Luvox dosage for severe ocd

The following information refers to OCD medications in adults. For information on medication in children, .

Contents

Overview

  • Medication is an effective treatment for OCD.
  • About 7 out of 10 people with OCD will benefit from either medication or Exposure and Response Prevention (ERP). For the people who benefit from medication, they usually see their OCD symptoms reduced by 40-60%.
  • For medications to work, they must be taken regularly and as directed by their doctor. About half of OCD patients stop taking their medication due to side effects or for other reasons. If you experience side effects, you should bring this up with your doctor so they can help you address them. They may be able to change your dose or find a different type of SRI that your system better tolerates.

What kinds of medications may help OCD?

The types of medication that research has shown to be most effective for OCD are a type of drug called a Serotonin Reuptake Inhibitor (SRI), which are traditionally used as an antidepressants, but also help to address OCD symptoms. (Note: Depression can sometimes result from OCD, and doctors can treat both the OCD and depression with the same medication.)

Do all antidepressants help OCD symptoms?

No! Some commonly used antidepressants have almost no effect whatsoever on OCD symptoms. Drugs, such as imipramine (Tofranil®) or amitriptyline (Elavil®), that are good antidepressants, rarely improve OCD symptoms.

Which Medications Help OCD?

The following antidepressants have been found to work well for OCD in research studies:

Have These Drugs Been Tested?

Anafranil has been around the longest and is the best-studied OCD medication. There is growing evidence that the other drugs are as effective. In addition to these carefully studied drugs, there are hundreds of case reports of other drugs being helpful. For example, duloxetine (Cymbalta®) has been reported to help OCD patients who have not responded to these other medications.

What Are the Usual Doses for These Drugs?

High doses are often needed for these drugs to work in most people.* Studies suggest that the following doses may be needed:

Which Drug Should Someone Try First?

Whenever any of the above drugs have been studied head to head, there seems to be no significant difference in how well they work. However, for any given patient, one drug may be very effective, and the others may not. The only way to tell which drug will be the most helpful with the least side effects is to try each drug for about 3 months. Remember! It is important not to give up after failing one or two drugs. Drugs work very differently for each person.

How Do These Medications Work?

It remains unclear as to how these particular drugs help OCD. The good news is that after decades of research, we know how to treat patients, even though we do not know exactly why our treatments work.

We do know that each of these medications affect a chemical in the brain called serotonin. Serotonin is used by the brain as a messenger. If your brain does not have enough serotonin, then your the nerves in your brain might not be communicating right. Adding these medications to your body can help boost your serotonin and get your brain back on track.

Are There Side Effects?

  • Yes. Most patients will experience one or more side effects from all of the medications listed above.
  • The patient and doctor must weigh the benefits of the drug against the side effects.
  • It is important for the patient to be open about problems that may be caused by the medication. Sometimes an adjustment in dose or a switch in the time of day it is taken is all that is needed.

Who Should Not Take These Medications?

  • Women who are pregnant or are breastfeeding should weigh the decision to take these drugs with their doctor. If severe OCD cannot be controlled any other way, research has indicated that these medications seem to be safe. Many pregnant women have taken them without difficulty. Some OCD patients choose to use exposure and response prevention (ERP) to minimize medication use during the first or last trimester of pregnancy.
  • Very elderly patients should avoid Anafranil as the first drug tried, since it has side effects that can interfere with thinking and can cause or worsen confusion.
  • Patients with heart problems should use special caution if taking Anafranil.

What if I cannot take even the smallest pill size of the medication?

Some patients are sensitive to these medications and can’t stand the effects that come with even the lowest dose. However, patients can start at very low doses (for example, 1-2 mg per day) and very slowly increase the dose. For most people, they will eventually be able to handle the medication at its normal dose.

Ask your doctor if you can try a lower dose by breaking pills in half or using a liquid form of medication to slowly increase your doses.

ALWAYS be sure to talk to your doctor before making any changes to the way you take your medications!

The following is one example as told by Dr. Michael Jenike:

“One woman, who was started on Prozac 20 mg/day, complained of bothersome side effects such as increased anxiety, shakiness, and terrible insomnia. She felt it made her OCD worse. She had horrible side effects from even 12.5 mg of Anafranil, and later with low dosages of Paxil and Zoloft. She requested to start 1-2 mg/day of liquid Prozac, because she heard it was good from other patients that she met from a computer bulletin board. She felt no side effects, and over a period of a few weeks, she got up to 20 mg/day without the previous side effects that she had felt on this dose in the past. Under the supervision of her doctor, she continued to increase the Prozac to 60 mg/day over a couple more months. Her OCD gradually improved quite dramatically.”

Should I Take These Medications Only When I Am Feeling Stressed?

No. This is a common mistake. These medications are meant to be taken every day to keep your serotonin at a constant level. They are not taken like typical anti-anxiety meds, when you feel upset or anxious. It is best not to miss doses if possible. However, if you do miss a dose here or there, it is unlikely that any bad effect on OCD will occur. In fact, sometimes your doctor might tell you to skip doses to help manage troublesome side effects, like sexual problems.

What Kind of Doctor Should I Look For to Prescribe These Medications?

Although any licensed physician can legally prescribe these drugs, it is probably best to deal directly with a board-certified psychiatrist who understands OCD. It is important to find a psychiatrist who has special knowledge about the use of drugs to treat mental health disorders. . (Look for therapists with an MD or DO after their name.)

What If I am Afraid to Take My Medication Because I Have an Obsessional Fear About Drugs?

Usually with help from a doctor that you trust, your fears can be overcome. If you have fears about taking medication, ERP can be started first and part of the therapy can focus on these fears of medications.

How Long Does it Take for These Medications to Work?

It is important not to give up on a medication until you have been taking it as prescribed for 10 to 12 weeks. Many patients feel no positive effects for the first few weeks of treatment but then improve greatly.

Will I Have to Take Medications Forever?

No one knows how long patients should take these medications once they have been effective. Some patients are able to stop their medications after a 6 to 12-month treatment period. It does appear that over half of OCD patients (and maybe many more) will need to be on at least a low dose of medication for years, perhaps even for life. It seems likely that the risk of relapse is lower if patients learn to use behavior therapy techniques while they are doing well on medications. And if medication is tapered slowly (even over several months), the ERP treatment may enable patients to control any symptoms that return when they stop taking the medication.

After medications are stopped, symptoms do not return immediately; they may start to return within a few weeks to a few months. If OCD symptoms return after a medication is stopped, most patients will have a good response if the medication is restarted.

Can I Drink Alcohol While on These Medications?

Many patients drink alcohol while on these medications and handle it well, but be sure to ask your doctor or pharmacist if it is safe. It is important to keep in mind that alcohol may have a greater effect on individuals who are taking these medications; one drink could affect an individual as if it were two drinks. Also, alcohol may limit some of the medications’ benefits, so it may be wise to try not to drink alcohol during the first couple of months after starting any new medication.

Do I Need Other Treatments Too?

Most psychiatrists and therapists believe that combining a type of Cognitive Behavior Therapy (CBT), specifically Exposure and Response Prevention (ERP), and medication is the most effective approach.

What if I Can’t Afford My Medication?

Drug companies give doctors free samples of some medications. Doctors give these samples to patients who cannot afford the cost of the medications.

Most drug companies also have programs that help patients get these and other medications free or at a reduced cost. For more information, visit: www.pparx.org or call 1-888-477-2669.

By Michael Jenike, MD
Chair, International OCD Foundation’s Scientific Advisory Board
Harvard Medical School

* The FDA has issued some warnings on the use of this medication in higher doses. Please check with your physician.

LUVOX®

fluvoxamine maleate tablets

Consumer Medicine Information

What is in this leaflet

This leaflet answers some of the common questions about Luvox. It does not contain all of the available information. It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you taking Luvox against the benefits they expect it will have for you.

If you have any concerns about using this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine. You may need to read it again.

What Luvox is used for

Luvox belongs to a family of medicines known as selective serotonin reuptake inhibitors (SSRIs) and is used for treatment of the conditions listed below, or your doctor may prescribe Luvox for another reason.

Depression
Luvox is used to treat depression in adults only. It is not recommended for treatment of this condition in children and adolescents as the safety and effectiveness of this medicine, when used for depression in this age group, have not been established.

Depression is longer lasting and/or more severe than the “low moods” everyone has from time to time due to the stress of everyday life. It can affect your whole body and can cause emotional and physical symptoms such as feeling low in spirit, loss of interest in activities, being unable to enjoy life, poor appetite or overeating, disturbed sleep, often waking up early, loss of sex drive, lack of energy and feeling guilty for no reason.

Obsessive compulsive disorder (OCD)
Luvox is also used to treat a condition known as obsessive compulsive disorder (OCD) in adults and children eight years of age or older.

People with OCD can have two types of symptoms – obsessions and compulsions. Obsessions are unwanted repeated thoughts or feelings, which are ongoing. Compulsions are the need to repeat actions over and over. The symptoms of OCD can vary from patient to patient.

Both of these conditions are thought to be caused by a chemical imbalance in parts of the brain. Luvox corrects this chemical imbalance and may help relieve the symptoms of depression and OCD.

Ask your doctor if you have any questions about why Luvox has been prescribed for you. Your doctor may have prescribed it for another purpose.

There is no evidence that this medicine is addictive.

Luvox is only available with a doctor’s prescription.

Before you take Luvox

When you must not take it

Do not take Luvox if you have an allergy to:

  • any medicine containing fluvoxamine
  • any of the ingredients listed at the end of this leaflet

Some of the symptoms of an allergic reaction may include:

  • shortness of breath
  • wheezing or difficulty breathing
  • swelling of the face, lips, tongue or other parts of the body
  • rash, itching or hives on the skin

Do not take Luvox if:

  • you are taking another antidepressant medicine called a monoamine oxidase inhibitor (MAOI) (e.g. moclobemide and selegiline) or have been taking it within the last 14 days. Taking Luvox with these types of medicines may cause a serious reaction with a sudden increase in body temperature, extremely high blood pressure and severe convulsions.
  • you are taking any of the following medicines:
    – cisapride
    – tizanidine
    – ramelteon

Ask your doctor or pharmacist if you are not sure if you have been taking one of these medicines.

Do not breast-feed if you are taking this medicine. The active ingredient in Luvox passes into breast milk and there is a possibility that your baby may be affected.

Do not take this medicine after the expiry date printed on the pack or if the packaging is torn or shows signs of tampering. If it has expired or is damaged, return it to your pharmacist for disposal.

If you are not sure whether you should start taking this medicine, talk to your doctor.

Before you start to take it

Tell your doctor if:

  • you are allergic to any other medicines, foods, dyes or preservatives
  • you have, or have had, any other medical conditions, including:
    – bipolar disorder or mania
    – any other mental illness
    – liver problems
    – kidney problems
    – epilepsy or convulsive disorders
    – a history of bleeding disorders
    – diabetes
    – glaucoma, an eye condition

Tell your doctor if you are pregnant or plan to become pregnant or are breast-feeding. Your doctor can discuss with you the risks and benefits involved.

You should avoid drinking alcohol while taking Luvox.

If you have not told your doctor about any of the above, tell him/ her before you start taking Luvox.

Taking other medicines

Tell your doctor if you are taking any other medicines, including any that you get without a prescription from your pharmacy, supermarket or health food shop.

Some medicines and Luvox may interfere with each other. Some of these include:

  • other medicines for the treatment of depression called monoamine oxidase inhibitors (MAOIs), such as moclobemide and selegiline. Taking Luvox with or within 14 days of stopping a MAOI may cause a serious reaction with sudden increase in body temperature, extremely high blood pressure, and convulsions
  • medicines used to treat depression, obsessive compulsive disorder, anxiety disorders, mood disorders, or other psychoses such as sertraline, amitriptyline, clomipramine, imipramine, clozapine, olanzapine, quetiapine, lithium and haloperidol
  • medicines used for strong pain management such as tramadol
  • some benzodiazepine medicines such as alprazolam, triazolam, midazolam and diazepam
  • medicines called NSAIDs used to relieve pain, swelling and inflammation including arthritis such as ibuprofen and diclofenac
  • medicines used to help control epilepsy such as carbamazepine or phenytoin
  • medicines used to treat migraine such as sumatriptan, zolmitriptan or eletriptan
  • medicines used to help stop the blood from clotting such as warfarin, aspirin or clopidogrel
  • cisapride, a medicine used to treat gastroesophageal reflux disease
  • tizanidine, a medicine used as a muscle relaxant
  • ramelteon, a medicine used to treat insomnia
  • terfenadine and astemizole, medicines used to treat symptoms of allergic reaction
  • phentermine, a medicine used to assist weight loss
  • theophylline, a medicine used to treat breathing conditions such as asthma
  • ciclosporin, a medicine used for immunosuppression
  • methadone, a medicine used for opioid detoxification
  • any herbal remedies that include St John’s Wort or tryptophan

There are many other medicines not listed here which could interfere with Luvox and vice versa. Always tell your doctor or pharmacist that you are taking Luvox before taking a new medication or complementary health product. These medicines may be affected by Luvox or may affect how well it works. You may need to take different amounts of your medicine or you may need to take different medicines.

Some combinations of medicines (including herbal and other remedies) can interact with Luvox and increase the risk of side effects, some of which can be potentially life-threatening.

Your doctor or pharmacist may have more information on medicines to avoid while taking Luvox.

How to take Luvox

Follow all directions given to you by your doctor or pharmacist carefully. These directions may differ from the information contained in this leaflet.

If you do not understand the instructions on the box, ask your doctor or pharmacist for help.

How much to take

Your doctor or pharmacist will tell you how many Luvox tablets to take each day. These will be printed on the pharmacy label on the container.

To treat depression:
Adults: The usual starting dose is 50 mg each day, but your doctor may adjust the number of tablets or the strength of the tablets you are taking until the desired response is achieved up to a maximum of 300 mg per day. If a daily dose of more than 150 mg is needed, the dose should be divided and taken 2 or 3 times per day.

To treat OCD:
Adults: The usual starting dose is 50 mg each day, but your doctor may adjust the number of tablets or the strength of the tablets you are taking until the desired response is achieved up to a maximum of 300 mg per day. If a daily dose of more than 150 mg is needed, the dose should be divided and taken 2 or 3 times per day.

Children & Adolescents: The usual starting dose is 25 mg each day. The doctor will probably adjust the dose until the desired response is achieved.

How to take it

Swallow the tablet with a full glass of water. Do not chew the tablets.

Take Luvox with or without food.

If you have any concerns about how to take this medicine, ask your doctor or pharmacist.

How long to take it

Even if you feel better, continue taking your medicine until your doctor tells you to stop.

The length of treatment will depend on how quickly your symptoms improve. Most antidepressants take time to work, so don’t be discouraged if you don’t feel better right away. Some of your symptoms may improve in 1 or 2 weeks but it can take up to 4 or 6 weeks to feel any real improvement. Even when you feel well, you will usually have to take Luvox for several months or even longer to make sure the benefits are maintained.

In general, antidepressant medication should be continued for at least 6 months following recovery of a depressive episode.

This medicine should not be stopped abruptly (unless you develop a severe side effect to Luvox (see ‘Side Effects’ below).

If your Luvox treatment needs to be stopped, your doctor or pharmacist will provide you with instructions to reduce the dose gradually over a period of at least one or two weeks.

If you forget to take it

If it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to. Otherwise, take it as soon as you remember, then go back to taking it as you would normally.

Do not take a double dose to make up for the dose you missed.

If you have trouble remembering to take your medicine, ask your pharmacist for some hints.

If you take too much (Overdose)

Immediately telephone your doctor or Poisons Information Centre (telephone 13 11 26 Australia or 0800 764 766 New Zealand), or go to Accident and Emergency at your nearest hospital, if you think you or anyone else may have taken too much Luvox.

Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention. The most common symptoms are nausea (feeling sick), vomiting and diarrhoea. You could also experience drowsiness and dizziness, rapid or irregular heartbeats, tremors or feel faint.

If possible, show the doctor the pack of tablets.

While you are taking Luvox

Things you must do

If you are about to start or stop any medicine, including any that you buy without a prescription from your pharmacy, supermarket or health food shop, tell your doctor and pharmacist that you are taking Luvox.

Tell all doctors, dentists and pharmacists who are treating you that you are taking Luvox.

Tell your doctor if, for any reason, you have not taken your medicine exactly as prescribed. Otherwise, your doctor may think that it was not effective and change your treatment unnecessarily.

Tell your doctor if you feel the tablets are not helping your condition.

If you are being treated for depression, be sure to discuss with your doctor any problems you may have and how you feel, especially any feelings of severe sadness or bursts of unusual energy or anger. This will help your doctor to determine the best treatment for you.

Tell your doctor immediately if you become pregnant while taking Luvox.

Be sure to keep all of your appointments with your doctor so that your progress can be checked.

Your doctor may want to take some blood tests and check your heart and blood pressure from time to time. This helps prevent unwanted side effects.

Things to be careful of

Tell your doctor immediately if you have any suicidal thoughts or other mental/mood changes. Care givers should consider all mentions of suicide or violence, which must be taken seriously.

Immediately contact your doctor or go to the nearest hospital for help if you or someone you know who are being treated for depression (or for any other condition) are demonstrating any of the warning signs of suicide.

Families and caregivers of children and adolescents who are taking Luvox should be especially watchful of the warning signs associated with suicide listed below.

The warning signs include:

  • Thoughts or talk of death or suicide
  • Thoughts or talk of self-harm or harm to others
  • Any recent attempts of self-harm
  • Mood changes such as an increase in aggressive or unusual behaviour, anxiety, irritability, agitation, panic attacks, insomnia, impulsivity, restlessness, or worsening of depressive symptoms.

Be especially careful of any suicidal thoughts or other mental/mood changes in the first few months of taking Luvox or when the dose is changed. There is a greater risk of suicide in people with history of suicidal thoughts prior to starting Luvox, and in those aged less than 24 years, including those not being treated for depression.

Be careful driving or operating machinery until you know how Luvox affects you. It may cause drowsiness, dizziness or sleepiness in some people and affect alertness.

Although drinking moderate amounts of alcohol is unlikely to affect your response to Luvox, your doctor may suggest avoiding alcohol while you are being treated for depression.

You should minimise your intake of caffeine-containing beverages (e.g. coffee or tea) while taking Luvox. Luvox can increase the effects of caffeine. People having large amounts of caffeine whilst on Luvox can experience tremor (shaking), palpitations (fast or irregular heart beat), nausea, restlessness and trouble or inability to sleep.

Older people may become confused when taking Luvox. Families and carers should be aware of this. Special care may be needed.

You should be careful for 1 or 2 weeks after stopping this medicine, because it will still be in your blood stream.

Things you must not do

Do not stop taking Luvox, increase or lower the dose, without first checking with your doctor. Do not let yourself run out of medicine over the weekend or on holidays. Suddenly stopping it may cause headache, nausea, dizziness and anxious feelings.

Do not give this medicine to anyone else, even if their symptoms seem similar to yours or if they have the same condition as you.

Do not use Luvox to treat any other complaints unless your doctor tells you to.

Side Effects

Check with your doctor as soon as possible if you do not feel well while you are taking Luvox, even if you do not think the problems are connected with the medicine or are not listed in this leaflet.

Like other medicines, Luvox can cause some side effects. If they occur, most are likely to be minor and temporary. However, some may be serious and need medical attention.

Do not be alarmed by this list of possible side effects. You may not experience any of them.

Tell your doctor if you notice any of the following and they worry you:

  • nausea, vomiting, stomach pain, constipation, diarrhoea, heart burn, loss of appetite, dry mouth
  • drowsiness, difficulty sleeping, dizziness, nervousness, feeling anxious, headache
  • muscle weakness, muscular pains, pins and needles
  • abnormal taste
  • faster heartbeat, sweating
  • weight gain, weight loss
  • restlessness, pacing, swinging of the legs while seated, rocking from foot to foot

Tell your doctor immediately if you notice any of the following:

  • Muscle spasms or twitches
  • Significant bleeding or bruising

Stop taking Luvox and tell your doctor immediately, or go to Accident and Emergency at your nearest hospital if any of the following happens:

  • Allergic reaction including swelling of limbs, face, lips, mouth or throat which may cause difficulty swallowing or breathing
  • Sudden onset of prolonged muscular spasm, affecting the eyes, head, neck and body
  • Sudden increase in body temperature, severe convulsions
  • Fast heartbeat, sweating, racing thoughts and restlessness
  • Severe blisters and bleeding in the lips, eyes, mouth, nose and genitals
  • Severe skin reaction with painful red areas, large blisters and peeling skin. This may be accompanied by fever and chills, aching muscles and generally feeling unwell.

These are very serious, though rare, side effects.

Other side effects observed more frequently in children are: abnormal thoughts or behaviour, cough, increased period pain, nose bleeds, increased restlessness, infection and sinusitis.

Tell your doctor if you notice anything else that is making you feel unwell including any suicidal thoughts or other mental/mood changes (see ‘Things to be careful of’). Other side effects not listed above may occur in some patients.

Ask your doctor or pharmacist to answer any questions you may have.

After using Luvox

Storage

Keep your tablets in their original pack until it is time to take them.

Keep the pack in a cool, dry place (below 25°C). Do not store Luvox in the bathroom, near a sink or leave it in the car on hot days. Heat and dampness can destroy some medicines.

Keep Luvox where young children cannot reach it. A locked cupboard at least one-and-a half metres above the ground is a good place to store medicines.

Disposal

If your doctor tells you to stop taking Luvox, or the tablets have passed their expiry date, ask your pharmacist what to do with any medicine that is left over.

Return any unused medicine to your pharmacist.

Product description

What it looks like

Luvox 50 mg tablets are round, biconvex, white film coated tablets marked with “291” on either side of the score line and no embossing on the other side. Packs of 30 tablets.

Luvox 100 mg tablets are oval, biconvex, white film coated tablets marked with “313” on either side of the score line, with no embossing on the other side. Packs of 30 tablets.

Ingredients

Active ingredient:

  • Luvox 50 mg tablets – fluvoxamine maleate 50 mg
  • Luvox 100 mg tablets – fluvoxamine maleate 100 mg

Inactive ingredients:

  • mannitol
  • maize starch
  • pregelatinised potato starch
  • sodium stearylfumarate
  • colloidal anhydrous silica
  • hypromellose
  • macrogol 6000
  • purified talc
  • titanium dioxide

Luvox does not contain lactose, sucrose, gluten, or tartrazine.

Luvox is manufactured in France and supplied in Australia by:

Mylan Health Pty Ltd
Level 1, 30 The Bond
30-34 Hickson Road
Millers Point NSW 2000

Phone: 1800 314 527

This leaflet was prepared in June 2019.

Australian Registration Number:

50 mg: AUST R 57632

100 mg: AUST R 57633

Luvox_cmiJun19/00

Published by MIMS August 2019

fluvoxamine (Rx)

Pregnancy

There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy; healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or visiting online at https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/antidepressants

Prolonged experience with fluvoxamine in pregnant women over decades, based on published observational studies, have not identified a clear drug-associated risk of major birth defects or miscarriage; there are risks associated with untreated depression in pregnancy and risks of persistent pulmonary hypertension of newborn (PPHN) and poor neonatal adaptation with exposure to selective serotonin reuptake inhibitors (SSRIs), including fluvoxamine, during pregnancy

Women who discontinue antidepressants during pregnancy are more likely to experience a relapse of major depression than women who continue antidepressants; consider risk of untreated depression when discontinuing or changing treatment with antidepressant medication during pregnancy and postpartum

Neonates exposed to therapy and other SSRIs or SNRIs late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding; such complications can arise immediately upon delivery; reported clinical findings have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying; these features are consistent with either a direct toxic effect of SSRIs and SNRIs or, possibly, a drug discontinuation syndrome; it should be noted that, in some cases, the clinical picture is consistent with serotonin syndrome

Animal findings suggest fertility may be impaired while taking fluvoxamine

Animal data

  • Pregnant rats treated orally with throughout period of organogenesis, increased embryofetal death and increased incidences of fetal eye abnormalities (folded retinas) was observed at doses ≥3 times maximum recommended human dose (MRHD) of 300 mg/day given to adolescents on a mg/m2 basis; in addition, decreased fetal body weight was seen at a dose 6 times MRHD given to adolescents on a mg/m2 basis
  • There were no adverse developmental effects in rabbits treated with fluvoxamine during period of organogenesis up to a dose 2 times MRHD given to adolescents on a mg/m2 basis; when drug was administered orally to rats during pregnancy and lactation, increased pup mortality at birth was seen at dose 2 times MRHD given to adolescents on a mg/m2 basis; in addition, decreases in pup body weight and survival were observed at doses that are ≥0.13 times MRHD given to adolescents

Persistent pulmonary hypertension of the newborn

  • Potential risk of persistent pulmonary hypertension of the newborn when used during pregnancy
  • Initial Public Health Advisory in 2006 was based on a single published study; since then, there have been conflicting findings from new studies, making it unclear whether use of SSRIs during pregnancy can cause PPHN
  • FDA has reviewed the additional new study results and has concluded that, given the conflicting results from different studies, it is premature to reach any conclusion about a possible link between SSRI use in pregnancy and PPHN
  • FDA recommendation: FDA advises healthcare professionals not to alter their current clinical practice of treating depression during pregnancy and to report any adverse events to the FDA MedWatch program
  • A meta-analysis of 7 observational studies, found exposure to SSRIs in late pregnancy (ie, >20 weeks’ gestation) more than doubled the risk of PPHN that could not be explained by other etiologies (eg, congenital malformations, meconium aspiration) (BMJ 2014;348:f6932)

Lactation

Data from published literature report presence of drug in human milk; no adverse effects on breastfed infant have been reported in most cases of maternal use of fluvoxamine during breastfeeding; however, there are reports of diarrhea, vomiting, decreased sleep, and agitation; there are no data on effect of fluvoxamine on milk production

Developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for fluvoxamine and any potential adverse effects on breastfed child from drug or from the underlying maternal condition

Monitor infants exposed to fluvoxamine through breast milk for diarrhea, vomiting, decreased sleep, and agitation

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.

FDA Approves LUVOX(R) CR (Fluvoxamine Maleate) Extended-Release Capsules for the Treatment of Social Anxiety Disorder (SAD) and Obsessive Compulsive Disorder (OCD)

PALO ALTO, Calif., February 28, 2008 – Today, Jazz Pharmaceuticals, Inc. (Nasdaq: JAZZ) announced that the U.S. Food and Drug Administration (FDA) has approved Once-A-Day LUVOX CR (fluvoxamine maleate) Extended-Release Capsules for the treatment of social anxiety disorder (SAD) and obsessive compulsive disorder (OCD) in adults. LUVOX CR is a selective serotonin reuptake inhibitor (SSRI) that incorporates Elan’s proprietary SODAS® (Spheroidal Oral Drug Absorption System) technology designed to minimize peak-to-trough plasma level fluctuations over a 24-hour period.

In clinical trials at the primary endpoint of 12 weeks, Once-A-Day LUVOX CR provided statistically significant improvement vs. placebo in SAD symptoms as measured by the LSAS (Liebowitz Social Anxiety Scale) and statistically significant improvement vs. placebo in OCD symptoms as measured by the Y-BOCS (Yale-Brown Obsessive Compulsive Scale)

“We are pleased to have FDA approval of this new, effective treatment option for patients in the United States with SAD and OCD and our proceeding towards launch by the end of this quarter,” said Samuel Saks, M.D., chief executive officer of Jazz Pharmaceuticals. “As part of our commitment to patients with these two serious and widely under-recognized anxiety disorders, we are working with patient advocacy organizations to raise awareness about these conditions and encourage patients to get accurately diagnosed.”

“The approval of Once-A-Day LUVOX CR (fluvoxamine maleate) Extended-Release Capsules for social anxiety disorder and obsessive compulsive disorder is important for the 15 million Americans with SAD and the 2.2 million Americans with OCD, two underdiagnosed and undertreated anxiety disorders,” said John H. Greist, M.D., distinguished senior scientist, Madison Institute of Medicine and clinical professor of psychiatry, University of Wisconsin Medical School. “Physicians have been using immediate-release fluvoxamine for years to treat OCD patients. Now having Once-A-Day LUVOX CR (fluvoxamine maleate) Extended-Release Capsules offers patients with SAD and OCD an additional option.”

The FDA evaluated a data package involving approximately 600 patients worldwide that included three clinical trials with positive outcomes evaluating the efficacy and safety of LUVOX CR. These studies were:

Social Anxiety Disorder

  • Davidson, Jonathan, et al. Fluvoxamine-controlled release formulation for the treatment of generalized social anxiety disorder. J Clin Psychopharmacol 2004; 24:118-125.
  • Westenberg, Herman, et al. A double-blind, placebo-controlled study of controlled-release fluvoxamine for the treatment of generalized social anxiety disorder. J Clin Psychopharmacol. 2004; 24:49-55.

Obsessive Compulsive Disorder

  • Hollander, Eric, et al. A double-blind, placebo-controlled study of the efficacy and safety of controlled-release fluvoxamine in patients with obsessive-compulsive disorder. J Clin Psychiatry. 2003; 64:640-647.

“SAD and OCD are serious, yet treatable conditions,” said Jerilyn Ross, M.A., L.I.C.S.W., president and CEO, Anxiety Disorders Association of America (ADAA). “We’re excited about new treatment options – both medications and psychological – to help patients with these chronic and undertreated anxiety disorders. Having treatment options benefits the patient, and that’s what is most important.”

LUVOX CR will be available in 100 mg and 150 mg dose strengths. Over the next several weeks, Jazz Pharmaceuticals will continue to work closely with Elan on the manufacturing of LUVOX CR for commercial launch.

In January 2007, Jazz Pharmaceuticals licensed the right to market Once-A-Day LUVOX CR (fluvoxamine maleate) Extended-Release Capsules in the U.S. from Solvay Pharmaceuticals. The license agreement provides for Jazz Pharmaceuticals to pay Solvay Pharmaceuticals $20 million as a result of the approval of LUVOX CR for both SAD and OCD and the approved expiry dating of the product.

The approval of LUVOX CR includes a post marketing commitment to conduct a safety and efficacy study in adolescent patients with SAD and a long-term safety and efficacy study in patients with SAD. The NDA for LUVOX CR is being transferred to Jazz Pharmaceuticals.

For more information about LUVOX CR, please visit www.JazzPharmaceuticals.com

Social Anxiety Disorder

SAD or social phobia is characterized by the fear and avoidance of social or performance situations where patients feel that others may scrutinize them and they may embarrass themselves. Patients experience physical symptoms of anxiety, including blushing, sweating, trembling and nausea. SAD affects an estimated 15 million American adults.

Obsessive Compulsive Disorder

OCD is a chronic and debilitating anxiety disorder that is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions) that are severe enough to cause significant impairment. Patients are compelled to perform repetitive behaviors such as hand washing, counting, checking or cleaning with the goal of preventing obsessive thoughts or making them go away.5 OCD affects approximately 2.2 million American adults.6

Important Safety Information

Antidepressants can increase suicidal thoughts and behaviors in children, adolescents and young adults. Patients should call their doctor right away if they experience new or worsening depression symptoms, unusual changes in behavior, or thoughts of suicide.

In clinical trials, the most commonly observed adverse events with an incidence of ≤5% and at least twice that of placebo were nausea, somnolence, asthenia, diarrhea, anorexia, tremor, and sweating. Overall, these side effects were mild to moderate in severity and transient in nature. Other common adverse events with an incidence of ≤5% and at least twice that of placebo included abnormal ejaculation and anorgasmia.

The use of alosetron, tizanidine, thioridazine, or pimozide with LUVOX CR Capsules is contraindicated. The use of MAO inhibitors in combination with LUVOX CR Capsules or within 14 days of discontinuing treatment with LUVOX CR Capsules is contraindicated. (see CONTRAINDICATIONS, WARNINGS and PRECAUTIONS in full prescribing information.) LUVOX CR Capsules are also contraindicated in patients with a history of hypersensitivity to fluvoxamine maleate or any of its excipients.

Clinical Measures

LSAS: A clinician-rated, 24-item scale used to assess the range of difficulties in social interaction (11 questions) and performance situations (13 questions) that a patient with SAD may have.

Y-BOCS: A clinician-rated, 10-item scale used to rate the severity of obsessive compulsive symptoms and to monitor improvement during treatment.

About Jazz Pharmaceuticals, Inc.

Jazz Pharmaceuticals, Inc. is a specialty pharmaceutical company focused on identifying, developing and commercializing innovative products to meet unmet medical needs in neurology and psychiatry. Jazz Pharmaceuticals will host an Investor Day on March 13, 2008 beginning at 10:00 a.m. Eastern Time/7:00 a.m. Pacific Time. The event will be available by live audio webcast, and the accompanying presentation materials will also be available on the investor relations section of Jazz Pharmaceuticals’ website. For further information, please visit www.JazzPharmaceuticals.com.

“Safe Harbor” Statement under the Private Securities Litigation Reform Act of 1995 This press release contains forward-looking statements, including, but not limited to, statements related to the planned commercial launch of LUVOX CR and Jazz Pharmaceuticals’ continuing efforts, including manufacturing to prepare for commercial launch. Words and phrases such as “will,” “are proceeding” and similar expressions are intended to identify forward-looking statements. These forward-looking statements are based upon Jazz Pharmaceuticals’ current expectations. Forward-looking statements involve significant risks and uncertainties. Jazz Pharmaceuticals’ actual results and the timing of events could differ materially from those anticipated in such forward-looking statements as a result of these risks and uncertainties, which include, without limitation, risks related to when or whether commercial launch of LUVOX CR will occur, Jazz Pharmaceuticals’ ability to attain market acceptance of LUVOX CR by physicians, patients and third party payors, Jazz Pharmaceuticals’ dependence on single source suppliers and manufacturers, and scaling up manufacturing of LUVOX CR to commercial capacity. These and other risk factors are discussed under “Risk Factors,” in the Quarterly Report on Form 10-Q for the quarter ended September 30, 2007 filed by Jazz Pharmaceuticals with the Securities and Exchange Commission on November 9, 2007. Jazz Pharmaceuticals undertakes no duty or obligation to update any forward-looking statements contained in this release as a result of new information, future events or changes in its expectations.

1 Davidson J, Yaryura-Tobias J, DuPont R, et al. Fluvoxamine-controlled release formulation for the treatment of generalized social anxiety disorder. J Clin Psychopharmacol. 2004;24:118-125.
2 Hollander E, Koran LM, Goodman WK, et al. A double-blind, placebo-controlled study of the efficacy and safety of controlled-release fluvoxamine in patients with obsessive-compulsive disorder. J Clin Psychiatry. 2003;64:640-647.
3 LUVOX CR Prescribing Information. Jazz Pharmaceuticals, Inc., Palo Alto, CA;2008.
4 Westenberg HGM, Stein DJ, Yang H, et al. A double-blind placebo-controlled study of controlled release fluvoxamine for the treatment of generalized social anxiety disorder. J Clin Psychopharmacol. 2004;24:49-55.
5 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed, revised. Washington, DC: American Psychiatric Association; 2000.
6 Kessler RC, et al. Arch Gen Psychiatry. 2005; 62:593-602/ NIMH Website: http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america.shtml#Anxiety, Date accessed December 14, 2007.

©2008 Jazz Pharmaceuticals, Inc.
SODAS® is a registered trademark of Elan Pharma International Limited, Ireland, a subsidiary of Elan Corporation, plc (NYSE; ELN)
LUVOX is a registered trademark of Solvay Pharmaceuticals, Inc.

What is fluvoxamine used for?

This antidepressant medicine is prescribed to treat:

  • Depression in adults over 18 years of age.
  • Obsessive-compulsive disorder (OCD) in adults and children aged eight years and over.

How does fluvoxamine work?

Fluvoxamine maleate is a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). It works by enhancing the activity of a neurotransmitter called serotonin in the brain.

Neurotransmitters are natural body chemicals that act as chemical messengers between the nerve cells. Serotonin is a neurotransmitter known to be involved in regulating emotions, mood and behaviour, among other things. In depression and anxiety disorders there is a decreased amount of serotonin released from nerve cells in the brain.

Fluvoxamine works by stopping the serotonin that has been released from being reabsorbed back into the nerve cells in the brain. This helps to prolong its effects and over time this helps to lighten mood and relieve depression. Antidepressants like fluvoxamine have also been found to be effective in relieving symptoms of anxiety, such as panic and fear.

Fluvoxamine won’t change your personality or make you feel instantly happy and relaxed. It works over time to correct the chemical changes in your brain that have made you become depressed or anxious, and gets you back to feeling like your old self.

How long does fluvoxamine take to work?

  • It can take between two to four weeks of taking fluvoxamine before it starts to work, so it’s very important that you keep taking it, even if it doesn’t seem to make much difference at first. You’ll usually need to keep taking fluvoxamine every day for several months. You should keep taking it for as long as your doctor asks you to.
  • If you feel your depression or OCD has got worse, or if you have any distressing thoughts, or feelings about suicide or harming yourself in the first few weeks, or indeed at any point during treatment or after stopping treatment, then it is very important to talk to your doctor. It’s a good idea to tell a relative or close friend that you’ve started taking fluvoxamine so they can support you and let you know if they think your depression or anxiety has got worse, or they notice any changes in your behaviour.

How do I take fluvoxamine?

  • Always follow the instructions given by your doctor regarding the fluvoxamine dose you should take. Remember that it takes a while for fluvoxamine to start working, so keep taking it as prescribed even if it doesn’t seem to make much difference at first. Do not take more than the dose prescribed by your doctor.
  • Fluvoxamine is usually taken once a day, in the evening, but your doctor may ask you to split your dose over the day if your dose is increased to more than 150mg.
  • Fluvoxamine tablets can be taken either with or without food, on a full or empty stomach.
  • If you forget to take a dose of fluvoxamine at your usual time, just leave out the missed dose and take your next dose as usual when it’s due. Do not take a double dose to make up for a missed dose.
  • You should keep taking fluvoxamine every day for as long as your doctor asks you to. With depression it’s normal for your doctor to ask you to keep taking it for at least six months after you feel better, as this has been shown to reduce the risk of your depression coming back.
  • Do not suddenly stop taking fluvoxamine unless your doctor tells you to, as this can cause withdrawal symptoms such as dizziness, sleep disturbances (including intense dreams), headache, feeling sick or weak, sweating, pins and needles, burning or electric shock sensations and feeling anxious. Withdrawal symptoms are temporary and are not due to addiction or dependence on the medicine. They can usually be avoided by stopping the medicine gradually, usually over a period of weeks or months, depending on your individual situation. Follow the instructions given by your doctor when it’s time to stop treatment with this medicine. On very rare occasions some people have experienced withdrawal symptoms after accidentally missing a dose of fluvoxamine.

What should I know about taking fluvoxamine?

  • Fluvoxamine may make some people feel tired or dizzy. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won’t affect your performance.
  • Selective serotonin re-uptake inhibitor (SSRI) antidepressants like fluvoxamine have sometimes been associated with unpleasant or distressing restlessness and feeling as though you need to move, often accompanied by an inability to sit or stand still. This is most likely to occur within the first few weeks of treatment if it’s going to affect you. If you experience these symptoms you should consult your doctor.
  • Fluvoxamine can slow down the metabolism of caffeine in your body, so it’s best to avoid consuming too much caffeine, eg in products like coffee, tea and cola drinks, because this may make you feel shaky, restless or sick, or cause palpitations or problems sleeping.

Can I drink alcohol while taking fluvoxamine?

  • Drinking alcohol in moderation while you’re taking fluvoxamine shouldn’t cause problems for most people, though if you find the medicine makes you feel tired or dizzy then alcohol could make this worse. However, it’s usually recommended that you avoid drinking alcohol while taking antidepressants because alcohol can make depression worse. If you want to drink alcohol you should get advice from your doctor about whether this is a good idea for you.

Who might need a lower fluvoxamine dose or extra monitoring?

  • Elderly people.
  • People with a history of mania, hypomania or bipolar affective disorder (manic depression). Fluvoxamine should be stopped in people entering a manic phase.
  • People also receiving electroconvulsive therapy (ECT).
  • People with kidney or liver problems.
  • People with diabetes. Fluvoxamine may alter the control of your blood sugar. As a result, you may need an adjustment in your dose of insulin or antidiabetic tablets. Discuss this with your doctor.
  • People with epilepsy. Tell your doctor if you experience more seizures than normal after starting fluvoxamine.
  • People with raised pressure in the eye or glaucoma.
  • People with heart disease.
  • People with a history of bleeding disorders and people taking medicine that affects blood clotting (see end of page for examples).
  • If your child is prescribed fluvoxamine for OCD it is very important that they are encouraged to report any distressing feelings, thoughts about suicide or self-harm, irritability, aggressive behaviour, mood changes or other unusual change in behaviour that they may experience while taking the medicine. If you notice a change in your child’s behaviour, or are worried about them at any point, it is important to talk to your doctor immediately.

Who shouldn’t take fluvoxamine?

  • People in a manic episode of bipolar affective disorder.
  • People with uncontrolled epilepsy.
  • People who have taken the MAOI medicines phenelzine, tranylcypromine, isocarboxazid, selegiline or rasagiline in the last two weeks, or moclobemide or linezolid in the last few days.
  • People who are allergic to any of ingredients of the medicine.

Can I take fluvoxamine while pregnant or breastfeeding?

  • Ideally fluvoxamine should not be used during pregnancy. However, the reality is that women who need to take antidepressants can also get pregnant or want to plan a baby. It may be necessary for some women to take fluvoxamine during their pregnancy in order for them to remain well during the pregnancy and be able to care for their baby.
  • It is important to talk to your doctor about the risks and benefits of taking fluvoxamine during the pregnancy compared with stopping treatment or using other treatments. This is particularly important in the first and third trimesters, where fluvoxamine could potentially have harmful effects on the baby. For example, SSRI antidepressants may carry a slightly increased risk of causing heart defects if taken in the first trimester, and symptoms that resemble side effects or withdrawal symptoms of fluvoxamine have been seen in new-born babies whose mothers took this medicine in the third trimester.
  • It’s important to get medical advice from your doctor if you think you could be pregnant or want to plan a pregnancy while taking fluvoxamine. If you decide to stop taking fluvoxamine you doctor will advise you how to do this. Remember that you should not stop taking fluvoxamine suddenly, as this can cause withdrawal symptoms.
  • Fluvoxamine passes into breast milk in small amounts and may affect your baby. You should get advice from your doctor if you want to breastfeed while taking fluvoxamine. Various factors need to be taken into consideration, for example whether you were taking fluvoxamine during the pregnancy and if the baby is healthy or was born prematurely. In some cases it’s OK to breastfeed while continuing to take fluvoxamine, as long as the baby is monitored for any potential problems. Always get advice from your doctor.

What are the possible side effects of fluvoxamine?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that may be associated with fluvoxamine. Just because a side effect is stated here doesn’t mean that all people taking this antidepressant will experience that or any side effect.

Common (affect between 1 in 10 and 1 in 100 people)

  • Disturbances of the gut such as feeling sick, vomiting, diarrhoea, constipation, indigestion or abdominal pain. If you find fluvoxamine makes you feel sick this usually improves within the first two weeks of taking it.
  • Loss of appetite.
  • Headache.
  • Sleepiness.
  • Dizziness.
  • Difficulty sleeping (insomnia).
  • Shaking, usually of the hands (tremor).
  • Feeling anxious, nervous or agitated.
  • Fast heartbeat or palpitations.
  • Dry mouth.
  • Sweating.
  • Feeling weak or generally unwell.

Uncommon (affect between 1 in 100 and 1 in 1000 people)

  • Confusion.
  • Aggression.
  • Hallucinations.
  • Skin reactions such as rash or itching.
  • Problems with balance or walking.
  • Aching muscles or joints.
  • Feeling dizzy when getting up from sitting or lying down.
  • Sexual problems such as problems with orgasm.

Rare or unknown frequency

  • Seizures (convulsions).
  • Abnormal liver function.
  • Increased sensitivity of the skin to sunlight.
  • Milky secretion from the breasts (galactorrhoea).
  • Changes in weight.
  • Change in menstrual periods, such as heavy periods.
  • Unusual bruising or bleeding, eg nosebleeds or haemorrhoids, or blood in the urine or stools.
  • Drop in the amount of sodium in the blood – a condition called hyponatraemia. This can cause symptoms such as drowsiness, confusion, muscle twitching or convulsions. Elderly people may be particularly susceptible to this effect. You should consult your doctor if you develop any of these symptoms while taking this medicine, so that your blood sodium level can be checked if necessary.
  • Serotonin syndrome. This may involve symptoms such as a fever, sweating, increased heart rate, diarrhoea, shivering, uncontrollable muscle contractions, mood changes, restlessness and increased salivation. See a doctor straight away if you get these symptoms.

Read the leaflet that comes with the medicine or talk to your doctor, nurse or pharmacist if you want more information about the possible side effects of fluvoxamine. If you think you have experienced a side effect, did you know you can report this using the yellow card website?

Can I take other medicines with fluvoxamine?

It’s important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start taking fluvoxamine.

The medicines mentioned below are those that may significantly interact with fluvoxamine. Always check with your doctor or pharmacist before taking any new medicines while taking fluvoxamine, to make sure that the combination is safe.

There may be an increased risk of bleeding if you take any of the following medicines with fluvoxamine:

  • anticoagulant medicines such as heparins, warfarin, rivaroxaban or dabigatran
  • antiplatelet medicines such as low dose aspirin, clopidogrel or dipyridamole
  • anti-inflammatory painkillers (NSAIDs) such as celecoxib, aspirin, ibuprofen, diclofenac or naproxen (Don’t take these painkillers while you’re taking fluvoxamine without checking with your doctor or pharmacist first. If you need a painkiller it’s fine to take paracetamol while you’re taking fluvoxamine.)
  • dapoxetine
  • nicotinic acid
  • other SSRI antidepressants such as fluoxetine
  • venlafaxine.

While you’re taking fluvoxamine, you’re more at risk of getting a side effect called the serotonin syndrome if you take other medicines or drugs that enhance the activity of serotonin in the brain, such as those below:

  • buspirone
  • dexamfetamine
  • dapoxetine
  • fentanyl
  • illegal drugs such as cocaine, amphetamine (speed) and ecstasy (MDMA)
  • linezolid
  • lithium
  • monoamine oxidase inhibitor antidepressants (MAOIs) such as phenelzine, isocarboxazid or tranylcypromine (should not be taken with fluvoxamine)
  • methadone
  • selegiline, rasagiline or safinamide for Parkinson’s disease (should not be taken with fluvoxamine)
  • SSRI, tricyclic or related antidepressants, eg paroxetine, amitriptyline, mirtazapine
  • the herbal remedy St John’s wort (Hypericum perforatum) – do not take this in combination with fluvoxamine
  • tramadol
  • triptans for migraine, eg sumatriptan
  • tryptophan.

Fluvoxamine may increase the blood levels of the following medicines and so could increase the risk of their side effects. Your doctor may want to do some extra monitoring or prescribe a lower dose of these if you take them with fluvoxamine:

  • agomelatine (should not be taken with fluvoxamine)
  • carbamazepine
  • certain benzodiazepines (eg alprazolam, diazepam)
  • ciclosporin
  • clozapine
  • duloxetine (should not be taken with fluvoxamine)
  • fosphenytoin
  • haloperidol
  • melatonin
  • methadone
  • mexiletine
  • olanzapine
  • phenytoin
  • propranolol
  • quetiapine
  • reboxetine
  • ropinirole
  • tacrine
  • theophylline and aminophylline (these medicines should usually be avoided in people taking fluvoxamine)
  • tizanidine (should not be taken with fluvoxamine)
  • tricyclic antidepressants such as amitriptyline, clomipramine, imipramine, maprotiline
  • warfarin.

What medicines contain fluvoxamine?

Fluvoxamine is a generic medicine, available as 50mg and 100mg tablets. Fluvoxamine tablets are also available under the brand name Faverin.

Last updated 12.04.2018

Helen Marshall, BPharm, MRPharmS Helen Marshall, BPharm, MRPharmS A UK registered pharmacist with a background in hospital pharmacy.

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Kandidat economic sciences, professor, doctor of Chinese medicine, a member of the International Society of Biology ESIVO Norway, member of the Scientific Council of Traditional Chinese Medicine, a member of the Association of Chinese Science Technology, a member of the Society for traditional Chinese medicine and pharmacology, Chinese, member of the Academy of energy sciences and academician of honor dental Academy of Ukraine, academician of honor of the Association of traditional medicine of Ukraine and Poltava medical Institute, the International Academy of safe development of humanity, the International Academy of bioenergotehnology, professor at the Institute of acupuncture Paley University, professor of the International Academy of traditional Chinese medicine and therapy Chen Chiu-Chzhuhay Na in the third and fourth phases of the “steam pool” bland and sometimes up to a minute maleate fluvoxamine medication side effects buy luvox cr no prescription order without online uk mg If you are a couple, the big man with biceps – and more Especially when you say “grilled”; sitting longer But do not just sit and maintain a friendly face on my way . they are next to the pool, only the head is important for passage Continue partner After some controversy to read on their faces in a supine position of the pool, with the understanding that turns his finger to his temple

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