Luvox: Targeted Serotonin Reuptake for OCD Symptom Control
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Synonyms | |||
Luvox (fluvoxamine maleate) is a selective serotonin reuptake inhibitor (SSRI) specifically indicated for the treatment of obsessive-compulsive disorder (OCD) in adults and pediatric patients. It functions by increasing serotonin levels in the brain, a neurotransmitter critically involved in mood regulation, anxiety, and repetitive behaviors. With a well-established efficacy profile, Luvox offers a specialized pharmacological approach for managing the intrusive thoughts and compulsive rituals characteristic of OCD. Its targeted mechanism and extensive clinical history make it a cornerstone in psychopharmacological treatment plans for this challenging condition.
Features
- Active ingredient: Fluvoxamine maleate
- Available in 25 mg, 50 mg, and 100 mg immediate-release tablets
- Selective serotonin reuptake inhibitor (SSRI) class
- FDA-approved for obsessive-compulsive disorder (OCD)
- Also used off-label for social anxiety disorder, panic disorder, and depression
- Typically administered orally, once daily at bedtime or twice daily
- Bioavailability of approximately 53%
- Peak plasma concentration reached within 3–8 hours
- Half-life of approximately 15–22 hours
- Metabolized primarily in the liver via cytochrome P450 enzymes
Benefits
- Reduces frequency and intensity of obsessive thoughts and compulsive behaviors
- Improves overall daily functioning and quality of life in patients with OCD
- Helps decrease anxiety associated with obsessive-compulsive symptoms
- May alleviate co-occurring depressive symptoms often present in OCD
- Supports long-term maintenance of symptom remission with consistent use
- Available in multiple strengths for individualized dosing titration
Common use
Luvox is primarily prescribed for the treatment of obsessive-compulsive disorder in both adult and pediatric populations aged 8 years and older. It is considered a first-line pharmacological intervention for OCD according to clinical practice guidelines. Beyond its FDA-approved indication, Luvox is sometimes used off-label for other anxiety disorders including social anxiety disorder, panic disorder, and post-traumatic stress disorder. Some clinicians may also prescribe it for major depressive disorder, particularly when OCD features are present, though other SSRIs are typically preferred for depression alone. The medication is generally used as part of a comprehensive treatment plan that may include cognitive-behavioral therapy, particularly exposure and response prevention for OCD.
Dosage and direction
For adults with OCD: Initiate treatment at 50 mg once daily at bedtime. Increase dosage in 50 mg increments at 4–7 day intervals as tolerated, based on therapeutic response and side effects. The effective dosage range is typically 100–300 mg daily. Doses above 100 mg daily should be divided, with the larger portion administered at bedtime. Maximum recommended dose is 300 mg daily.
For pediatric patients (ages 8–17) with OCD: Initiate at 25 mg once daily at bedtime. Increase by 25 mg increments every 4–7 days as tolerated. The recommended target dosage range is 50–200 mg daily. Doses above 50 mg daily should be divided into two administrations, with the larger dose given at bedtime. Maximum dose should not exceed 200 mg daily.
Tablets should be swallowed whole with water, with or without food. Consistent daily administration is important for maintaining stable blood levels. Dosage adjustments should be made under medical supervision, particularly when increasing or decreasing the medication.
Precautions
Patients should be monitored for emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and mania. Closely observe patients for clinical worsening and suicide risk, especially during initial treatment and dosage adjustments. Use with caution in patients with history of seizures, mania, or hyponatremia. May increase risk of bleeding events, particularly when combined with NSAIDs, aspirin, or other anticoagulants. Caution advised in patients with hepatic impairment, requiring dosage reduction and careful monitoring. May cause activation of psychosis or manic episodes in patients with bipolar disorder. Discontinuation symptoms may occur with abrupt cessation; taper gradually under medical supervision.
Contraindications
Concomitant use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy. Contraindicated in patients taking thioridazine, pimozide, alosetron, or tizanidine due to potentially dangerous interactions. Hypersensitivity to fluvoxamine maleate or any component of the formulation. Not recommended in patients with uncontrolled narrow-angle glaucoma. Avoid use in patients with severe hepatic impairment.
Possible side effects
Common side effects (≥5% incidence): nausea, somnolence, insomnia, asthenia, dizziness, constipation, anorexia, nervousness, sweating, abnormal ejaculation, dry mouth.
Less common side effects: headache, diarrhea, dyspepsia, tremor, anxiety, agitation, vomiting, flatulence, vision changes, taste perversion, palpitations.
Serious side effects (require medical attention): serotonin syndrome, suicidal thoughts or behaviors, seizures, mania/hypomania, abnormal bleeding, hyponatremia, angle-closure glaucoma, severe skin reactions.
Sexual side effects may include decreased libido, orgasm dysfunction, and erectile dysfunction. Most side effects are dose-dependent and may diminish with continued treatment.
Drug interaction
Strong inhibitor of CYP1A2 and CYP2C19 enzymes, with moderate inhibition of CYP3A4 and CYP2C9. May significantly increase levels of: theophylline, clozapine, olanzapine, methadone, warfarin, benzodiazepines, carbamazepine, and tricyclic antidepressants. Contraindicated with MAOIs due to risk of serotonin syndrome. Use with caution with other serotonergic drugs (tramadol, linezolid, lithium, tryptophan, St. John’s wort). May enhance effects of alcohol and CNS depressants. NSAIDs and antiplatelet agents may increase bleeding risk. Protein-bound drugs may be displaced. Requires dosage adjustment with drugs metabolized by affected cytochrome enzymes.
Missed dose
If a dose is missed, take it as soon as remembered unless it is close to the time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed dose. Maintain regular dosing intervals to ensure consistent therapeutic effect. If multiple doses are missed, contact healthcare provider for guidance on resumption, as dosage adjustment may be necessary.
Overdose
Symptoms may include nausea, vomiting, drowsiness, dizziness, tachycardia, bradycardia, hypotension, liver function abnormalities, seizures, and coma. Serotonin syndrome manifestations may include agitation, confusion, diaphoresis, hyperthermia, hyperreflexia, and coordination problems. Fatalities have been reported with mixed overdoses involving multiple drugs. No specific antidote exists. Provide supportive care with gastric lavage if presented early, activated charcoal, and appropriate symptomatic treatment. Monitor cardiac function and vital signs. Forced diuresis, dialysis, and hemoperfusion are not effective due to high protein binding and large volume of distribution.
Storage
Store at controlled room temperature 20°–25°C (68°–77°F). Keep container tightly closed. Protect from light and moisture. Keep out of reach of children and pets. Do not use after expiration date printed on packaging. Properly dispose of unused medication through medication take-back programs or according to FDA guidelines.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Individual response to medication may vary. Luvox should only be used under the supervision of a qualified healthcare professional. Patients should not initiate, adjust, or discontinue medication without consulting their prescribing physician. The complete prescribing information should be reviewed before initiating therapy.
Reviews
Clinical studies demonstrate Luvox’s efficacy in reducing Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores by approximately 35–45% in responsive patients. Many patients report significant reduction in obsessive thoughts and compulsive behaviors within 4–6 weeks of therapeutic dosing. Some users note initial side effects including nausea and drowsiness that often diminish with continued use. Long-term users frequently report maintained efficacy with stable dosing. Some patients require combination therapy or switching to alternative agents due to inadequate response or side effects. Overall, Luvox remains a well-established option for OCD management with a favorable risk-benefit profile when appropriately prescribed and monitored.