Fluvoxamine is a potent and
selective serotonin reuptake inhibitor (SSRI) that has little or no effect on other monoamine reuptake mechanisms. Relative to other
SSRIs,
fluvoxamine is a weak inhibitor of
cytochrome P450 (
CYP) 2D6, a moderate inhibitor of
CYP2C19 and
CYP3A4 and a potent inhibitor of
CYP1A2. In randomised, double-blind trials.
fluvoxamine 100 to 300 mg/day for 6 to 10 weeks significantly reduced symptoms of
obsessive-compulsive disorder (OCD) compared with placebo. Response rates of 38 to 52% have been reported with
fluvoxamine, compared with response rates of 0 to 18% with placebo. In patients with OCD,
fluvoxamine had similar efficacy to that of
clomipramine and, in smaller trials, the
SSRIs paroxetine and
citalopram and was significantly more effective than
desipramine. Maintenance
therapy with
fluvoxamine may reduce the likelihood of relapses in up to 67% of patients with OCD.
Fluvoxamine < or = 300 mg/day for 6 to 8 weeks was as effective as
imipramine in patients with
panic disorder, and significantly more effective than placebo. In addition, treatment with
fluvoxamine < or = 300 mg/day for > or = 8 weeks improved symptoms of
social phobia (
social anxiety disorder),
post-traumatic stress disorder (
PTSD),
pathological gambling, compulsive buying,
trichotillomania,
kleptomania,
body dysmorphic disorder,
eating disorders and
autistic disorder. Large trials comparing the efficacy of
fluvoxamine and other
SSRIs in patients with
anxiety disorders are warranted.
Fluvoxamine is generally well tolerated; in postmarketing studies,
nausea was the only adverse event occurring in >10% of patients with less commonly reported events including
somnolence,
asthenia,
headache, dry mouth and
insomnia.
Fluvoxamine is associated with a low risk of suicidal behaviour, sexual dysfunction and withdrawal syndrome. Fewer
anticholinergic or cardiovascular events are associated with
fluvoxamine than
tricyclic antidepressants. Although comparative data are lacking, the tolerability profile of
fluvoxamine appears to be broadly similar to those of other
SSRIs.
CONCLUSION:
Fluvoxamine has demonstrated short term efficacy in the treatment of OCD,
panic disorder,
social phobia,
PTSD and in a range of obsessive-compulsive spectrum disorders. The
drug is as effective as
clomipramine in patients with OCD but appears to have a better tolerability profile. On the basis of current treatment guidelines,
fluvoxamine, like other
SSRIs, is recommended as first-line treatment for a number of
anxiety disorders. It appears to offer some pharmacokinetic advantages and a different drug interaction profile to the other
SSRIs with a broadly similar spectrum of adverse events. However, direct comparisons are required to assess the relative efficacy and tolerability of the different agents of this
drug class.