Fluvoxamine - An updated review of its use in the management of adults with anxiety disorders

Fluvoxamine is a potent and selective serotonin reuptake inhibitor (SSRI) t hat has little or no effect on other monoamine reuptake mechanisms. Relativ e 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 C YP1A2, In randomised, double-blind trials, fluvoxamine 100 to 300 mg/day for 6 to 10 weeks significantly reduced symptoms of obsessive-compulsive disorder (O CD) compared with placebo. Response rates of 38 to 52% have been reported w ith 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 signif icantly more effective than desipramine, Maintenance therapy with fluvoxami ne may reduce the likelihood of relapses in up to 67% of patients with OCD, Fluvoxamine less than or equal to 300 mg/day for 6 to 8 weeks was as effect ive as imipramine in patients with panic disorder, and significantly more e ffective than placebo. In addition, treatment with fluvoxamine 1300 mg/day for greater than or equal to8 weeks improved symptoms of social phobia (soc ial anxiety disorder), post-traumatic stress disorder (PTSD), pathological gambling, compulsive buying, trichotillomania, kleptomania, body dysmorphic disorder, eating disorders and autistic disorder. Large trials comparing t he efficacy of fluvoxamine and other SSRIs in patients with anxiety disorde rs are warranted. Fluvoxamine is generally well tolerated; in postmarketing studies, nausea w as the only adverse event occurring in >10% of patients with less commonly reported events including somnolence, asthenia, headache, dry mouth and ins omnia. Fluvoxamine is associated with a low risk of suicidal behaviour, sex ual dysfunction and withdrawal syndrome. Fewer anticholinergic or cardiovas cular events are associated with fluvoxamine than tricyclic antidepressants . Although comparative data are lacking, the tolerability profile of fluvox amine appears to be broadly similar to those of other SSRIs. Conclusion: Fluvoxamine has demonstrated short term efficacy in the treatme nt 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 r ecommended as first-line treatment for a number of anxiety disorders. It ap pears to offer some pharmacokinetic advantages and a different drug interac tion profile to the other SSRIs with a broadly similar spectrum of adverse events. However, direct comparisons are required to assess the relative eff icacy and tolerability of the different agents of this drug class.