Fluvoxamine facilitates serotoninergic neurotransmission via potent and selective inhibition of
serotonin (
5-hydroxytryptamine; 5-HT) reuptake into presynaptic neurones. The overall
antidepressant efficacy of
fluvoxamine 100 to 300 mg/day for 4 to 6 weeks in once daily or divided dosage regimens appears to be at least comparable to that of
imipramine and similar to that of
clomipramine,
dothiepin,
desipramine,
amitriptyline,
lofepramine,
maprotiline,
mianserin and
moclobemide. The efficacy of
fluvoxamine has been maintained for up to 1 year, but long term data are limited, and there are no comparative studies of
fluvoxamine with other
selective serotonin reuptake inhibitors. In some studies,
fluvoxamine appeared to have an earlier beneficial effect on suicidal ideation and/or anxiety or somatic complaints compared with
imipramine,
dothiepin and
maprotiline. Gastrointestinal adverse effects, especially
nausea, are commonly reported with
fluvoxamine but are generally mild to moderate in severity. The tolerability profile of
fluvoxamine appears to be more favourable than that of
tricyclic antidepressants in terms of cardiotoxic and
anticholinergic adverse effects, sedation,
weight gain and death from overdosage. Thus,
fluvoxamine is an effective and well tolerated
antidepressant agent that is becoming established as an alternative to older agents in patients with mild, moderate or severe depression.
Fluvoxamine may be particularly beneficial in potentially suicidal patients with severe depression, in those with an underlying
compulsive personality or cardiovascular disorder, in patients with coexistent anxiety or agitation, and in the elderly.