FluvoxamineFluvoxamine Maleate

About Fluvoxamine

Fluvoxamine is thought to work by blocking the reuptake of serotonin in the brain. The tablets are labeled for obsessions and compulsions in obsessive-compulsive disorder in adults and in children and adolescents aged 8 to 17; the extended-release capsules are labeled for the same disorder but have not been evaluated in children. Adults start the tablets at 50 mg at bedtime and go up by 50 mg every 4 to 7 days as tolerated, to no more than 300 mg a day, with any dose above 100 mg split in two and the larger dose taken at bedtime. Children start at 25 mg at bedtime and go up by 25 mg every 4 to 7 days, with a ceiling of 200 mg a day for ages 8 to 11 and 300 mg for adolescents. The capsules start at 100 mg at bedtime and rise by 50 mg a week, also to 300 mg a day.

The boxed warning, shared by all antidepressants, is a higher risk of suicidal thoughts and behavior in children, teenagers and young adults in short-term studies, so mood and behavior are watched closely, above all early on and after dose changes. It is contraindicated with tizanidine, thioridazine, pimozide and alosetron, whose levels it raises, and ramelteon must not be used with it either; MAO inhibitors are ruled out during treatment and within 14 days of stopping either drug, and it is not started in someone receiving linezolid or intravenous methylene blue. Other warnings cover serotonin syndrome, bleeding, angle-closure glaucoma, mania, seizures, low sodium and sexual side effects. Nausea, sleepiness, insomnia, weakness, nervousness, indigestion, sweating, loss of appetite, tremor, vomiting and abnormal ejaculation are the common side effects.

Fluvoxamine slows the breakdown of many other medicines, which is why its interaction list is long: the theophylline dose is cut to a third with blood levels checked, warfarin needs closer clotting tests, alprazolam is started at no more than half the usual dose, diazepam is generally avoided, and clozapine, methadone, mexiletine, propranolol, metoprolol, carbamazepine and tricyclic antidepressants may need lower doses or closer watching. Smokers break it down faster than nonsmokers. It is tapered rather than stopped suddenly, since stopping can bring dizziness, irritability, sleep problems, headache and electric shock sensations.

Taking Fluvoxamine

How to take it

Tablets: once a day at bedtime, or twice a day with the larger dose at bedtime once the daily dose is above 100 mg (above 50 mg for children), with or without food. Extended-release capsules: once a day at bedtime, swallowed whole, never crushed or chewed. The dose is raised gradually, and it is not stopped suddenly.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

At room temperature in a tightly closed container, away from excess heat and moisture (not in the bathroom), out of reach of children. Use a take-back program for unused medicine.

Interactions to know about

Never combine it with tizanidine, thioridazine, pimozide, alosetron, ramelteon or an MAO inhibitor. Tell the prescriber about theophylline, warfarin, benzodiazepines, clozapine, methadone, propranolol or metoprolol, carbamazepine, tricyclic antidepressants and lithium, and about aspirin or NSAIDs, which add to the risk of bleeding. Do not drink alcohol while taking it; cigarette smoking may make it less effective.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Fluvoxamine differs from pharmacy to pharmacy

Fluvoxamine tablets are an old generic, but only a few companies make them, so not every pharmacy stocks them or puts them on a flat-price list, and quotes for the same tablet vary. A pharmacy that fills it rarely may order it in and price it as a slow-moving item.

The extended-release capsules are a separate product, and a pharmacy may stock one form but not the other. Capsules and tablets cannot be swapped at the counter without a new prescription, so the quote is always for the form written.

Ways to pay less for Fluvoxamine without insurance

• Ask whether fluvoxamine tablets are on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• If extended-release capsules are prescribed and quoted high, ask the prescriber whether tablets taken once or twice a day would suit you.
• Ask the pharmacy to quote the strength combination that makes up your daily dose, since one tablet of a higher strength can be priced differently from several smaller ones.
• Ask for a ninety-day supply once your dose is stable.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Fluvoxamine

1. 1.Do any of my medicines, such as tizanidine, theophylline, warfarin or a sleep medicine, interact with it?
2. 2.Should I take my whole dose at bedtime or split it?
3. 3.Will smoking, or quitting smoking, change how well it works for me?
4. 4.How should my dose be tapered if I need to stop?

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