Fluvoxamine is a
selective serotonin reuptake inhibitor (SSRI) which may be used for the management of
anxiety disorders in children and adolescents. Absorption of
fluvoxamine was similar in adolescents to that in adults, which suggests that the maximum dosage of the
drug for patients aged between 12 and 17 years can be as high as 300 mg/day. However, steady-state plasma
fluvoxamine concentrations were 2 to 3 times higher in children (aged between 6 and 11 years) than in adolescents; thus, the maximum
fluvoxamine dosage recommended for children is 200 mg/day.
Fluvoxamine (50 to 300 mg/day) for 8 to 16 weeks significantly reduced symptoms of
obsessive-compulsive disorder (OCD) [measured across multiple assessment scales] compared with placebo in a well controlled trial in paediatric patients (n = 120) or from baseline in noncomparative trials in adolescent (n = 20) or paediatric (n = 16) patients. Improvements with
fluvoxamine (up to 200 mg/day) were observed for up to 1 year in 98 patients with OCD in a noncomparative trial. The
drug (up to 250 or 300 mg/day) also improved symptoms of anxiety compared with placebo in an 8-week well controlled trial in 128 paediatric patients with
social phobia,
separation anxiety disorder or generalised
anxiety disorder (GAD).
Fluvoxamine (50 to 300 mg/day) appears to be well tolerated in paediatric patients, with most adverse events with the
drug (except abdominal discomfort, which occurred more often in patients receiving
fluvoxamine) occurring with a similar incidence to those with placebo. The most common adverse events involved the CNS or gastrointestinal system. Most adverse events reported by paediatric patients with OCD were similar to those reported by adults. In conclusion,
fluvoxamine is generally well tolerated and has demonstrated short-term efficacy compared with placebo in the treatment of OCD, and
social phobia,
separation anxiety disorder or GAD in well controlled trials in paediatric patients. Reductions in symptoms of anxiety with
fluvoxamine have been observed for up to 1 year in children and adolescents with OCD. However, there are currently no comparative trials of
fluvoxamine with other pharmacological agents. In the absence of such trials, current consensus opinion recommends that when
pharmacotherapy is indicated,
fluvoxamine, like other
SSRIs, can be used as first-line treatment for
anxiety disorders, particularly OCD, in paediatric patients. However, direct comparisons are required to assess the relative efficacy and tolerability of pharmacological agents in order to make firm recommendations for the treatment of
anxiety disorders in this patient group.