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Fluvoxamine Maleate: Brands, Price & Uses in Bangladesh
Fluvoxamine Maleate is a selective serotonin reuptake inhibitor (SSRI) used primarily to treat obsessive-compulsive disorder and more.
About Fluvoxamine Maleate
Indications of Fluvoxamine Maleate
Fluvoxamine Maleate is a selective serotonin reuptake inhibitor (SSRI) used primarily to treat obsessive-compulsive disorder, and is also used in the management of depressive illness and certain anxiety-related conditions. Its indications can be classified by strength of evidence as follows:
Established / Approved Uses
- Obsessive-Compulsive Disorder (OCD): Treatment of obsessions and compulsions in adults and children/adolescents (8-17 years) whose symptoms cause marked distress, are time-consuming, or significantly interfere with social or occupational functioning. This is the primary approved indication for Fluvoxamine Maleate.
- Social Anxiety Disorder (Social Phobia): Extended-release formulations of Fluvoxamine Maleate are approved in some markets for the treatment of social anxiety disorder in adults.
Guideline-Supported / Widely Accepted Uses
- Major Depressive Disorder: Fluvoxamine Maleate is used, and supported by clinical guidelines in several countries, as an antidepressant for major depressive episodes.
- Panic Disorder: Used as part of a comprehensive treatment plan for panic disorder, with or without agoraphobia.
Off-Label Uses (commonly used but not formally approved)
- Body dysmorphic disorder
- Post-traumatic stress disorder (PTSD)
- Premenstrual dysphoric disorder
- Certain eating disorders (as an adjunct to psychotherapy)
The specific indication and duration of therapy with Fluvoxamine Maleate should always be determined by a qualified physician based on individual assessment.
Dosage & Administration of Fluvoxamine Maleate
Dosage of Fluvoxamine Maleate must be individualized by a physician according to the indication being treated, patient age, and response/tolerability. Treatment is generally started at a low dose and titrated gradually.
| Indication | Adult Dose | Pediatric Dose |
|---|---|---|
| Obsessive-Compulsive Disorder | Start 50 mg once daily at bedtime; increase in increments of 50 mg every 4-7 days as tolerated, up to a maximum of 300 mg/day. Total daily doses above 100 mg should be given in two divided doses (larger dose at bedtime). | Children/adolescents 8-17 years: start 25 mg once daily at bedtime; increase by 25 mg every 4-7 days. Maximum 200 mg/day (ages 8-11) or 300 mg/day (ages 12-17); doses above 50 mg/day divided. |
| Depression / Anxiety-related disorders | Start 50 mg once daily at bedtime; usual effective range 100-300 mg/day, titrated according to response. | Not established; not routinely recommended for depression in children. |
Renal/Hepatic Impairment
In patients with hepatic impairment, clearance of Fluvoxamine Maleate is reduced by approximately 30%; a lower starting dose with slow titration and close monitoring is recommended. Dose adjustment may also be needed in patients with significant renal impairment; consult a physician for individualized dosing.
Discontinuation
Doses should be reduced gradually rather than abruptly discontinued, to minimize the risk of discontinuation symptoms (see Precautions and Warnings).
For detailed administration technique, see Administration. For quick-reference dosing figures, see Dosage.
Side Effects of Fluvoxamine Maleate
Common side effects of Fluvoxamine Maleate (occurring in approximately 5% or more of patients) include:
- Nausea (most common)
- Somnolence (drowsiness)
- Insomnia
- Asthenia (weakness/fatigue)
- Nervousness and anxiety
- Dyspepsia (indigestion)
- Dry mouth
- Headache
- Sweating
- Tremor
- Vomiting and diarrhea
- Sexual dysfunction (abnormal ejaculation, decreased libido, anorgasmia, impotence)
- Anorexia with weight loss
Less common but more serious effects can include activation of mania/hypomania, seizures, abnormal bleeding, hyponatremia, and serotonin syndrome (see Precautions and Warnings for details). Any severe, persistent, or concerning side effect should be reported to a physician promptly.
Contraindications of Fluvoxamine Maleate
Fluvoxamine Maleate is contraindicated in the following situations:
- Known hypersensitivity to Fluvoxamine Maleate or any component of the formulation.
- Concurrent use, or use within 14 days, of a monoamine oxidase inhibitor (MAOI), including linezolid or intravenous methylene blue, due to the risk of serious, potentially fatal serotonin syndrome.
- Concurrent use with thioridazine, due to the risk of serious, potentially fatal cardiac arrhythmias from elevated thioridazine levels.
- Concurrent use with pimozide, due to the risk of QT prolongation and serious cardiac arrhythmias.
- Concurrent use with tizanidine, due to the risk of pronounced hypotension and sedation.
- Concurrent use with alosetron, due to significantly increased alosetron exposure.
Frequently Asked Questions about Fluvoxamine Maleate
What is Fluvoxamine Maleate used for?
Fluvoxamine Maleate is mainly used to treat obsessive-compulsive disorder (OCD) in adults and children aged 8 years and above. It is also used for depression and certain anxiety-related conditions under a physician's guidance.
Can Fluvoxamine Maleate be taken with other antidepressants or MAOIs?
No. Fluvoxamine Maleate must not be combined with monoamine oxidase inhibitors (MAOIs), or used within 14 days of stopping one, because this combination can cause a serious, potentially fatal reaction called serotonin syndrome. Combining Fluvoxamine Maleate with other serotonergic antidepressants also increases this risk and should only be done under close medical supervision.
Is it safe to stop taking Fluvoxamine Maleate suddenly?
No. Stopping Fluvoxamine Maleate abruptly can cause discontinuation symptoms such as dizziness, irritability, anxiety, and sensory disturbances. The dose should always be tapered down gradually under a physician's supervision.
Can Fluvoxamine Maleate be used during pregnancy or breastfeeding?
Fluvoxamine Maleate should be used in pregnancy only if clearly needed, as third-trimester use has been linked to a risk of breathing problems and poor adaptation in the newborn. Fluvoxamine Maleate also passes into breast milk, so breastfeeding while using it should only be done under close medical supervision. Always consult a physician before use during pregnancy or breastfeeding.
What should I do if I miss a dose or take too much Fluvoxamine Maleate?
If a dose of Fluvoxamine Maleate is missed, take it as soon as remembered, but skip it if it is almost time for the next dose — do not double the dose. If an overdose is suspected, seek immediate medical attention or contact emergency services/poison control right away, as overdose can be serious.
Does Fluvoxamine Maleate increase the risk of suicidal thoughts?
Yes, Fluvoxamine Maleate, like other antidepressants, carries a boxed warning about an increased risk of suicidal thinking and behavior in children, adolescents, and young adults up to age 24, especially early in treatment or after dose changes. Patients and caregivers should watch closely for any worsening mood or unusual behavior and report it to a physician immediately.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.