fluvoxamine (Rx)

Brand and Other Names:Luvox, Luvox CR (DSC)
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablets

  • 25mg
  • 50mg
  • 100mg

Obsessive-Compulsive Disorder

Conventional tablets

  • 50 mg qHS initially; may increase by 50 mg/day q4-7Days up to 100-300 mg/day
  • Dose >100 mg/day should be divided q12hr

Social Phobia (Off-label)

Immediate release

  • 50 mg PO qDay; may increase by 50 mg at 1 week interval; usual dose range is 100-300 mg/day

Panic Disorder (Off-label)

25-50 mg PO qDay; after several days, gradually increase to 100-200 mg/day; may increase to 300 mg/day for patients who fail to respond after several weeks of treatment

Dosing considerations

  • Continue therapy for 1-2 years, and consider discontinuation with close supervision; when discontinuing therapy, a slow taper over 2-6 months is recommended

Posttraumatic Stress Disorder (Off-label)

50 mg/day PO initially; may increase dose to 100-250 mg in adults and 100 mg in older adults; not to exceed 300 mg/day

Dosing considerations

  • Patients who respond to therapy may need to continue therapy indefinitely
  • May attempt tapering after 6-12 months in patients with acute PTSD; tapering should occur gradually over 2 weeks to 1 month to avoid withdrawal symptoms; tapering should take place over 4-12 weeks in patients at risk of relapse

Dosing Modifications

Hepatic impairment: Decrease dose

Therapy discontinuation

  • To discontinue therapy, gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for detection of re-emerging symptoms

Dosage Forms & Strengths

tablet

  • 25mg
  • 50mg
  • 100mg

Obsessive-Compulsive Disorder

<8 years: Safety and efficacy not established

Ages 8-17 years (conventional tablets): 25 mg PO qHS initially; may titrate by 25 mg/day increments every 4-7 days to 50-200 mg/day

Not to exceed 200 mg (for ages 8-11 years) or 300 mg for adolescents

Give doses >50 mg/day divided q12hr

The elderly are prone to SSRI/SNRI-induced hyponatremia; monitor closely

Obsessive-Compulsive Disorder

Conventional tablets: 25 mg qHS initially; may increase by 50 mg/day q4-7days up to 100-300 mg/day; dose >100 mg/day should be divided q12hr

Social Phobia (Off-label)

Conventional tablets: 50 mg PO qDay initially; may increase by 50 mg at 1 week interval; usual dose range is 100-300 mg/day

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Interactions

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            Contraindicated (6)

            • alosetron

              fluvoxamine will increase the level or effect of alosetron by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated.

            • dihydroergotamine

              fluvoxamine will increase the level or effect of dihydroergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • isocarboxazid

              fluvoxamine and isocarboxazid both increase serotonin levels. Contraindicated.

            • lonafarnib

              fluvoxamine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lonafarnib is a sensitive CYP3A4 substrate. Coadministration with strong or moderate CYP3A4 inhibitors is contraindicated.

            • ramelteon

              fluvoxamine will increase the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated.

            • selegiline

              fluvoxamine will increase the level or effect of selegiline by affecting hepatic enzyme CYP2B6 metabolism. Contraindicated.

            Serious - Use Alternative (111)

            • abametapir

              abametapir will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP1A2 substrates. If not feasible, avoid use of abametapir.

            • alfentanil

              fluvoxamine and alfentanil both increase serotonin levels. Avoid or Use Alternate Drug.

            • almotriptan

              fluvoxamine will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • amitriptyline

              fluvoxamine and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • amoxapine

              fluvoxamine and amoxapine both increase serotonin levels. Avoid or Use Alternate Drug.

            • arsenic trioxide

              fluvoxamine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

            • avapritinib

              fluvoxamine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of avapritinib with moderate CYP3A4 inhibitors. If unable to avoid, reduce avapritinib starting dose. See drug monograph Dosage Modifications

            • bupropion

              fluvoxamine increases toxicity of bupropion by Other (see comment). Avoid or Use Alternate Drug. Comment: May lower seizure threshold; keep bupropion dose as low as possible.

            • buspirone

              fluvoxamine and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.

            • cilostazol

              fluvoxamine increases toxicity of cilostazol by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Decrease cilostazol dose by 50%; serum levels of 3,4-dehydrocilostazole (active metabolite) increased by strong CYP2C19 inhibitors.

            • cimetidine

              fluvoxamine will increase the level or effect of cimetidine by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug.

            • citalopram

              fluvoxamine and citalopram both increase serotonin levels. Avoid or Use Alternate Drug. Combinatiomay increase risk of serotonin syndrome or neuroleptic malignant syndromn e like reactions.

            • clomipramine

              fluvoxamine and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.

            • clopidogrel

              fluvoxamine decreases effects of clopidogrel by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Clopidogrel efficacy may be reduced by drugs that inhibit CYP2C19. Inhibition of platelet aggregation by clopidogrel is entirely due to an active metabolite. Clopidogrel is metaolized to this active metabolite in part by CYP2C19.

            • clozapine

              fluvoxamine will increase the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

            • colchicine

              fluvoxamine will increase the level or effect of colchicine by Other (see comment). Avoid or Use Alternate Drug. Colchicine is a P-gp and CYP3A4 substrate. Avoid use with drugs that are both P-gp and strong CYP3A4 inhibitors. If coadministration is necessary, decrease colchicine dose or frequency as recommended in prescribing information. Use of any colchicine product in conjunction with strong CYP3A4 inhibitors is contraindicated in patients with renal or hepatic impairment.

            • cyclobenzaprine

              fluvoxamine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.

            • dacomitinib

              fluvoxamine will increase the level or effect of dacomitinib by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP3D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities

            • desflurane

              desflurane and fluvoxamine both increase QTc interval. Avoid or Use Alternate Drug.

            • desipramine

              fluvoxamine and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.

            • desvenlafaxine

              fluvoxamine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

            • dextromethorphan

              fluvoxamine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.

            • dihydroergotamine intranasal

              fluvoxamine will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • disopyramide

              fluvoxamine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.

            • dolasetron

              fluvoxamine and dolasetron both increase serotonin levels. Avoid or Use Alternate Drug.

            • dosulepin

              fluvoxamine and dosulepin both increase serotonin levels. Avoid or Use Alternate Drug.

            • doxepin

              fluvoxamine and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.

            • dronedarone

              fluvoxamine will increase the level or effect of dronedarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

              dronedarone will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

            • duloxetine

              fluvoxamine will increase the level or effect of duloxetine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

              fluvoxamine and duloxetine both increase serotonin levels. Avoid or Use Alternate Drug.

            • eltrombopag

              fluvoxamine will increase the level or effect of eltrombopag by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

            • entrectinib

              fluvoxamine will increase the level or effect of entrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. avoid coadministration of moderate CYP3A4 inhibitors with entrectinib, a CYP3A4 substrate. If coadministration unavoidabole, reduce dose to 200 mg/day for patients aged 12 y or older with BSA >1.5m2. Resume previous entrectinib dose after discontinuing moderate CYP3A4 inhibitor for 3-5 elimination half-lives.

            • ergotamine

              fluvoxamine will increase the level or effect of ergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • escitalopram

              fluvoxamine and escitalopram both increase serotonin levels. Avoid or Use Alternate Drug.

            • esomeprazole

              fluvoxamine will increase the level or effect of esomeprazole by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug.

            • etravirine

              fluvoxamine will increase the level or effect of etravirine by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug.

            • everolimus

              fluvoxamine will increase the level or effect of everolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • fedratinib

              fluvoxamine will increase the level or effect of fedratinib by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of fedratinib (a CYP3A4 and CYP2C19 substrate) with dual CYP3A4 and CYP2C19 inhibitor. Effect of coadminitration of a dual CYP3A4 and CYP2C19 inhibitor with fedratinib not studied

            • fentanyl

              fluvoxamine and fentanyl both increase serotonin levels. Avoid or Use Alternate Drug.

            • fentanyl transdermal

              fluvoxamine and fentanyl transdermal both increase serotonin levels. Avoid or Use Alternate Drug.

            • fentanyl transmucosal

              fluvoxamine and fentanyl transmucosal both increase serotonin levels. Avoid or Use Alternate Drug.

            • fluoxetine

              fluvoxamine and fluoxetine both increase serotonin levels. Avoid or Use Alternate Drug.

            • gilteritinib

              gilteritinib will increase the level or effect of fluvoxamine by Other (see comment). Avoid or Use Alternate Drug. Coadministrationwith drugs that inhibit 5HT2B or sigma nonspecific receptors. Avoid use of these drugs with gilteritinib unless coadministration is necessary

            • givosiran

              givosiran will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP1A2 substrates with givosiran. If unavoidable, decrease the CYP1A2 substrate dosage in accordance with approved product labeling.

              givosiran will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

            • granisetron

              fluvoxamine and granisetron both increase serotonin levels. Avoid or Use Alternate Drug.

            • hydromorphone

              fluvoxamine and hydromorphone both increase serotonin levels. Avoid or Use Alternate Drug.

            • ibutilide

              fluvoxamine and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.

            • imipramine

              fluvoxamine and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.

            • indapamide

              fluvoxamine and indapamide both increase QTc interval. Avoid or Use Alternate Drug.

            • infigratinib

              fluvoxamine will increase the level or effect of infigratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • levomilnacipran

              fluvoxamine and levomilnacipran both increase serotonin levels. Avoid or Use Alternate Drug.

            • lidocaine

              fluvoxamine and lidocaine both increase serotonin levels. Avoid or Use Alternate Drug.

            • linezolid

              fluvoxamine and linezolid both increase serotonin levels. Avoid or Use Alternate Drug.

            • lofepramine

              fluvoxamine and lofepramine both decrease serotonin levels. Avoid or Use Alternate Drug.

            • lorcaserin

              fluvoxamine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

            • lovastatin

              fluvoxamine will increase the level or effect of lovastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • lurbinectedin

              fluvoxamine will increase the level or effect of lurbinectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • maprotiline

              fluvoxamine and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.

            • meperidine

              fluvoxamine and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.

            • methylene blue

              fluvoxamine increases toxicity of methylene blue by serotonin levels. Avoid or Use Alternate Drug.

            • metoclopramide

              fluvoxamine and metoclopramide both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects: Increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactions

            • metoclopramide intranasal

              fluvoxamine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

            • mexiletine

              fluvoxamine will increase the level or effect of mexiletine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

            • milnacipran

              fluvoxamine and milnacipran both increase serotonin levels. Avoid or Use Alternate Drug.

            • mobocertinib

              fluvoxamine will increase the level or effect of mobocertinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use of moderate CYP3A4 inhibitor unavoidable, reduce mobocertinib dose by ~50% (eg, 160 to 80 mg); closely monitor QTc interval.

            • nefazodone

              fluvoxamine and nefazodone both increase serotonin levels. Avoid or Use Alternate Drug.

            • neratinib

              fluvoxamine will increase the level or effect of neratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • netupitant/palonosetron

              fluvoxamine increases toxicity of netupitant/palonosetron by serotonin levels. Avoid or Use Alternate Drug.

            • nortriptyline

              fluvoxamine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • olanzapine

              fluvoxamine will increase the level or effect of olanzapine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

            • omeprazole

              fluvoxamine will increase the level or effect of omeprazole by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug.

            • ondansetron

              fluvoxamine and ondansetron both increase serotonin levels. Avoid or Use Alternate Drug.

            • ozanimod

              ozanimod increases toxicity of fluvoxamine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because active metabolite of ozanimod inhibits MAO-B in vitro, there is potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use. .

            • palonosetron

              fluvoxamine and palonosetron both increase serotonin levels. Avoid or Use Alternate Drug.

            • paroxetine

              fluvoxamine and paroxetine both increase serotonin levels. Avoid or Use Alternate Drug.

            • pazopanib

              fluvoxamine will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If it must be coadminister, decrease pazotinib dose to 400 mg/day

            • pentamidine

              fluvoxamine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • pexidartinib

              fluvoxamine will increase the level or effect of pexidartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors is unavoidable, reduce pexidartinib dose (refer to drug monograph dosage modifications). After discontinuing the CYP3A4 inhibitor for 3 elimination half-lives, may resume previous pexidartinib dose.

            • phenelzine

              fluvoxamine and phenelzine both increase serotonin levels. Contraindicated.

            • phentermine

              fluvoxamine and phentermine both increase serotonin levels. Avoid or Use Alternate Drug.

            • pimozide

              fluvoxamine increases toxicity of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

              fluvoxamine and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

            • pirfenidone

              fluvoxamine will increase the level or effect of pirfenidone by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Use of strong CYP1A2 inhibitors should be discontinued before initiating treatment and avoided during treatment; if strong CYP1A2 inhibitor is only option, dosage reduction recommended

            • pomalidomide

              fluvoxamine will increase the level or effect of pomalidomide by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

            • procainamide

              fluvoxamine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.

            • procarbazine

              fluvoxamine and procarbazine both increase serotonin levels. Contraindicated.

            • protriptyline

              fluvoxamine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.

            • quinidine

              fluvoxamine and quinidine both increase QTc interval. Avoid or Use Alternate Drug.

            • ranolazine

              fluvoxamine will increase the level or effect of ranolazine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • rasagiline

              fluvoxamine and rasagiline both increase serotonin levels. Avoid or Use Alternate Drug. Severe CNS toxicity associated with hyperpyrexia reported with combined treatment of antidepressant and rasagiline; avoid combination within 14 days of MAOI use

            • remifentanil

              fluvoxamine and remifentanil both increase serotonin levels. Avoid or Use Alternate Drug.

            • ropinirole

              fluvoxamine will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

            • selegiline

              fluvoxamine and selegiline both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of either drug and initiation of the other one

            • selegiline transdermal

              fluvoxamine and selegiline transdermal both increase serotonin levels. Avoid or Use Alternate Drug.

            • selinexor

              selinexor, fluvoxamine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

            • sertraline

              fluvoxamine and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.

            • siponimod

              fluvoxamine will increase the level or effect of siponimod by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration with a moderate or strong CYP3A4 inhibitor PLUS a moderate or strong CYP2C9 inhibitor not recommended

            • sotalol

              fluvoxamine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • St John's Wort

              fluvoxamine and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.

            • tazemetostat

              fluvoxamine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of avapritinib with moderate CYP3A4 inhibitors. If unable to avoid, reduce avapritinib starting dose. See drug monograph Dosage Modifications

            • tedizolid

              fluvoxamine and tedizolid both increase serotonin levels. Avoid or Use Alternate Drug.

            • theophylline

              fluvoxamine will increase the level or effect of theophylline by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

            • thioridazine

              fluvoxamine will increase the level or effect of thioridazine by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated.

              fluvoxamine and thioridazine both increase QTc interval. Contraindicated.

            • tipranavir

              tipranavir will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

            • tizanidine

              fluvoxamine will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

            • tolvaptan

              fluvoxamine will increase the level or effect of tolvaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • tranylcypromine

              fluvoxamine and tranylcypromine both increase serotonin levels. Contraindicated.

            • trazodone

              fluvoxamine and trazodone both increase serotonin levels. Avoid or Use Alternate Drug.

            • trimipramine

              fluvoxamine will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

            • venlafaxine

              fluvoxamine and venlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.

            • vilazodone

              fluvoxamine and vilazodone both increase serotonin levels. Avoid or Use Alternate Drug. Discontinue concomitant therapy immediately if signs and symptoms of serotonin syndrome emerge and supportive sympathomimetic treatment should be initiated

            • vortioxetine

              fluvoxamine, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.

            • warfarin

              fluvoxamine will increase the level or effect of warfarin by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

            Monitor Closely (297)

            • 5-HTP

              fluvoxamine and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.

            • abiraterone

              abiraterone will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. If therapy cannot be avoided, exercise caution and consider a dose reduction of CYP2D6 substrate

            • acalabrutinib

              fluvoxamine will increase the level or effect of acalabrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease dose to 100 mg once daily if coadministered with CYP3A4 inhibitor

            • aceclofenac

              fluvoxamine, aceclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

            • acemetacin

              fluvoxamine, acemetacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

            • alfentanil

              fluvoxamine will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • alfuzosin

              fluvoxamine and alfuzosin both increase QTc interval. Use Caution/Monitor.

            • alitretinoin

              fluvoxamine will increase the level or effect of alitretinoin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • almotriptan

              fluvoxamine and almotriptan both increase serotonin levels. Modify Therapy/Monitor Closely.

            • alosetron

              fluvoxamine will increase the level or effect of alosetron by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • alprazolam

              fluvoxamine will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • amifampridine

              fluvoxamine increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

            • amiodarone

              fluvoxamine and amiodarone both increase QTc interval. Use Caution/Monitor.

            • amitriptyline

              fluvoxamine and amitriptyline both increase QTc interval. Modify Therapy/Monitor Closely.

            • amoxapine

              fluvoxamine and amoxapine both increase QTc interval. Modify Therapy/Monitor Closely.

            • antipyrine

              fluvoxamine will increase the level or effect of antipyrine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

            • apixaban

              fluvoxamine increases effects of apixaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

            • asenapine

              fluvoxamine will increase the level or effect of asenapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Dose reduction may be necessary

            • asenapine transdermal

              fluvoxamine will increase the level or effect of asenapine transdermal by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Dose reduction may be necessary

            • aspirin

              fluvoxamine, aspirin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding SSRIs inhib. serotonin uptake by platelets.

            • aspirin rectal

              fluvoxamine, aspirin rectal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding SSRIs inhib. serotonin uptake by platelets.

            • atogepant

              fluvoxamine will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • avanafil

              fluvoxamine will increase the level or effect of avanafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Maximum recommended dose of STENDRA is 50mg, not to exceed once every 24hr for patients taking concomitant moderate CYP3A4 inhibitors

            • axitinib

              fluvoxamine will increase the level or effect of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • belzutifan

              fluvoxamine will increase the level or effect of belzutifan by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Belzutifan is a CYP2C19 substrate. Coadministration with CYP2C19 inhibitors may increase incidence or severity of adverse effects. Monitor for anemia and hypoxia and reduce belzutifan dose as recommended.

            • bendamustine

              fluvoxamine will increase the level or effect of bendamustine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Decreased conversion of bendamustine to active metabolite. May decrease concentration of active metabolites

            • benzhydrocodone/acetaminophen

              fluvoxamine, benzhydrocodone/acetaminophen. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. If concomitant use warranted, carfully observe patient, particularly during treatment initiation and dose adjustment.

            • betrixaban

              fluvoxamine, betrixaban. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor.

            • bexarotene

              fluvoxamine will increase the level or effect of bexarotene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • bortezomib

              fluvoxamine will increase the level or effect of bortezomib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • bosentan

              fluvoxamine will increase the level or effect of bosentan by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • budesonide

              fluvoxamine will increase the level or effect of budesonide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • buprenorphine subdermal implant

              fluvoxamine and buprenorphine subdermal implant both increase serotonin levels. Use Caution/Monitor. If concomitant use warranted, carefully observe patient, particularly during treatment initiation, and during dose adjustment of serotonergic drug. Discontinue buprenorphine if serotonin syndrome suspected

            • buprenorphine, long-acting injection

              fluvoxamine and buprenorphine, long-acting injection both increase serotonin levels. Use Caution/Monitor. If concomitant use warranted, carefully observe patient, particularly during treatment initiation, and during dose adjustment of serotonergic drug. Discontinue buprenorphine if serotonin syndrome suspected

            • bupropion

              fluvoxamine will increase the level or effect of bupropion by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

            • buspirone

              fluvoxamine will increase the level or effect of buspirone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • caffeine

              fluvoxamine will increase the level or effect of caffeine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

            • cannabidiol

              fluvoxamine will increase the level or effect of cannabidiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Consider reducing cannabidiol dose when coadministered with a moderate CYP3A4 inhibitor

            • carbamazepine

              fluvoxamine will increase the level or effect of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor plasma levels when used concomitantly

            • carvedilol

              fluvoxamine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • celecoxib

              fluvoxamine will increase the level or effect of celecoxib by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • chlorpromazine

              fluvoxamine and chlorpromazine both increase QTc interval. Modify Therapy/Monitor Closely.

            • choline magnesium trisalicylate

              fluvoxamine, choline magnesium trisalicylate. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding SSRIs inhib. serotonin uptake by platelets.

            • cilostazol

              fluvoxamine will increase the level or effect of cilostazol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • cimetidine

              cimetidine will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • cinacalcet

              fluvoxamine will increase the level or effect of cinacalcet by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • citalopram

              fluvoxamine will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Citalopram 20 mg/day is maximum recommended dose for patients taking CYP2C19 inhibitors because of the risk of QT prolongation

            • clarithromycin

              fluvoxamine and clarithromycin both increase QTc interval. Modify Therapy/Monitor Closely.

            • clobazam

              fluvoxamine will increase the level or effect of clobazam by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Dosage adjustment may be necessary ; CYP2C19 inhibitors may result in increased exposure to N-desmethylclobazam (active metabolite)

              clobazam will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. May be necessary to admininister lower doses of drugs metabolized by CYP2D6 when used concomitantly

            • clobetasone

              fluvoxamine will increase the level or effect of clobetasone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • clomipramine

              fluvoxamine and clomipramine both increase QTc interval. Modify Therapy/Monitor Closely.

            • clonidine

              fluvoxamine, clonidine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. CNS derpressant effects enhanced.

            • clopidogrel

              fluvoxamine will increase the level or effect of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SSRIs affect platelet activation; coadministration may increase risk of bleeding

            • clozapine

              fluvoxamine will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • cobicistat

              fluvoxamine will increase the level or effect of cobicistat by Other (see comment). Use Caution/Monitor. Carfully titrate dose of antidepressant to desired effect, including using lowest feasible initial or maintenance dose , and monitor its response during coadministration with SSRIs and cobicistat

            • cocaine

              fluvoxamine and cocaine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • conivaptan

              fluvoxamine will increase the level or effect of conivaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • cortisone

              fluvoxamine will increase the level or effect of cortisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • cyclophosphamide

              fluvoxamine will increase the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

            • cyclosporine

              fluvoxamine will increase the level or effect of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • cyproheptadine

              cyproheptadine decreases effects of fluvoxamine by pharmacodynamic antagonism. Use Caution/Monitor. May deminish serotonergic effect of SSRIs.

            • darifenacin

              fluvoxamine will increase the level or effect of darifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • darunavir

              fluvoxamine will increase the level or effect of darunavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • dasatinib

              fluvoxamine and dasatinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • deferasirox

              deferasirox will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

            • defibrotide

              defibrotide increases effects of fluvoxamine by Other (see comment). Use Caution/Monitor. Comment: Defibrotide may enhance effects of platelet inhibitors.

            • deflazacort

              fluvoxamine will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose by one-third of recommended dose if coadministered with moderate or strong CYP3A4 inhibitors

            • degarelix

              degarelix and fluvoxamine both increase QTc interval. Use Caution/Monitor.

            • desipramine

              fluvoxamine and desipramine both increase QTc interval. Modify Therapy/Monitor Closely.

            • desvenlafaxine

              desvenlafaxine will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. With higher desvenlafaxine doses (eg, 400 mg) decrease CYP2D6 substrate dose by up to 50%; dose adjustment not necessary with desvenlafaxine doses <100mg

            • deutetrabenazine

              deutetrabenazine and fluvoxamine both increase QTc interval. Use Caution/Monitor.

            • dexfenfluramine

              fluvoxamine and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • dextroamphetamine

              fluvoxamine and dextroamphetamine both decrease serotonin levels. Modify Therapy/Monitor Closely.

            • diazepam

              fluvoxamine will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • diazepam intranasal

              fluvoxamine will increase the level or effect of diazepam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May decrease rate of diazepam elimination, causing a decrease in diazepam elimnation, thereby increasing adverse reactions to diazepam

            • dichlorphenamide

              dichlorphenamide and fluvoxamine both decrease serum potassium. Use Caution/Monitor.

            • diclofenac

              fluvoxamine, diclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

            • diflunisal

              fluvoxamine, diflunisal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

            • dihydroergotamine

              fluvoxamine and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • dihydroergotamine intranasal

              fluvoxamine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.

            • diltiazem

              fluvoxamine will increase the level or effect of diltiazem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • dofetilide

              fluvoxamine and dofetilide both increase QTc interval. Modify Therapy/Monitor Closely.

            • dolasetron

              fluvoxamine and dolasetron both increase QTc interval. Use Caution/Monitor.

            • donepezil

              donepezil and fluvoxamine both increase QTc interval. Use Caution/Monitor.

            • edoxaban

              fluvoxamine will increase the level or effect of edoxaban by anticoagulation. Use Caution/Monitor. SSRIs affect platelet activation; coadministration may increase risk of bleeding

            • efavirenz

              fluvoxamine will increase the level or effect of efavirenz by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

            • eletriptan

              fluvoxamine and eletriptan both increase serotonin levels. Modify Therapy/Monitor Closely.

            • eliglustat

              eliglustat will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations; consider reducing dosage of concomitant drug and titrate to clincal effect

            • eltrombopag

              fluvoxamine will increase the level or effect of eltrombopag by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • eluxadoline

              fluvoxamine will increase the level or effect of eluxadoline by affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Use caution when coadministering with strong CYP1A2 inhibitors; Not studied

              fluvoxamine will increase the level or effect of eluxadoline by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Use caution when coadministering with CYP2C19 inhibitors; not studied

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              elvitegravir/cobicistat/emtricitabine/tenofovir DF will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Caution with CYP2D6 substrates for which elevated plasma concentrations may cause life-threatening events

            • epinephrine

              fluvoxamine and epinephrine both increase QTc interval. Modify Therapy/Monitor Closely.

            • epinephrine racemic

              fluvoxamine and epinephrine racemic both increase QTc interval. Modify Therapy/Monitor Closely.

            • ergotamine

              fluvoxamine and ergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • erlotinib

              fluvoxamine will increase the level or effect of erlotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • erythromycin base

              fluvoxamine and erythromycin base both increase QTc interval. Modify Therapy/Monitor Closely.

            • erythromycin ethylsuccinate

              fluvoxamine and erythromycin ethylsuccinate both increase QTc interval. Modify Therapy/Monitor Closely.

            • erythromycin lactobionate

              fluvoxamine and erythromycin lactobionate both increase QTc interval. Modify Therapy/Monitor Closely.

            • erythromycin stearate

              fluvoxamine and erythromycin stearate both increase QTc interval. Modify Therapy/Monitor Closely.

            • ethinylestradiol

              ethinylestradiol will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

            • ethotoin

              fluvoxamine will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • etodolac

              fluvoxamine, etodolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding; SSRIs inhib. srotonin uptake by platelets.

            • etravirine

              fluvoxamine will increase the level or effect of etravirine by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • fedratinib

              fedratinib will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of CYP2D6 substrates as necessary

            • felodipine

              fluvoxamine will increase the level or effect of felodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • fenbufen

              fluvoxamine, fenbufen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding; SSRIs inhib. srotonin uptake by platelets.

            • fenfluramine

              fluvoxamine and fenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely.

              fenfluramine, fluvoxamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.

            • fenoprofen

              fluvoxamine, fenoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

            • fesoterodine

              fluvoxamine will increase the level or effect of fesoterodine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • fexinidazole

              fexinidazole will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

            • finerenone

              fluvoxamine will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or moderate CYP3A4 inhibitors. Adjust finererone dosage as needed.

            • fish oil triglycerides

              fish oil triglycerides will increase the level or effect of fluvoxamine by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants

            • flecainide

              fluvoxamine and flecainide both increase QTc interval. Use Caution/Monitor.

            • flibanserin

              fluvoxamine will increase the level or effect of flibanserin by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. May increase risk of hypotension, syncope, and CNS depression

            • fluconazole

              fluvoxamine and fluconazole both increase QTc interval. Modify Therapy/Monitor Closely.

            • fluphenazine

              fluvoxamine and fluphenazine both increase QTc interval. Use Caution/Monitor.

            • flurbiprofen

              fluvoxamine, flurbiprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • fluvastatin

              fluvoxamine will increase the level or effect of fluvastatin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • fondaparinux

              fluvoxamine will increase the level or effect of fondaparinux by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, which may increase bleeding risk when coadministered with anticoabulants

            • formoterol

              fluvoxamine and formoterol both increase QTc interval. Modify Therapy/Monitor Closely.

            • fosamprenavir

              fluvoxamine will increase the level or effect of fosamprenavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • foscarnet

              fluvoxamine and foscarnet both increase QTc interval. Use Caution/Monitor.

            • fosphenytoin

              fluvoxamine will increase the level or effect of fosphenytoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • frovatriptan

              fluvoxamine and frovatriptan both increase serotonin levels. Modify Therapy/Monitor Closely.

            • gabapentin

              fluvoxamine, gabapentin. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coaadministration with CNS depressant may result in fatal respiratory depression. Use lowest dose possible and monnitor for respiratory depression and sedation.

            • gabapentin enacarbil

              fluvoxamine, gabapentin enacarbil. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coaadministration with CNS depressant may result in fatal respiratory depression. Use lowest dose possible and monnitor for respiratory depression and sedation.

            • grapefruit

              grapefruit will increase the level or effect of fluvoxamine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • green tea

              green tea, fluvoxamine. Either increases toxicity of the other by anticoagulation. Use Caution/Monitor.

            • guanfacine

              fluvoxamine will increase the level or effect of guanfacine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If coadministered with extended release, reduce guanfacine dosage in half of recommended dose; specific recommendation for immediate release form not available

            • haloperidol

              fluvoxamine and haloperidol both increase QTc interval. Modify Therapy/Monitor Closely.

            • hydrocodone

              fluvoxamine and hydrocodone both increase serotonin levels. Use Caution/Monitor. If concomitant use warranted, carfully observe patient, particularly during treatment initiation and dose adjustment

            • ibrutinib

              ibrutinib will increase the level or effect of fluvoxamine by anticoagulation. Use Caution/Monitor. Ibrutinib may increase risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding

            • ibuprofen

              fluvoxamine, ibuprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding; SSRIs inhib. srotonin uptake by platelets.

            • ibuprofen IV

              fluvoxamine, ibuprofen IV. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

            • ifosfamide

              fluvoxamine will decrease the level or effect of ifosfamide by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor. CYP2B6 inhibitors may decrease metabolism of ifosfamide to its active metabolite, potentially reducing ifosfamide therapeutic effects

            • iloperidone

              fluvoxamine and iloperidone both increase QTc interval. Use Caution/Monitor.

            • imatinib

              imatinib will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • imipramine

              fluvoxamine will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • indinavir

              fluvoxamine will increase the level or effect of indinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • indomethacin

              fluvoxamine, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

            • irinotecan

              fluvoxamine will increase the level or effect of irinotecan by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

            • irinotecan liposomal

              fluvoxamine will increase the level or effect of irinotecan liposomal by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

            • isavuconazonium sulfate

              fluvoxamine will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • isoniazid

              fluvoxamine and isoniazid both increase serotonin levels. Modify Therapy/Monitor Closely.

            • ivacaftor

              fluvoxamine will increase the level or effect of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce ivacaftor dose if coadministered with CYP3A4 inhibitors; see ivacaftor prescribing information for precise dosage information

            • ivosidenib

              fluvoxamine will increase the level or effect of ivosidenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May increase ivosidenib plasma concentrations, thus increasing risk of QTc prolongation; monitor for increased risk of QTc interval prolongation

            • ixabepilone

              fluvoxamine will increase the level or effect of ixabepilone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ketamine

              fluvoxamine will increase the level or effect of ketamine by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

            • ketoconazole

              fluvoxamine and ketoconazole both increase QTc interval. Modify Therapy/Monitor Closely.

            • ketoprofen

              fluvoxamine, ketoprofen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding SSRIs inhib. serotonin uptake by platelets.

            • ketorolac

              fluvoxamine, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding SSRIs inhib. serotonin uptake by platelets.

            • ketorolac intranasal

              fluvoxamine, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding; SSRIs inhib. srotonin uptake by platelets.

            • L-tryptophan

              fluvoxamine and L-tryptophan both increase serotonin levels. Modify Therapy/Monitor Closely.

            • lamotrigine

              lamotrigine increases toxicity of fluvoxamine by serotonin levels. Modify Therapy/Monitor Closely. psychomotor impairment may be enhanced.

            • lansoprazole

              fluvoxamine will increase the level or effect of lansoprazole by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

            • lapatinib

              fluvoxamine and lapatinib both increase QTc interval. Use Caution/Monitor.

            • lasmiditan

              fluvoxamine and lasmiditan both increase serotonin levels. Use Caution/Monitor.

            • lefamulin

              fluvoxamine will increase the level or effect of lefamulin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for adverse effects if lefamulin is coadministered with moderate CYP3A inhibitors.

            • lemborexant

              fluvoxamine will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Avoid coadministration of lemborexant with moderate or strong CYP3A4 inhibitors

              fluvoxamine, lemborexant. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. May have additive effect with other CNS depressants; dose adjustment may be necessary.

            • levamlodipine

              fluvoxamine will increase the level or effect of levamlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. May requre amlodipine dose reduction; monitor for symptoms of hypotension and edema when amlodipine is coadminitered with CYP3A4 inhibitors to determine need for those adjustment

            • levofloxacin

              fluvoxamine and levofloxacin both increase QTc interval. Use Caution/Monitor.

            • lisdexamfetamine

              fluvoxamine, lisdexamfetamine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue along with concomitant serotonergic drug(s).

            • lithium

              fluvoxamine and lithium both increase serotonin levels. Modify Therapy/Monitor Closely.

            • lofepramine

              fluvoxamine and lofepramine both increase QTc interval. Modify Therapy/Monitor Closely.

            • lomitapide

              fluvoxamine will increase the level or effect of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day

            • lopinavir

              fluvoxamine will increase the level or effect of lopinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • loratadine

              fluvoxamine will increase the level or effect of loratadine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • lorcaserin

              lorcaserin will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • lornoxicam

              fluvoxamine, lornoxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

            • lsd

              fluvoxamine and lsd both increase serotonin levels. Modify Therapy/Monitor Closely.

            • lumefantrine

              fluvoxamine and lumefantrine both increase QTc interval. Modify Therapy/Monitor Closely.

            • lurasidone

              fluvoxamine, lurasidone. Either increases toxicity of the other by sedation. Use Caution/Monitor. Monitor for increased adverse effects and toxicity.

            • maprotiline

              fluvoxamine and maprotiline both increase QTc interval. Modify Therapy/Monitor Closely.

            • maraviroc

              fluvoxamine will increase the level or effect of maraviroc by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • meclofenamate

              fluvoxamine, meclofenamate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding SSRIs inhib. serotonin uptake by platelets.

            • mefenamic acid

              fluvoxamine, mefenamic acid. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding SSRIs inhib. serotonin uptake by platelets.

            • meloxicam

              fluvoxamine, meloxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding; SSRIs inhib. srotonin uptake by platelets.

            • metformin

              fluvoxamine increases effects of metformin by pharmacodynamic synergism. Use Caution/Monitor.

            • methadone

              fluvoxamine and methadone both increase QTc interval. Use Caution/Monitor.

            • midazolam

              fluvoxamine will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May increase risk of hypoventilation, airway obstruction, or apnea and may contribute to profound and/or prolonged drug effect

            • midazolam intranasal

              fluvoxamine will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May increase risk of hypoventilation, airway obstruction, or apnea and may contribute to profound and/or prolonged drug effect

            • mirabegron

              mirabegron will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • mirtazapine

              fluvoxamine and mirtazapine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • morphine

              fluvoxamine and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • moxifloxacin

              fluvoxamine and moxifloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

            • nabumetone

              fluvoxamine, nabumetone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding SSRIs inhib. serotonin uptake by platelets.

            • naldemedine

              fluvoxamine will increase the level or effect of naldemedine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for potential adverse effects

            • naproxen

              fluvoxamine, naproxen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

            • naratriptan

              fluvoxamine and naratriptan both increase serotonin levels. Modify Therapy/Monitor Closely.

            • nateglinide

              fluvoxamine will increase the level or effect of nateglinide by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • nelfinavir

              fluvoxamine will increase the level or effect of nelfinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nicardipine

              fluvoxamine will increase the level or effect of nicardipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nifedipine

              fluvoxamine will increase the level or effect of nifedipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nilotinib

              fluvoxamine will increase the level or effect of nilotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nimodipine

              fluvoxamine will increase the level or effect of nimodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nisoldipine

              fluvoxamine will increase the level or effect of nisoldipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nitrendipine

              fluvoxamine will increase the level or effect of nitrendipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nortriptyline

              fluvoxamine and nortriptyline both increase QTc interval. Modify Therapy/Monitor Closely.

            • octreotide

              fluvoxamine and octreotide both increase QTc interval. Modify Therapy/Monitor Closely.

            • octreotide (Antidote)

              fluvoxamine and octreotide (Antidote) both increase QTc interval. Modify Therapy/Monitor Closely.

            • ofloxacin

              fluvoxamine and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

            • oliceridine

              fluvoxamine will increase the level or effect of oliceridine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal.

              fluvoxamine, oliceridine. Either increases toxicity of the other by serotonin levels. Modify Therapy/Monitor Closely.

            • ospemifene

              fluvoxamine will increase the level or effect of ospemifene by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

            • oxaprozin

              fluvoxamine, oxaprozin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

            • oxycodone

              fluvoxamine and oxycodone both increase serotonin levels. Use Caution/Monitor.

            • paliperidone

              fluvoxamine and paliperidone both increase QTc interval. Use Caution/Monitor.

            • pantoprazole

              fluvoxamine will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

            • parecoxib

              fluvoxamine will increase the level or effect of parecoxib by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Increased risk of upper GI bleeding; SSRIs inhib. srotonin uptake by platelets

            • paroxetine

              fluvoxamine and paroxetine both increase QTc interval. Use Caution/Monitor.

            • peginterferon alfa 2b

              fluvoxamine, peginterferon alfa 2b. Other (see comment). Use Caution/Monitor. Comment: Therapeutic effect may be altered with coadministration of CYP2D6 substrates; peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.

            • pentazocine

              fluvoxamine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.

            • pentoxifylline

              fluvoxamine and pentoxifylline both increase anticoagulation. Use Caution/Monitor. may increase bleeding

            • perphenazine

              fluvoxamine and perphenazine both increase QTc interval. Use Caution/Monitor.

            • phenytoin

              fluvoxamine will increase the level or effect of phenytoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • piroxicam

              fluvoxamine, piroxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

            • posaconazole

              fluvoxamine and posaconazole both increase QTc interval. Use Caution/Monitor.

            • pregabalin

              fluvoxamine, pregabalin. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration may result in life-threatening, and fatal respiratory depression; use lowest dose possible and monitor for respiratory depression and sedation.

            • prochlorperazine

              fluvoxamine and prochlorperazine both increase QTc interval. Use Caution/Monitor.

            • promazine

              fluvoxamine and promazine both increase QTc interval. Modify Therapy/Monitor Closely.

            • promethazine

              fluvoxamine and promethazine both increase QTc interval. Use Caution/Monitor.

            • propafenone

              fluvoxamine will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • propofol

              fluvoxamine will increase the level or effect of propofol by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

            • protriptyline

              fluvoxamine and protriptyline both increase QTc interval. Modify Therapy/Monitor Closely.

            • quetiapine

              fluvoxamine will increase the level or effect of quetiapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • quinidine

              quinidine will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • rabeprazole

              fluvoxamine will increase the level or effect of rabeprazole by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

            • ramelteon

              fluvoxamine will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • ranolazine

              fluvoxamine and ranolazine both increase QTc interval. Use Caution/Monitor.

            • remimazolam

              remimazolam, fluvoxamine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

            • repaglinide

              fluvoxamine will increase the level or effect of repaglinide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • riluzole

              fluvoxamine will increase the level or effect of riluzole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

            • rimegepant

              fluvoxamine will increase the level or effect of rimegepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Avoid repeating dose within 48 hr if coadministered with moderate CYP3A4

            • risperidone

              fluvoxamine and risperidone both increase QTc interval. Use Caution/Monitor.

            • ritonavir

              fluvoxamine will increase the level or effect of ritonavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rivaroxaban

              fluvoxamine will increase the level or effect of rivaroxaban by pharmacodynamic synergism. Use Caution/Monitor. May increase risk of bleeding

            • rizatriptan

              fluvoxamine and rizatriptan both increase serotonin levels. Modify Therapy/Monitor Closely.

            • roflumilast

              fluvoxamine increases levels of roflumilast by Other (see comment). Modify Therapy/Monitor Closely. Comment: coadministration with dual inhibitors of CYP3A4 and CYP1A2 may increase systemic exposure and result in increased adverse reactions.

            • rolapitant

              rolapitant will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase serum concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration

            • romidepsin

              fluvoxamine and romidepsin both increase QTc interval. Use Caution/Monitor.

            • rucaparib

              rucaparib will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP1A2 substrates, if clinically indicated.

            • safinamide

              fluvoxamine, safinamide. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Monitor for serotonin syndrome.

            • salicylates (non-asa)

              fluvoxamine, salicylates (non-asa). Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

            • salsalate

              fluvoxamine, salsalate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

            • SAMe

              fluvoxamine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.

            • saquinavir

              fluvoxamine will increase the level or effect of saquinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • silodosin

              fluvoxamine will increase the level or effect of silodosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases effects of fluvoxamine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate increases effects of fluvoxamine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.

            • sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

              fluvoxamine, sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Increased risk for water retention or electrolyte imbalance.

            • sofosbuvir/velpatasvir

              fluvoxamine will increase the level or effect of sofosbuvir/velpatasvir by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

            • solifenacin

              fluvoxamine will increase the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • stiripentol

              fluvoxamine, stiripentol. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. May require dosage adjustment.

            • sufentanil

              fluvoxamine and sufentanil both increase serotonin levels. Use Caution/Monitor. Carefully observe patient for serotonin syndrome during treatment initiation and dose adjustment

            • sufentanil SL

              fluvoxamine and sufentanil SL both decrease serotonin levels. Use Caution/Monitor. Carefully observe patient for serotonin syndrome during treatment initiation and dose adjustment

            • sulfamethoxazole

              fluvoxamine and sulfamethoxazole both increase QTc interval. Use Caution/Monitor.

            • sulfasalazine

              fluvoxamine will increase the level or effect of sulfasalazine by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding SSRIs inhib. serotonin uptake by platelets

            • sulindac

              fluvoxamine, sulindac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • sumatriptan

              fluvoxamine and sumatriptan both increase serotonin levels. Modify Therapy/Monitor Closely.

            • sumatriptan intranasal

              fluvoxamine and sumatriptan intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.

            • sunitinib

              fluvoxamine will increase the level or effect of sunitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tacrolimus

              fluvoxamine will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tadalafil

              fluvoxamine will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tamoxifen

              fluvoxamine, tamoxifen. affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Decreases tamoxifen metabolism to active metabolites.

            • tapentadol

              fluvoxamine and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.

            • tasimelteon

              fluvoxamine will increase the level or effect of tasimelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. May increase adverse effects

            • telavancin

              fluvoxamine and telavancin both increase QTc interval. Use Caution/Monitor.

            • temsirolimus

              fluvoxamine will increase the level or effect of temsirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • terbinafine

              terbinafine will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

              fluvoxamine will increase the level or effect of terbinafine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

            • teriflunomide

              teriflunomide will decrease the level or effect of fluvoxamine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

            • tezacaftor

              fluvoxamine will increase the level or effect of tezacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dose when coadministered with a moderate CYP3A4 inhibitor

            • tinidazole

              fluvoxamine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tipranavir

              fluvoxamine will increase the level or effect of tipranavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tofacitinib

              fluvoxamine increases levels of tofacitinib by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Decrease tofacitinib dose is coadministered with both moderate CYP3A4 and potent CYP2C19 inhibitors.

            • tolbutamide

              fluvoxamine will increase the level or effect of tolbutamide by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • tolfenamic acid

              fluvoxamine, tolfenamic acid. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

            • tolmetin

              fluvoxamine, tolmetin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.

            • tramadol

              fluvoxamine and tramadol both increase serotonin levels. Modify Therapy/Monitor Closely.

            • trazodone

              fluvoxamine and trazodone both increase QTc interval. Modify Therapy/Monitor Closely.

            • triazolam

              fluvoxamine will increase the level or effect of triazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • trifluoperazine

              fluvoxamine and trifluoperazine both increase QTc interval. Modify Therapy/Monitor Closely.

            • trimethoprim

              fluvoxamine and trimethoprim both increase QTc interval. Use Caution/Monitor.

            • trimipramine

              fluvoxamine and trimipramine both increase QTc interval. Modify Therapy/Monitor Closely.

            • tropisetron

              fluvoxamine and tropisetron both increase QTc interval. Use Caution/Monitor.

            • valerian

              fluvoxamine and valerian both increase sedation. Use Caution/Monitor.

            • velpatasvir

              fluvoxamine will increase the level or effect of velpatasvir by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.

            • venlafaxine

              fluvoxamine and venlafaxine both increase QTc interval. Use Caution/Monitor.

            • verapamil

              fluvoxamine will increase the level or effect of verapamil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • voclosporin

              fluvoxamine will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • vorapaxar

              fluvoxamine, vorapaxar. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. SSRIs and SNRIs may cause platelet serotonin depletion.

            • voriconazole

              fluvoxamine and voriconazole both increase QTc interval. Use Caution/Monitor.

            • warfarin

              fluvoxamine will increase the level or effect of warfarin by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

            • zaleplon

              fluvoxamine will increase the level or effect of zaleplon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • zanubrutinib

              fluvoxamine will increase the level or effect of zanubrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce dose when coadministered with moderate CYP3A4 inhibitor; interrupt dose as recommended for adverse reactions; after discontinuing CYP3A4 inhibitor, resume previous dose of zanubrutinib; see zanubrutinib dosage modifications for precise recommendation

            • ziprasidone

              fluvoxamine and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • zolmitriptan

              fluvoxamine and zolmitriptan both increase serotonin levels. Modify Therapy/Monitor Closely.

            • zolpidem

              fluvoxamine will increase the level or effect of zolpidem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • zonisamide

              fluvoxamine will increase the level or effect of zonisamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            Minor (0)

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              Adverse Effects

              >10%

              Nausea (40%)

              Headache (22-35%)

              Somnolence (22-27%)

              Weakness (14-26%)

              Insomnia (20-35%)

              Diarrhea (11-18%)

              Dizziness (11-15%)

              Xerostomia (10-14%)

              Anorexia (6-14%)

              Abnormal ejaculation (8-11%)

              1-10%

              Pain (10%)

              Dyspepsia (8-10%)

              Constipation (4-10%)

              Decreased libido (2-10%)

              Upper respiratory infections (9%)

              Anxiety (5-8%)

              Tremor (5-8%)

              Sweating (6-7%)

              Vomiting (4-6%)

              Abdominal pain (5%)

              Myalgia (5%)

              Abnormal taste (2-5%)

              Bruising (4%)

              Abnormal dreams (3%)

              Abnormal thinking (3%)

              Chest pain (3%)

              Palpitation (3%)

              Agitation (2-3%)

              Vasodilation (2-3%)

              Hypertension (1-2%)

              Increased LFTs (1-2%)

              Weight change (1-2%)

              Manic reaction

              <1%

              Activation of mania/hypomania, seizures (discontinue)

              Sinusitis

              Frequency Not Defined

              Edema

              Amnesia

              Apathy

              Asthenia

              Malaise

              Nervousness

              Dry mouth

              Myoclonus

              Cough

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              Warnings

              Black Box Warnings

              In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 years) taking antidepressants for major depressive disorders and other psychiatric illnesses

              This increase was not seen in patients aged >24 years; a slight decrease in suicidal thinking was seen in adults >65 years

              In children and young adults, risks must be weighed against the benefits of taking antidepressants

              Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments

              The patient’s family should communicate any abrupt changes in behavior to the healthcare provider

              Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy

              This drug is not approved for use in pediatric patients

              Contraindications

              Hypersensitivity

              Coadministration with serotonergic drugs

              • Concomitant use or within 14 days of MAOIs increases risk of serotonin syndrome
              • Reactions to concomitant administration with MAOIs include tremor, myoclonus, diaphoresis, nausea, vomiting, flushing, dizziness, hyperthermia with features resembling neuroleptic malignant syndrome, seizures, rigidity, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes (including extreme agitation progressing to delirium and coma)
              • Starting fluvoxamine in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome
              • If linezolid or IV methylene blue must be administered, discontinue SSRI immediately and monitor for CNS toxicity; may resume 24 hr after last linezolid or methylene blue dose, or after 2 weeks of monitoring (5 weeks for fluoxetine), whichever comes first

              Cautions

              Conflicting evidence regarding use of SSRIs during pregnancy and increased risk of persistent pulmonary hypertension of the newborn (see Pregnancy)

              In neonates exposed to SNRIs/SSRIs late in third trimester: Risk of complications such as feeding difficulties, irritability, and respiratory problems

              Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy

              May need to modify dose for hepatic impairment; titrate at smaller increments and longer intervals

              Clinical worsening and suicide ideation may occur despite medication in adolescents and young adults (18-24 years); prescriptions should be written for the smallest quantity consistent with good patient care

              May worsen mania symptoms or precipitate mania in patients with bipolar disorder

              May impair platelet aggregation; increases risk of bleeding in patients taking anticoagulants/antiplatelets concomitantly

              Do not use concurrently with alosetron, astemizole, cisapride, pimozide, terfenadine, or tizanidine due to QT prolongation risk

              Potentially life-threatening serotonin syndrome has been reported with drugs that impair serotonin metabolism (in particular, MAOIs, including nonpsychiatric MAOIs, such as linezolid and IV methylene blue); it has also been reported with reported with SNRIs and SSRIs, including fluvoxamine, alone but particularly with concomitant use of serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John's Wort (see Contraindications)

              May impair ability to operate heavy machinery and other tasks requiring mental alertness

              Bone fractures have been associated with antidepressant treatment; consider possibility of fragility fracture if patient presents with pain, joint tenderness, or swelling

              Impaired glucose control (hyperglycemia or hypoglycemia) reported; monitor for signs/symptoms of loss of glucose control, especially in patients with diabetes

              Syndrome of inapropriate antidiuretic hormone and hyponatremia reported with SSRI and SNRI use; volume deplretion and/or concurrent use of diuretics may increase risk; consider discontinuing therapy if symptomatic hyponatremia occurs

              Use caution in patients with cardiovascular disease or history of seizure disorder

              Sexual dysfunction

              • Use of may cause symptoms of sexual dysfunction in both male and female patients; inform patients that they should discuss any changes in sexual function and potential management strategies with their healthcare provider
              • Use of SSRIs, may cause symptoms of sexual dysfunction; in male patients, SSRI use may result in ejaculatory delay or failure, decreased libido, and erectile dysfunction
              • In female patients, SSRI/SNRI use may result in decreased libido and delayed or absent orgasm
              • Important for prescribers to inquire about sexual function prior to initiation of therapy and to inquire specifically about changes in sexual function during treatment, because sexual function may not be spontaneously reported
              • When evaluating changes in sexual function, obtaining a detailed history (including timing of symptom onset) is important because sexual symptoms may have other causes, including underlying psychiatric disorder
              • Discuss potential management strategies to support patients in making informed decisions about treatment
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              Pregnancy & Lactation

              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.

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              Pharmacology

              Mechanism of Action

              Selective serotonin reuptake inhibitor; little or no affinity for dopamine, alpha-adrenergic histamine, or cholinergic receptor

              Absorption

              Bioavailability: 53%

              Peak plasma time: 3-8 hr

              Peak plasma concentration: 88-546 ng/mL (nonlinear)

              Distribution

              Protein bound: 80%

              Vd: 25 L/kg

              Metabolism

              Metabolism: Hepatic oxidative demethylation, deamination

              Metabolites: Inactive

              Enzymes inhibited: Hepatic CYP1A2, CYP2C9, CYP3A4

              Elimination

              Half-life: 15.6 hr; 17.4-25.9 hr (elderly)

              Dialyzable: No

              Excretion: Urine (85%)

              Pharmacogenomics

              Several SSRIs (eg, fluoxetine, fluvoxamine, paroxetine, sertraline) are metabolized by CYP2D6

              CYP2D6 is involved in the metabolism of approximately 20% of drugs in clinical use and displays large individual-to-individual variability in activity due to genetic polymorphisms

              More than 80 CYP2D6 variant alleles have been identified; however, 4 of the most prevalent alleles, CYP2D6*3, *4, *5, and *6, account for 93-97% of CYP2D6 poor metabolizers (PMs)

              CYP2D6*4, the most common variant (~25% frequency in whites), causes a splicing defect; CYP2D6*3 (2.7% frequency) causes a frameshift mutation; and CYP3D6*5 (2.6%) is an entire deletion of the CYP2D6 gene; individuals homozygous for these alleles have no CYP2D6 activity

              The impact of CYP2D6 activity is further complicated in some SSRIs (eg, fluoxetine, fluvoxamine, paroxetine, sertraline) that, in addition to being substrates for CYP2D6, are also known to moderately inhibit CYP2D6 activity

              Genetic testing laboratories

              • Genotyping tests for CYP2D6 variants are commercially available through Applied Biosystems (http://www.appliedbiosystems.com/) and GenPath Diagnostics (http://www.genpathdiagnostics.com/)
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              Administration

              Oral Administration

              May take with or without food

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              fluvoxamine oral
              -
              25 mg tablet
              fluvoxamine oral
              -
              50 mg tablet
              fluvoxamine oral
              -
              150 mg capsule
              fluvoxamine oral
              -
              100 mg tablet
              fluvoxamine oral
              -
              50 mg tablet
              fluvoxamine oral
              -
              25 mg tablet
              fluvoxamine oral
              -
              100 mg tablet
              fluvoxamine oral
              -
              50 mg tablet
              fluvoxamine oral
              -
              100 mg tablet
              fluvoxamine oral
              -
              50 mg tablet
              fluvoxamine oral
              -
              25 mg tablet
              fluvoxamine oral
              -
              100 mg capsule
              fluvoxamine oral
              -
              25 mg tablet
              fluvoxamine oral
              -
              100 mg tablet
              fluvoxamine oral
              -
              50 mg tablet
              fluvoxamine oral
              -
              25 mg tablet
              fluvoxamine oral
              -
              150 mg capsule
              fluvoxamine oral
              -
              100 mg capsule

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              fluvoxamine oral

              FLUVOXAMINE - ORAL

              (floo-VOX-a-meen)

              COMMON BRAND NAME(S): Luvox

              WARNING: Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.

              USES: Fluvoxamine is used to treat obsessive-compulsive disorder (OCD). It helps decrease persistent/unwanted thoughts (obsessions) and urges to perform repeated tasks (compulsions such as hand-washing, counting, checking) that interfere with daily living. Fluvoxamine is known as a selective serotonin reuptake inhibitor (SSRI). This medication works by helping to restore the balance of a certain natural substance (serotonin) in the brain.

              HOW TO USE: Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start taking fluvoxamine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually once daily at bedtime, or twice daily (once in the morning and once at bedtime). If you are taking this medication twice daily and the doses are not equal, then the larger of the 2 doses should be taken at bedtime.The dosage is based on your medical condition, response to treatment, age, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). In children, the dosage may also be based on their age and gender. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully.Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase. Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.Keep taking this medication even if you feel well. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Also, you may experience symptoms such as mood swings, headache, tiredness, sleep changes, and brief feelings similar to electric shock. To prevent these symptoms while you are stopping treatment with this drug, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details. Report any new or worsening symptoms right away.It may take up to several weeks before you get the full benefit of this drug.Tell your doctor if your condition does not improve or if it worsens.

              SIDE EFFECTS: See also Warning section.Nausea, vomiting, drowsiness, dizziness, loss of appetite, trouble sleeping, weakness, and sweating may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: easy bruising/bleeding, shaking (tremor), decrease in sexual interest/ability.Get medical help right away if you have any very serious side effects, including: fainting, black stools, vomit that looks like coffee grounds, seizures, eye pain/swelling/redness, widened pupils, vision changes (such as seeing rainbows around lights at night, blurred vision).This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual restlessness.Rarely, males may have a painful or prolonged erection lasting 4 or more hours. If this occurs, stop using this drug and get medical help right away, or permanent problems could occur.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking fluvoxamine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: personal or family history of bipolar/manic-depressive disorder, personal or family history of suicide attempts, liver problems, seizures, low sodium in the blood, intestinal ulcers/bleeding (peptic ulcer disease) or bleeding problems, personal or family history of glaucoma (angle-closure type).This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Fluvoxamine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using fluvoxamine, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics "water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using fluvoxamine safely.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially bleeding, or loss of coordination, QT prolongation. Older adults may also be more likely to develop a type of salt imbalance (hyponatremia), especially if they are taking "water pills" (diuretics). Loss of coordination can increase the risk of falling.Children may be more sensitive to the side effects of this drug, especially loss of appetite and weight loss. Monitor weight and height in children who are taking this drug.During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. Also, babies born to mothers who have used this drug during the last 3 months of pregnancy may rarely develop withdrawal symptoms such as feeding/breathing difficulties, seizures, muscle stiffness, or constant crying. If you notice any of these symptoms in your newborn, tell the doctor promptly.Since untreated mental/mood problems (such as depression, obsessive compulsive disorder, post-traumatic stress disorder) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy.This drug passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen, "blood thinners" such as warfarin).Aspirin can increase the risk of bleeding when used with this medication. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.Many drugs besides fluvoxamine may affect the heart rhythm (QT prolongation), including pimozide, thioridazine, among others.This medication can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include alosetron, clozapine, methadone, melatonin, ramelteon, tacrine, tizanidine, certain benzodiazepines such as alprazolam/diazepam/triazolam, certain beta-blockers such as metoprolol/propranolol, tricyclic antidepressants such as imipramine, among others.Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including other SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), tryptophan, among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.This medication can increase the effects of caffeine. Avoid drinking large amounts of beverages containing caffeine (coffee, tea, colas) or eating large amounts of chocolate or taking nonprescription products that contain caffeine.Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and opioid pain relievers (such as codeine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.Cigarette smoking decreases blood levels of this medication. Tell your doctor if you smoke or if you have recently stopped smoking.This medication may interfere with certain medical/laboratory tests (including brain scan for Parkinson's disease), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: fast/slow/irregular heartbeat, trouble breathing, seizures.

              NOTES: Do not share this medication with others.Keep all regular medical and psychiatric appointments.

              MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised September 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.