Names and pronunciation
(flu-vox′a-meen) Luvox
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Drug reference
(flu-vox′a-meen) Luvox
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Func. class.: Antidepressant SSRI (selective serotonin reuptake inhibitor)
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Do not confuse: FluvoxaMINE/FluPHENAZine/Flavoxate
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ACTION: Inhibits CNS neuron uptake of serotonin but not of norepinephrine
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USES: Obsessive-compulsive disorder, social phobia
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CONTRAINDICATIONS: Hyper- sensitivity, MAOIs Precautions: Pregnancy, breastfeeding, geriatric patients, hepatic/cardiac disease, abrupt discontinuation, dehydration, ECT, hyponatremia, hypovolemia, bipolar dis- order, seizure disorder
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Black Box Warning: Children <8 yr, sui- cidal ideation Black Box Warning: Suicidal thoughts/ behaviors: risk increases in children, young adults; this group needs to be monitored more closely, weekly × 4 wk, then every other wk × 4 wk, then at 12 wk; only small amounts should be given on each refill • Pregnancy, breastfeeding: neonatal abstinence syndrome can occur; do not breastfeed • Neuroleptic malignant syndrome: high fever, confusion, rigid muscles, dia- phoresis, tachypenia; notify prescriber immediately • Hepatic studies: AST, ALT, bilirubin • Mental status: mood, sensorium, affect, suicidal tendencies; increase in psychiat- ric symptoms: depression, panic, obses- F sive-compulsive symptoms • Constipation; most likely in geriatric patients • Growth rate (children), bone density (postmenopausal females), glucose (diabetes) • Serotonin syndrome: agitation, hypo- thermia, hallucinations, tachycardia, nau- sea, vomiting, diarrhea, instability, changes in B/P • For toxicity: nausea, vomiting, diar- rhea, syncope, increased pulse, seizures • Beers: avoid in older adults unless safer alternatives are unavailable; may cause ataxia, impaired motor function Black Box Warning: That suicidal thoughts/behaviors may occur; that family health care providers should look closely for suicidal tendencies, especially during early therapy or in young adults, children • Serotonin syndrome: to report imme- diately nausea, vomiting, diarrhea, agita- tion, instability, hallucinations • To stop taking MAOIs at least 14 days before starting product
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SIDE EFFECTS CNS: Headache, drowsiness, dizziness, seizures, sleep disorders, insomnia, sui- cidal ideation (children/adolescents), neuroleptic malignant syndrome–like reactions, weakness, neuroleptic malig- nant syndrome, tremors CV: Palpitation, chest pain, syncope, ner- vousness, agitation GI: Nausea, anorexia, constipation, hepatotoxicity, vomiting, diarrhea, dry mouth, altered taste GU: Decreased libido, anorgasmia, uri- nary frequency, priapism INTEG: Rash, sweating MS: Myalgia SYST: Neonatal abstinence syndrome
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INTERACTIONS Increase: CNS depression—alcohol, bar- biturates, benzodiazepines Increase: effect of—ramelteon, thiorida- zine; do not use together Increase: QT prolongation, death— pimozide; do not use together Increase: fluvoxaMINE, toxicity levels— tricyclics, cloZAPine, alosetron, tiZANi- dine, thioridazine; do not use together Increase: metabolism, decrease effects— smoking Increase: serotonin syndrome, neurolep- tic malignant syndrome: SSRIs, SNRIs, serotonin-receptor agonists, atypical antipsychotics, traMADol, MAOIs, methy- lene blue, linezolid Increase: bleeding risk—anticoagulants, NSAIDs, salicylates, thrombolytics Decrease: metabolism, increase action of propranolol, diazepam, lithium, theoph- ylline, carBAMazepine, warfarin Drug/Herb Increase: CNS effect—kava, valerian Increase: serotonin syndrome—trypto- phan, St. John’s wort; do not use together
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TREATMENT OF OVERDOSE: Gastric lavage
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DOSAGE AND ROUTES Depression, OCD, social anxiety dis- order • Adult: PO 50 mg at bedtime, increase by 50 mg/day at 4-7 day intervals, max 300 mg/day; doses over 100 mg should be divided; EXT REL 100 mg at bedtime, may titrate upward by 50 mg/ wk, max 300 mg/day • Child 8-18 yr: PO 25 mg at bedtime, in- crease by 25 mg/day q4-7days, max 300 mg/ day ≥12 yr; max 200 mg/day 8-12 yr (OCD), 250 mg (social anxiety disorder); doses over 50 mg should be divided Hepatic dose/geriatric • Adult: PO 25 mg at bedtime, may titrate upward slowly
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Available forms: Tabs 25, 50, 100 mg
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Administer: • With food, milk for GI symptoms • When discontinuing, taper by 50%, af- ter 3 days taper by another 50% for 3 days, then discontinue • Store at room temperature; do not freeze • Immediate release: give at bedtime; doses >100 mg/day (or >50 mg/day in those aged 8-17 yr) in 2 divided doses; if doses are not equal, give larger dose at bedtime • Ext rel: give at bedtime; do not break, crush, chew ext rel product
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Assess:
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Evaluate: • Therapeutic response: decrease in OCD, social phobia symptoms
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That therapeutic effects may take 2-3 wk; not to discontinue abruptly • To use caution when driving, perform- ing other activities requiring alertness because drowsiness, dizziness may occur • Not to use other CNS depressants, alco- hol, barbiturates, benzodiazepines, St. John’s wort, kava • Pregnancy/breastfeeding: to avoid use in pregnancy; not to breastfeed • To notify prescriber if pregnancy is suspected, planned • To notify prescriber of allergic reaction • To increase bulk in diet if constipation occurs, especially in geriatric patients
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PHARMACOKINETICS Crosses blood-brain barrier, 77% protein binding, metabolism by the liver, termi- nal half-life 15.6 hr, peak 2-8 hr
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• Adult: PO 50 mg at bedtime, increase by 50 mg/day at 4-7 day intervals, max 300 mg/day; doses over 100 mg should be divided; EXT REL 100 mg at bedtime, may titrate upward by 50 mg/ wk, max 300 mg/day
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• Child 8-18 yr: PO 25 mg at bedtime, in- crease by 25 mg/day q4-7days, max 300 mg/ day ≥12 yr; max 200 mg/day 8-12 yr (OCD), 250 mg (social anxiety disorder); doses over 50 mg should be divided Hepatic dose/geriatric
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• Adult: PO 25 mg at bedtime, may titrate upward slowly
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