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Patients taking fluvoxamine (LUVOX), a selective serotonin reuptake inhibitor (SSRI), should be aware that it has clinically important interactions with many other prescription and over-the-counter medications. Fluvoxamine is approved by the Food and Drug Administration only for treatment of obsessive-compulsive disorder.[1]
Public Citizen’s Health Research Group has designated fluvoxamine as Limited Use.
Interference with breakdown of other drugs[2],[3]
Fluvoxamine inhibits several...
Patients taking fluvoxamine (LUVOX), a selective serotonin reuptake inhibitor (SSRI), should be aware that it has clinically important interactions with many other prescription and over-the-counter medications. Fluvoxamine is approved by the Food and Drug Administration only for treatment of obsessive-compulsive disorder.[1]
Public Citizen’s Health Research Group has designated fluvoxamine as Limited Use.
Interference with breakdown of other drugs[2],[3]
Fluvoxamine inhibits several liver enzymes that break down numerous other drugs (see Table, below, for a list of examples). Thus, concomitant use of fluvoxamine with these other drugs may increase the blood concentrations of the interacting drugs to toxic levels, potentially resulting in serious adverse effects.
For several of these drugs, the risk of a dangerous drug interaction is so high that they should not be taken concomitantly with fluvoxamine. For example, fluvoxamine should never be taken concomitantly with the drugs thioridazine or pimozide (both available in generics only). The resulting high thioridazine or pimozide blood levels can cause prolongation of the QT interval — a change in the electrical activity of the heart that can lead to a fatal heart-rhythm disturbance called torsades de pointes, which can trigger cardiac arrest and sudden death.
Examples of Oral Drugs That Interact With Fluvoxamine
| Generic Name | Brand Name(s)† | Drug Class |
|---|---|---|
| Concomitant use of fluvoxamine with the following drugs can cause dangerously high blood levels of the interacting drug | ||
| alosetron* | LOTRONEX | Irritable bowel syndrome drug |
| alprazolam** | XANAX | Benzodiazepine |
| clozapine*** | CLOZARIL, VERSACLOZ | Antipsychotic |
| diazepam* | VALIUM | Benzodiazepine |
| methadone*** | METHADOSE | Opioid |
| mexiletine*** | generic only | Abnormal heart rhythm drug |
| pimozide | generic only | Tourette’s syndrome drug |
| ramelteon*** | ROZEREM | Insomnia drug |
| thioridazine* | generic only | Antipsychotic |
| tizanidine*** | ZANAFLEX | Drug for spasticity |
| triazolam* | HALCION | Benzodiazepine |
| warfarin | JANTOVEN | Anticoagulant (blood thinner) |
| Concomitant use of fluvoxamine with the following drugs increases the risk of serotonin syndrome | ||
| amitriptyline* | generic only | Tricyclic antidepressant |
| amoxapine* | generic only | Tricyclic antidepressant |
| buspirone*** | generic only | Antianxiety drug |
| doxepin* | SILENOR | Tricyclic antidepressant |
| fentanyl*** | ACTIQ, FENTORA | Opioid |
| imipramine* | TOFRANIL | Tricyclic antidepressant |
| isocarboxazid*** | MARPLAN | MAO inhibitor |
| linezolid | ZYVOX | Antibiotic |
| lithium*** | LITHOBID | Bipolar disorder drug |
| nortriptyline*** | PAMELOR | Tricyclic antidepressant |
| phenelzine*** | NARDIL | MAO inhibitor |
| selegiline*** | ZELAPAR | MAO inhibitor |
| tramadol* | CONZIP, QDOLO, ULTRAM | Opioid |
†Brand-name combination products were excluded.
*Designated as Do Not Use by Worst Pills, Best Pills News
**Designated as Do Not Use Except for Panic Disorder by Worst Pills, Best Pills News
***Designated as Limited Use by Worst Pills, Best Pills News
Other important drug interactions[4],[5]
Drugs that increase bleeding risk
Fluvoxamine, like other SSRIs, may increase the risk of bleeding in the gastrointestinal tract and elsewhere. Concomitant use of fluvoxamine with any of the following drugs increases this bleeding risk further (brand names for combination products not listed below):
- aspirin (BAYER ASPIRIN, DURLAZA, ECOTRIN, VAZALORE)
- other nonsteroidal anti-inflammatory drugs, including ibuprofen (ADVIL, MIDOL LIQUID GELS, MOTRIN, TAB-PROFEN) and naproxen (ALEVE, ANAPROX DS, NAPRELAN, NAPROSYN)
- clopidogrel (PLAVIX)
- warfarin (JANTOVEN)
Serotonin syndrome
Fluvoxamine rarely can cause serotonin syndrome, a potentially fatal condition characterized by agitation, confusion, hallucinations, rapid heartbeat, high blood pressure, high fever, shivering, sweating, nausea, vomiting, diarrhea and muscle rigidity. In severe cases, the syndrome can lead to seizures and coma.
The risk of serotonin syndrome increases when fluvoxamine is taken concomitantly with other drugs that cause elevated serotonin levels in the body (see Table, above, for a list of examples). Such drugs include certain opioids, monoamine oxidase (MAO) inhibitors for depression and tricyclic antidepressants, among others. For the MAO inhibitors and the antibiotic linezolid (ZYVOX), the risk of serotonin syndrome is so great that they should never be taken concomitantly with fluvoxamine.
Concomitant use of fluvoxamine with the dietary supplement St. John’s wort also raises the risk of serotonin syndrome.
What You Can Do
If you need treatment with fluvoxamine, review all your other medications with your doctor to assess for potentially significant drug interactions. If you are taking a medication that interacts with fluvoxamine, you may need to stop or adjust the dosage of the interacting drug, or your doctor may advise you to take a different drug for your obsessive-compulsive disorder. Be aware that other drugs not listed in this article also may have dangerous interactions with fluvoxamine.
References
[1] ANI Pharmaceuticals, Inc. Label: fluvoxamine (LUVOX). July 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/021519s018lbl.pdf. Accessed October 5, 2022.
[2] ANI Pharmaceuticals, Inc. Label: fluvoxamine (LUVOX). July 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/021519s018lbl.pdf. Accessed October 5, 2022.
[3] IBM Micromedex. Drug interactions. http://www.micromedexsolutions.com/home/dispatch. Search term: “fluvoxamine.” Accessed October 5, 2022.
[4] ANI Pharmaceuticals, Inc. Label: fluvoxamine (LUVOX). July 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/021519s018lbl.pdf. Accessed October 5, 2022.
[5] IBM Micromedex. Drug interactions. http://www.micromedexsolutions.com/home/dispatch. Search term: “fluvoxamine.” Accessed October 5, 2022.
