What is luvox. Luvox (Fluvoxamine): Uses, Side Effects, and Essential Information

21.07.202306.07.2023 by alexxlab

What is Luvox and how does it work. What are the main uses of Luvox. What are the potential side effects of Luvox. How should Luvox be taken properly. What precautions should be considered when using Luvox. How does Luvox interact with other medications. What is the importance of monitoring while taking Luvox.

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Understanding Luvox: An In-Depth Look at Fluvoxamine

Luvox, also known by its generic name fluvoxamine, is a medication that belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs). This powerful antidepressant is primarily used to treat obsessive-compulsive disorder (OCD), but it may also be prescribed for other mental health conditions. To fully grasp the significance of this medication, it’s crucial to understand its mechanism of action, uses, and potential effects on the body.

How Does Luvox Work?

Luvox works by helping to restore the balance of serotonin in the brain. Serotonin is a neurotransmitter that plays a vital role in mood regulation and mental well-being. By inhibiting the reuptake of serotonin, Luvox increases the availability of this essential chemical in the brain, which can help alleviate symptoms associated with OCD and other mental health disorders.

Primary Uses and Benefits of Luvox

The primary use of Luvox is in the treatment of obsessive-compulsive disorder (OCD). OCD is characterized by persistent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that a person feels compelled to perform. Luvox helps to decrease these unwanted thoughts and reduce the urge to perform repetitive tasks that interfere with daily living.

How Does Luvox Help with OCD?

Luvox assists in managing OCD symptoms by:

Reducing the frequency and intensity of obsessive thoughts
Decreasing the urge to perform compulsive behaviors
Improving overall mood and reducing anxiety associated with OCD
Enhancing quality of life by minimizing the impact of OCD on daily activities

While OCD is the primary indication for Luvox, healthcare providers may sometimes prescribe it off-label for other conditions such as social anxiety disorder, panic disorder, or depression. However, it’s important to note that the use of Luvox for these conditions should be carefully evaluated and monitored by a healthcare professional.

Proper Administration and Dosage of Luvox

Proper administration of Luvox is crucial for its effectiveness and safety. The medication is typically taken orally, either once daily at bedtime or twice daily (morning and bedtime). The dosage is determined by several factors, including the patient’s medical condition, response to treatment, age, and other medications they may be taking.

What is the Recommended Dosage Schedule for Luvox?

The dosage schedule for Luvox can vary, but generally follows these guidelines:

Initial dosage: Often starts low, typically 50 mg once daily at bedtime
Gradual increase: The dose may be increased gradually over several weeks
Maintenance dose: Usually ranges from 100 mg to 300 mg daily
Maximum dose: Should not exceed 300 mg per day

It’s important to note that in children, the dosage may be based on age and gender. Always follow your doctor’s instructions carefully and do not adjust your dose without consulting your healthcare provider.

Potential Side Effects and Risks of Luvox

Like all medications, Luvox can cause side effects. While not everyone experiences side effects, it’s important to be aware of potential adverse reactions. Common side effects of Luvox include nausea, vomiting, drowsiness, dizziness, and sexual problems.

Are There Any Serious Side Effects Associated with Luvox?

While rare, some serious side effects may occur with Luvox use. These can include:

Serotonin syndrome (a potentially life-threatening condition)
Increased risk of suicidal thoughts or behaviors, especially in young adults
Severe allergic reactions
Abnormal bleeding
Seizures
Manic episodes in people with bipolar disorder

If you experience any severe or persistent side effects, it’s crucial to seek medical attention immediately. Your healthcare provider can help determine if the benefits of continuing Luvox outweigh the risks in your specific case.

Important Precautions and Warnings for Luvox Users

Before starting Luvox, it’s essential to discuss your medical history and current medications with your healthcare provider. Certain conditions and medications may interact with Luvox, potentially causing serious complications.

Who Should Exercise Caution When Taking Luvox?

Extra precautions should be taken by individuals with:

A history of bipolar disorder or mania
Liver or kidney disease
Seizure disorders
Bleeding disorders
Heart conditions
Glaucoma

Additionally, pregnant women, those planning to become pregnant, or breastfeeding mothers should discuss the potential risks and benefits of Luvox with their healthcare provider. The medication may pass into breast milk and could affect a nursing infant.

Drug Interactions and Contraindications with Luvox

Luvox can interact with various medications, potentially altering their effectiveness or increasing the risk of side effects. It’s crucial to inform your healthcare provider about all medications, supplements, and herbal products you’re taking.

Which Medications Should Not Be Taken with Luvox?

Luvox should not be taken in combination with:

Monoamine oxidase inhibitors (MAOIs)
Thioridazine
Tizanidine
Alosetron
Pimozide
Ramelteon

Additionally, Luvox may interact with other medications that affect serotonin levels, such as other antidepressants, certain pain medications, or St. John’s Wort. Always consult your healthcare provider or pharmacist before starting any new medication while taking Luvox.

Monitoring and Follow-up Care for Luvox Treatment

Regular monitoring is essential when taking Luvox to ensure its effectiveness and minimize potential risks. Your healthcare provider will likely schedule follow-up appointments to assess your response to the medication and make any necessary adjustments.

What Should Be Monitored During Luvox Treatment?

During Luvox treatment, your healthcare provider may monitor:

Improvement in OCD symptoms
Changes in mood or behavior
Emergence of side effects
Blood tests to check liver function
Weight and appetite changes
Sexual function

It’s crucial to attend all scheduled appointments and report any changes in your condition or new symptoms promptly. This helps ensure that you’re receiving the most appropriate and effective treatment.

Long-term Use and Discontinuation of Luvox

Luvox is often prescribed for long-term use in managing OCD symptoms. However, the duration of treatment can vary depending on individual circumstances and response to the medication. It’s important to continue taking Luvox as prescribed, even if you feel better, unless directed otherwise by your healthcare provider.

How Should Luvox Be Discontinued?

Discontinuing Luvox should always be done under medical supervision. Abrupt discontinuation can lead to withdrawal symptoms, including:

Dizziness
Nausea
Headaches
Irritability
Flu-like symptoms
Electric shock sensations

To minimize these effects, your healthcare provider may recommend gradually reducing your dose over time. This process, known as tapering, allows your body to adjust to decreasing levels of the medication.

In conclusion, Luvox (fluvoxamine) is a powerful medication primarily used in the treatment of obsessive-compulsive disorder. While it can be highly effective in managing OCD symptoms, it’s crucial to use it under close medical supervision, be aware of potential side effects and interactions, and follow proper administration guidelines. Regular monitoring and open communication with your healthcare provider are key to ensuring the safe and effective use of Luvox in your treatment plan.

Luvox Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Warnings:

Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.

Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.

Warnings:

Uses

Fluvoxamine is used to treat obsessive-compulsive disorder (OCD). It helps decrease thoughts that are unwanted or that don’t go away (obsessions), and it helps to reduce the urge to perform repeated tasks (compulsions such as hand-washing, counting, checking) that interfere with daily living. Fluvoxamine is known as a selective serotonin reuptake inhibitor (SSRI). This medication works by helping to restore the balance of a certain natural substance (serotonin) in the brain.

How to use Luvox Tablet

Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start taking fluvoxamine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth with or without food as directed by your doctor, usually once daily at bedtime, or twice daily (once in the morning and once at bedtime). If you are taking this medication twice daily and the doses are not equal, then the larger of the 2 doses should be taken at bedtime.

The dosage is based on your medical condition, response to treatment, age, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). In children, the dosage may also be based on their age and gender. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor’s instructions carefully.

Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase. Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

Keep taking this medication even if you feel well. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Also, you may experience symptoms such as mood swings, headache, tiredness, sleep changes, and brief feelings similar to electric shock. To prevent these symptoms while you are stopping treatment with this drug, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details. Report any new or worsening symptoms right away.

It may take up to several weeks before you get the full benefit of this drug.

Tell your doctor if your condition does not improve or if it worsens.

Side Effects

Precautions

Before taking fluvoxamine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: personal or family history of bipolar/manic-depressive disorder, personal or family history of suicide attempts, liver problems, seizures, low sodium in the blood, bleeding problems, personal or family history of glaucoma (angle-closure type).

This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

Fluvoxamine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.

The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using fluvoxamine, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).

Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics “water pills”) or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using fluvoxamine safely.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older adults may be more sensitive to the side effects of this drug, especially bleeding, or loss of coordination, QT prolongation. Older adults may also be more likely to develop a type of salt imbalance (hyponatremia), especially if they are taking “water pills” (diuretics). Loss of coordination can increase the risk of falling.

Children may be more sensitive to the side effects of this drug, especially loss of appetite and weight loss. Monitor weight and height in children who are taking this drug.

During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. Also, babies born to mothers who have used this drug during the last 3 months of pregnancy may rarely develop withdrawal symptoms such as feeding/breathing difficulties, seizures, muscle stiffness, or constant crying. If you notice any of these symptoms in your newborn, tell the doctor promptly.

Since untreated mental/mood problems (such as depression, obsessive compulsive disorder, post-traumatic stress disorder) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy.

This drug passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Some products that may interact with this drug are: other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen/naproxen, “blood thinners” such as dabigatran/warfarin).

Aspirin can increase the risk of bleeding when used with this medication. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.

Many drugs besides fluvoxamine may affect the heart rhythm (QT prolongation), including pimozide, thioridazine, among others.

This medication can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include alosetron, clozapine, methadone, melatonin, ramelteon, tacrine, tizanidine, certain benzodiazepines such as alprazolam/diazepam/triazolam, certain beta-blockers such as metoprolol/propranolol, tricyclic antidepressants such as imipramine, among others.

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/”ecstasy,” St. John’s wort, certain antidepressants (including other SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), tryptophan, among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.

This medication can increase the effects of caffeine. Avoid drinking large amounts of beverages containing caffeine (coffee, tea, colas) or eating large amounts of chocolate or taking nonprescription products that contain caffeine.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and opioid pain relievers (such as codeine).

Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

Cigarette smoking decreases blood levels of this medication. Tell your doctor if you smoke or if you have recently stopped smoking.

This medication may interfere with certain medical/laboratory tests (including brain scan for Parkinson’s disease), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

Does Luvox Tablet interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: fast/slow/irregular heartbeat, trouble breathing, seizures.

Do not share this medication with others.

Keep all regular medical and psychiatric appointments.

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

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Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Fluvoxamine (Luvox) | NAMI: National Alliance on Mental Illness

Generic name: fluvoxamine (floo VOKS a meen)

Brand names:

Luvox®
- Tablets (immediate release): 25 mg, 50 mg, 100 mg

Luvox CR®
- Capsules (extended release): 100 mg, 150 mg

All FDA black box warnings are at the end of this fact sheet. Please review before taking this medication.

What Is Fluvoxamine And What Does It Treat?

Fluvoxamine is an antidepressant medication that works in the brain. It is approved for the treatment of obsessive compulsive disorder (OCD) in adults and children ages 8 and older.

Obsessive Compulsive Disorder (OCD) occurs when a person experiences the following symptoms at the same time:

Obsessions (unwanted, recurrent, and disturbing thoughts)

Compulsions (repetitive, ritualized behaviors that the person feels driven to perform in order to lessen the anxiety produced by the obsessions)

Fluvoxamine may also be helpful when prescribed “off-label” for major depressive disorder (MDD), social phobia (also known as social anxiety disorder), posttraumatic stress disorder (PTSD), panic disorder, and eating disorders including bulimia nervosa and binge-eating disorder. “Off-label” means that it hasn’t been approved by the Food and Drug Administration for this condition. Your mental health provider should justify his or her thinking in recommending an “off-label” treatment. They should be clear about the limits of the research around that medication and if there are any other options.

Symptoms of depression include:

Depressed mood – feeling sad, empty, or tearful

Feeling worthless, guilty, hopeless, and helpless

Loss of interest or pleasure in your usual activities

Sleep and eat more or less than usual (for most people it is less)

Low energy, trouble concentrating, or thoughts of death (suicidal thinking)

Psychomotor agitation (‘nervous energy’)

Psychomotor retardation (feeling like you are moving and thinking in slow motion)

Suicidal thoughts or behaviors

Social phobia (also known as social anxiety disorder) is a fear of situations where one may feel as if they are being judged by others. Symptoms include:

Blushing

Difficulty talking

Nausea

Sweating

Shaking

What Is The Most Important Information I Should Know About Fluvoxamine?

Do not stop taking fluvoxamine, even when you feel better. With input from you, your health care provider will assess how long you will need to take the medicine.

Missing doses of fluvoxamine may increase your risk for relapse in your symptoms.

Stopping fluvoxamine abruptly may result in one or more of the following withdrawal symptoms: irritability, nausea, dizziness, vomiting, nightmares, headache, and/or paresthesias (prickling, tingling sensation on the skin).

Depression is also a part of bipolar illness. People with bipolar disorder who take antidepressants may be at risk for “switching” from depression into mania. Symptoms of mania include “high” or irritable mood, very high self-esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees).

Medical attention should be sought if serotonin syndrome is suspected. Please refer to serious side effects for signs/symptoms.

Are There Specific Concerns About Fluvoxamine And Pregnancy?

If you are planning on becoming pregnant, notify your health care provider to best manage your medications. People living with MDD who wish to become pregnant face important decisions. Untreated MDD has risks to the fetus, as well as the mother. It is important to discuss the risks and benefits of treatment with your doctor and caregivers. For women who take antidepressant medications during weeks 13 through the end of their pregnancy (second and third trimesters), there is a risk that the baby can be born before it is fully developed (before 37 weeks).

For mothers who have taken SSRIs during their pregnancy, there appears to be less than a 1% chance of infants developing persistent pulmonary hypertension. This is a potentially fatal condition that is associated with use of the antidepressant in the second half of pregnancy. However, women who discontinued antidepressant therapy were five times more likely to have a depression relapse than those who continued their antidepressant. If you are pregnant, please discuss the risks and benefits of antidepressant use with your health care provider.

Caution is advised with breastfeeding since fluvoxamine does pass into breast milk.

What Should I Discuss With My Health Care Provider Before Taking Fluvoxamine?

Symptoms of your condition that bother you the most

If you have thoughts of suicide or harming yourself

Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects

If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require changes in the medication.

Any other psychiatric or medical problems you have, including a history of bipolar disorder

All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have

Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.

If you are pregnant, plan to become pregnant, or are breastfeeding

If you drink alcohol or use drugs

How Should I Take Fluvoxamine?

Fluvoxamine is usually taken two times per day with or without food. The extended release formulation may be taken one time per day with or without food.

Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.

The dose usually ranges from 50 mg to 300 mg. Only your health care provider can determine the correct dose for you.

Consider using a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication. You may also ask a family member or friend to remind you or check in with you to be sure you are taking your medication.

The extended-release forms should be swallowed whole. They should not be chewed, crushed, or broken.

What Happens If I Miss A Dose Of Fluvoxamine?

If you miss a dose of fluvoxamine, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your health care provider. Do not double your next dose or take more than what is prescribed.

What Should I Avoid While Taking Fluvoxamine?

Avoid drinking alcohol or using illegal drugs while you are taking antidepressant medications. They may decrease the benefits (e.g., worsen your condition) and increase adverse effects (e.g., sedation) of the medication.

What Happens If I Overdose With Fluvoxamine?

If an overdose occurs, call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.

A specific treatment to reverse the effects of fluvoxamine does not exist.

What Are The Possible Side Effects Of Fluvoxamine?

Common side effects

Headache, nausea, diarrhea, dry mouth, dizziness, increased sweating, feeling nervous, restless, fatigued, or having trouble sleeping (insomnia). These will often improve over the first week or two as you continue to take the medication.

Sexual side effects, such as problems with orgasm or ejaculatory delay, often do not diminish over time.

Rare/serious side effects

Low sodium blood levels (symptoms of low sodium levels may include headache, weakness, difficulty concentrating and remembering), teeth grinding, angle closure glaucoma (symptoms of angle closure glaucoma may include eye pain, changes in vision, swelling or redness in or around eye), serotonin syndrome (symptoms may include shivering, diarrhea, confusion, severe muscle tightness, fever, seizures, and death), seizure

SSRI antidepressants including fluvoxamine may increase the risk of bleeding events. Combined use of aspirin, nonsteroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen), warfarin, and other anti-coagulants may increase this risk. This may include symptoms such as gums that bleed more easily, nose bleed, or gastrointestinal bleeding. Some cases have been life threatening.

Are There Any Risks For Taking Fluvoxamine For Long Periods Of Time?

To date, there are no known problems associated with long term use of fluvoxamine. It is a safe and effective medication when used as directed.

What Other Medications May Interact With Fluvoxamine?

Fluvoxamine should not be taken with or within 6 weeks of taking monoamine oxidase inhibitors (MAOIs). These include phenelzine (Nardil®), tranylcypromine (Parnate®), isocarboxazid (Marplan®), rasagiline (Azilect®), and selegiline (Emsam®).

Although rare, there is an increased risk of serotonin syndrome when fluvoxamine is used with other medications that increase serotonin, such as other antidepressants, migraine medications called “triptans” (e.g., Imitrex®), some pain medications (e.g., tramadol (Ultram®), amphetamines, and the antibiotic linezolid (Zyvox®).

Fluvoxamine may increase the levels and effects of:

Warfarin (Coumadin®)

Theophylline (Theo-Dur®)

Certain anticonvulsants: carbamazepine (Tegretol®, Equetro®), phenytoin (Dilantin®)

Beta blockers, such as propranolol (Inderal®), metoprolol (Lopressor®, Toprol XL®)

Benzodizapines, such as alprazolam (Xanax®), diazepam (Valium®)

Certain antipsychotics, such as olanzapine (Zyprexa®), clozapine (Clozaril®), aripiprazole (Abilify®), quetiapine (Seroquel®)

Mexiletine (Mexitil®)

Omeprazole (Prilosec®)

Methadone (Dolophine®)

Tricyclic antidepressants, such as amitriptyline (Elavil®)

Fluvoxamine may decrease the effects of clopidogrel (Plavix®).

Fluvoxamine may increase the effects of other medications that can cause bleeding (e.g., ibuprofen (Advil®, Motrin®), warfarin (Coumadin®), and aspirin).

Combining fluvoxamine with ramelteon (Rozerem^TM), tizanidine (Zanaflex®), thioridazine (Mellaril®), pimozide, or alosetron (Lotronex®) is not recommended.

How Long Does It Take For Fluvoxamine To Work?

Sleep, energy, or appetite may show some improvement within the first 1-2 weeks. Improvement in these physical symptoms can be an important early signal that the medication is working. Depressed mood and lack of interest in activities may need up to 6-8 weeks to fully improve.

Summary of FDA Black Box Warnings

Suicidal thoughts or actions in children and adults

Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications. This risk may persist until significant remission occurs.

In short-term studies, antidepressants increased the risk of suicidality in children, adolescents, and young adults when compared to placebo. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24. Adults age 65 and older taking antidepressants have a decreased risk of suicidality. Patients, their families, and caregivers should be alert to the emergence of anxiety, restlessness, irritability, aggressiveness and insomnia. If these symptoms emerge, they should be reported to the patient’s prescriber or health care professional. All patients being treated with antidepressants for any indication should watch for and notify their health care provider for worsening symptoms, suicidality and unusual changes in behavior, especially during the first few months of treatment.

Provided by

(January 2023)

©2020 The American Association of Psychiatric Pharmacists (AAPP) and the National Alliance on Mental Illness (NAMI). AAPP and NAMI make this document available under the Creative Commons Attribution-No Derivatives 4.0 International License. Last Updated: January 2016.

This information is being provided as a community outreach effort of the American Association of Psychiatric Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the medication. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The American Association of Psychiatric Pharmacists disclaims any and all liability alleged as a result of the information provided herein.

Prozac of Life – Indicator

Why mussel breeders need serotonin, how its reuptake inhibitors work, and how Prozac conquered and then almost destroyed the United States, will tell the new issue of the Ig Nobel is Serious column.

Surely many of you have heard about serotonin, a neurotransmitter that is often called the “hormone of happiness,” which is absolutely wrong. Hormones are produced in some organs of our body, and perform their functions in others. Serotonin is produced and works in one place – the neurons of the brain. It conducts nerve impulses between neurons in parts of the brain, including those responsible for good mood. The physiological functions of serotonin are very diverse: it is involved in the regulation of vascular tone, plays an important role in the processes of blood coagulation, allergic and inflammatory reactions, enhances the peristalsis of the gastrointestinal tract and affects the reproductive system, namely, the processes of excitation and inhibition in the genital organs. This last property of serotonin has been used for a long time in the mussel and oyster industry: the owners of farms where mussels and oysters are grown add serotonin to the water – and the clams begin to multiply actively in response.

“Shellfish breeders—those who can afford it—use serotonin to stimulate spawning. When shellfish actively and simultaneously reproduce, farmers get a rich “harvest” that will be ready to be sold in a single batch,” says Peter Fong, winner of the 1998 Ig Nobel Prize in Biology. However, this pleasure is not cheap – about two decades ago, the cost of serotonin reached $ 22 per gram, which made this neurotransmitter too expensive for use in developing countries.

Peter Fong and his colleagues Peter Huminski and Lynette d’Urso found a cheaper alternative. They tested the effects of the selective serotonin reuptake inhibitors fluvoxamine, fluoxetine and paroxetine on the bivalve Sphaerium striatinum . What are they? Serotonin, like other neurotransmitters, must be transmitted from one nerve cell to the receptors of another, ensuring the transmission of a nerve impulse between them. But sometimes, when one neuron releases too much serotonin into the synaptic cleft, the excess “gathers” back into the same cell from which it was released – this is reuptake. Inhibitors (from the Latin word inhibere – “delay”, “slow down”) – substances that suppress or slow down the course of various processes – resist reuptake, and all serotonin can safely go to its destination.

All three substances studied by scientists had some effect on the reproduction of mollusks, but only fluoxetine accelerated the process ten times. A little later, Phong’s test subjects were mollusks Dreissena polymorpha – fluoxetine acted on them in the same way.

Well, it’s time to show the cards. All three serotonin reuptake inhibitors are probably known to you as antidepressants by their trade names: fluvoxamine is Luvox, paroxetine is Paxil, and fluoxetine, which has shown itself to be the best of all, is Prozac. At the time of the events described (1998), Prozac cost about 190 times more than pure serotonin, but the benefits for farmers were obvious. Peter Fong told The New York Times: Shellfish breeders can use Prozac at concentrations a thousand times lower than serotonin concentrations, and the effect will be the same.

However, the 1998 Ig Nobel Prize in Biology was not just awarded for a study in which the reproduction of mollusks was sped up with the help of an antidepressant – it has a much deeper meaning. Prozac has become a real symbol of the era of the late XX – early XXI century, a drug that is taken by tens of millions of people around the world. The fact that its unusual use was included in the list of achievements “that make you laugh first, and then think” is very symptomatic.

Prozac’s active ingredient, fluoxetine, was discovered in 1972 by the pharmaceutical company Eli Lilly and Company among dozens of candidate molecules synthesized by its chemists, and in the mid-1980s, the US Food and Drug Administration (FDA) allowed bring the drug to market. In its first year, Prozac sold $350 million in the United States and became known as the “happiness pill.” In other countries, similar success awaited him, and by 19In 1994, the drug became the world leader among antidepressants. Prozac has been considered a panacea for major depressive disorder, obsessive-compulsive disorder, bulimia nervosa, panic disorder, and premenstrual dysphoric disorder. In 2001, the patent for the drug expired, and generics flooded the market.

However, in reality, not everything was so rosy. It was believed that the side effects of Prozac are significantly less than those of other antidepressants. However, they do include gastrointestinal disturbances, sleep problems, loss of appetite, manic episodes, seizures, and an increased risk of suicide, especially in people under 25 years of age. I would like to dwell on the last problem in more detail.

In the late 1990s – 2000s, Prozac in the United States began to be actively prescribed to pregnant women, children and adolescents, and then completely sold without a prescription. It was not for nothing that the Americans were called the “Prozac Nation” – more and more people “got hooked” on it. Meanwhile, the Food and Drug Administration was receiving more and more reports of patients taking Prozac who chose to voluntarily die, and dozens of lawsuits were filed against Eli Lilly and Company because of this. According to statistics, as the drug spread to a young audience in the country, the number of crimes committed by teenagers increased, and cases of shootings in schools became more frequent. In 2004, the FDA required manufacturers of antidepressants to display a warning on their packaging that the drug may increase the risk of suicide in people under 25 years of age.

As Vladislav Dorofeev writes in his book Great Medicines, later two independent panels of FDA experts conducted statistical studies based on the results of three hundred trials of 11 antidepressants. The work showed that the use of fluoxetine contributed to the manifestation of aggression and doubled the risk of suicide in children and adolescents, but in adults this risk decreased by about 30%. However, this information did not come as a surprise to the manufacturer: there are more than 500 studies of Prozac in the databases of scientific articles. At the same time, some reviews noted that manufacturers did not publish all the data obtained during the work. Eli Lilly and Company have been known to write off suicides during clinical trials of the drug as overdose or increased depression.

What do the other published studies of the drug say? Findings vary depending on the disorder the drug is being used against. For the fight against depression, a significant number of reviews call fluoxetine effective (sometimes only compared to placebo, and not other antidepressants), and the toxicity of the drug is lower compared to analogues. However, for example, in the case of obsessive-compulsive disorder, the situation is unclear, since there is not enough data for unambiguous conclusions. Prozac is recognized as a leader among other antidepressants for the fight against bulimia nervosa, but the authors are still not ready to recommend it as a standard treatment method, since not all clinical data are available for analysis. In addition, it is worth considering: Prozac is a serotonin reuptake inhibitor, and depression can be caused by a variety of reasons, such as serious diseases (cancer, diabetes, cirrhosis of the liver), lack of vitamins, psychological trauma.

So Prozac is not a “happiness pill” and not a panacea for mental problems, but just one of the many antidepressants, with its effectiveness and serious side effects, difficult to select dosage and intake, which should be carried out only under the supervision of a doctor. And the Ig Nobel Prize in Biology in 1998 really makes you think about many things: our psychological state, the need to take serious medications only according to indications and after consultations with specialists, the fragility of human life. Well, about mussels with white wine sauce, where without it. By the way, shellfish breeders still use serotonin to stimulate the reproduction of their wards, only now they do not pour it into water, but inject oysters and mussels directly into the ovaries.

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All About Cytochrome P450 Enzyme Assays

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Psychiatrists and psychotherapists use Cytochrome P450 Enzyme (CYP450) assays to assess how well a drug is processed by the body. Due to genetic differences in these enzymes, drugs can affect each person differently. Pharmacogenomics (pharmacogenetics) is the study of the body’s response to certain drugs. Special studies are aimed at finding variations in genes that determine the degree of individual effectiveness or intolerance of drugs. Cytochrome P450 includes the CYP2D6 enzyme, which processes many antidepressants and antipsychotic drugs. By checking DNA for gene variations, CYP450 tests provide insight into the body’s response to a particular antidepressant. Also, CYP450 tests can detect variations in other enzymes such as CYP2C19.. Doctors are trying to understand why some brands of antidepressants work for some people and not for others.

When to do a Cytochrome P450 Enzyme Test

Medicines for depression are usually prescribed based on symptoms and medical history. For some people, the antidepressant quickly relieves the symptoms of the disease and has tolerable side effects. But other patients select drugs by trial and error. Some people take months to find the right antidepressant. The cytochrome P450 test can speed up the identification of drugs that will be the best solution for a particular person. Better selection of the drug leads to fewer side effects and increased efficiency. Typically, CYP450 tests are used when initial treatment has failed.

The CYP2D6 test helps evaluate the effectiveness of cancer drugs (eg, tamoxifen in the treatment of breast cancer). CYP2C9 analysis will help determine the optimal dosage of warfarin, a blood thinner, to reduce the risk of side effects.

How Cytochrome P450 Enzyme Assays are Performed

No special test preparations are required. For the cytochrome P450 test, a sample of your DNA is taken in one of the following ways:

Cheek swab. The specialist will run a cotton swab across the inside of the cheek to obtain a sample of the cells.
Collection of saliva. You just spit saliva into a special test tube.
Blood test. Biomaterial is taken from a vein in the arm.
The material will then be sent to a laboratory where it will be analyzed for certain genes.

Results

Cytochrome P450 test results usually take 4-5 business days. Together with your doctor, you will be able to discuss the results, as well as adjust the further treatment plan. The results of the analysis are classified according to the rate of assimilation of specific drugs. For example, CYP2D6 test data will show the main characteristics:

Bad metabolizers . The lack of an enzyme can lead to slow processing of the drug. Because of this, it will accumulate. Accumulation, in turn, can provoke the appearance of side effects. In this case, it is possible to benefit from drugs only at reduced dosages.
Intermediate metabolizers . When enzyme function is reduced, drug processing is not as efficient as in people with normal metabolizers.
Normal (extensive) metabolisers. In this case, antidepressants will work as efficiently as possible with reduced risks of side effects.
Ultra-fast metabolisers. Medicines are processed and excreted so quickly that they do not have time to work properly. Most likely, you will need higher dosages of the drug.

CYP450 testing is useful but not universal. It effectively shows itself in working with a number of medicines:

CYP2D6 is involved in the metabolism of the following antidepressants: fluoxetine (Prozac), paroxetine (Paxil, Pexeva), fluvoxamine (Luvox) and venlafaxine (Effexor XR). The enzyme also metabolizes tricyclic antidepressants: nortriptyline (pamelor), amitriptyline, clomipramine (anafranil), desipramine (norpramine), and imipramine (tofranil). Some drugs, such as fluoxetine and paroxetine, can slow down the activity of the CYP2D6 enzyme.
The CYP2C19 enzyme is involved in the metabolism of citalopram (Celexa) and escitalopram (Lexapro).

Limitations

Despite their great potential, CYP450 tests have some limitations:

Genetic testing is only available for certain drugs.
When planning to re-switch a drug, a new lab test will be required to evaluate its effectiveness.
Genetic analysis does not show the best drug. It only helps doctors to choose the most effective solutions.
The tests only look at some of the genes involved in the metabolism of certain drugs. It is always important to remember that factors outside the scope of the test can also affect the effectiveness of an antidepressant.
Research is focused on how the body metabolizes the drug, not what the drug does to it. Example: the effect of a drug on brain receptors in order to eliminate symptoms.
Sometimes genetic testing alone is not enough. Even if there is a conclusion, it may be necessary to try different antidepressants and dosages.

Despite the above nuances, psychotherapists and psychiatrists find CYP450 tests useful and use them in their practice. But laboratory research should not be the only way to select medicines. This is just one of the few tools to speed up the development of a therapeutic plan. The use of antidepressants based on the patient’s history and symptoms is still the standard method for determining the best drug to this day.

Author: Telegina Natalya Dmitrievna

Specialization: Therapist

Where does the appointment: MRI Center and Clinic RIORIT

References:

BogniA., Monshouwer M., Moscone A. , Hidestrand M., Ingelman-Sundberg M., Hartimg T., Coecke S. Substrate specific metabolism by polymorphic cytochrome P450 2D6 alleles. // Toxicology in Vitro.— 2005.—Vol. 19. -p. 621-629.

Klin. medicine. – 2010. – No. 2. – C. 61-67.

Kuzikov, A. V. Electrochemical monitoring of the catalytic activity of cytochromes P450: dis. . cand. biol. Sciences: 03.01.04 / Kuzikov Alexey Vladimirovich. – M., 2017. – 190 p.
Makhova A. A. Possibility of regulating the activity of cytochrome P450 3A4 with vitamins-antioxid antami / A. A. Makhova // Tyumen medical journal, materials of scientific and practical. conf. with international participation “Medicine: achievements of the new century”, June 26-28, 2012, Costa Brava, Spain. – 2012. – No. 2. – S. 62.
Moskaleva N. E. Modern methods of analysis of P450 cytochromes / N. E. Moskaleva, V. G. Zgoda // Biomedical Chemistry. – 2012. – T. 58 – Issue. 6. -S. 617-634.

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