over 100 mg/day and give larger dose hs. If symptoms do not improve within 10–12 wk, treatment with fluvoxamine should be reconsidered.
PEDIATRIC PATIENTS 8–17 YR
- Initially, 25 mg PO at bedtime. Increase dose by 25 mg/day every 4–7 days to achieve desired effect. Divide doses over 50 mg/day and give larger dose at bedtime.
GERIATRIC PATIENTS OR PATIENTS WITH HEPATIC IMPAIRMENT
- Give a reduced dose (25 mg PO at bedtime), adjust more slowly.
Therapeutic actions
- Fluvoxamine, derived from aralkylketone, inhibits the re-uptake of serotonin in brain neurons.
Indications
- Treatment of OCD
- Unlabeled uses: Treatment of depression, bulimia nervosa, panic disorder, social phobia
Adverse effects
- Headache, asthenia, tremor, palpitations, nausea, diarrhoea, constipation, anorexia, vomiting, flatulence, somnolence, insomnia, dry mouth, nervousness, dizziness, tremor, anxiety, agitation, decreased libido, depression, CNS stimulation, dyspnoea, yawn, sweating, abnormal ejaculation, urinary frequency, anorgasmia, urinary retention.
Contraindications
- Hypersensitivity. Not to be used with thioridazine, terfenadine, astemizole, cisapride, pimozide, aloestron, tizanidine. Lactation.
Nursing considerations
Assessment
- Hypersensitivity to fluvoxamine; lactation; impaired hepatic function; suicidal tendencies; seizures; mania; CV disease; labor and delivery; pregnancy
- Weight; T; skin rash, lesions; reflexes; affect; bowel sounds; liver evaluation; P, peripheral perfusion; LFTs, renal function tests
Interventions
- Give lower or less frequent doses in elderly patients and with hepatic or renal impairment.
- BLACK BOX WARNING: Establish suicide precautions for severely depressed patients, children, and adolescents. Limit quantity of tablets dispensed.
- Administer drug at bedtime. If dose exceeds 100 mg, divide dose and administer the largest dose at bedtime.
- Monitor patient for therapeutic response for up to 4–7 days before increasing dose.
- Monitor patient for serotonin hypertension syndrome, elevated fever, severe anxiety, rigidity.
- WARNING: When discontinuing the drug, taper dose by 50 mg/day every 5–7 days.
Teaching points
- Take this drug at bedtime; if a large dose is needed, the dose may be divided but take the largest dose at bedtime.
- Do not stop taking this drug abruptly; it should be discontinued slowly.
- You may experience these side effects: Dizziness, drowsiness, nervousness, insomnia (avoid driving or performing hazardous tasks), nausea, vomiting, weight loss (eat frequent small meals), sexual dysfunction (reversible).
- Report rash, mania, seizures, severe weight loss.