HEALTHY LIFESTYLE




Fluvoxamine maleate
Fluvoxamine maleate.JPG

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

    Route

    Oral

    Rate of Administration

    Comments

  • other drugs