Fluvoxamine maleate

CLINICAL USE

SSRI antidepressant:Depression Obsessive compulsive disorder

DOSE IN NORMAL RENAL FUNCTION

50–300 mg daily (doses over 150 mg in divided doses)Depression: usual maintenance dose 100 mg dailyObsessive compulsive disorder: usual maintenance dose 100–300 mg daily

PHARMACOKINETICS

Molecular weight :434.4

%Protein binding :80

%Excreted unchanged in urine : 2

Volume of distribution (L/kg) :25

half-life – normal/ESRD (hrs) :13–15/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

30–50 Dose as in normal renal function10–30 Dose as in normal renal function

<10 : Dose as in normal renal function but titrate slowly

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in GFR <10 mL/min

HD :Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux :Not dialysed. Dose as in GFR <10 mL/min

CAV/VVHD :Unknown dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Analgesics: increased risk of bleeding with aspirin and NSAIDs; possibly increased concentration of methadone; increased risk of CNS toxicity with tramadol

Anti-arrhythmics: increased risk of toxicity with mexiletine

Anticoagulants: effect of coumarins possibly enhanced

Antidepressants: avoid concomitant use with reboxetine, MAOIs, moclobemide and St John’s wort; possibly enhanced serotonergic effects with duloxetine, fluvoxamine inhibits metabolism of duloxetine – avoid concomitant use; can increase tricyclics concentration; increased agitation and nausea with tryptophan

Anti-epileptics: antagonise anticonvulsant threshold; concentration of carbamazepine and phenytoin increased

Antimalarials: avoid concomitant use with artemether/lumefantrine

Antipsychotics: plasma concentration of clozapine and olanzapine increased

Antivirals: plasma concentration possibly increased by ritonavir

Ciclosporin: may increase ciclosporin concentration

Dopaminergics: increased risk of CNS toxicity with rasagiline; hypertension and CNS excitation with selegiline – avoid concomitant use5HT 1 agonist: risk of CNS toxicity increased with sumatriptan; possibly increased risk of serotonergic effects with frovatriptan; inhibits metabolism of frovatriptan; possibly inhibits metabolism of zolmitriptan – reduce zolmitriptan doseLinezolid: use with care, possibly increased risk of side effects

Lithium: increased risk of CNS effects – monitor levels

Sibutramine: increased risk of CNS toxicity – avoid concomitant useTheophylline: increased theophylline concentrations – avoid concomitant use; if not possible, halve theophylline dose and monitor levels

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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