Can fluvoxamine be used to treat COVID-19?
Reviewed by Yael Cooperman, MD, Ro,
Written by Gina Allegretti, MD
last updated: Sep 30, 2021
3 min read
Here's what we'll cover
The COVID pandemic is a major challenge for healthcare providers for many reasons, leaving healthcare providers constantly looking for new ways to treat the disease that has managed to wreak global havoc.
Scientists have identified a few valuable treatments, like monoclonal antibodies and the antiviral drug remdesivir, but they are always on the hunt for more, often exploring the use of existing medications in an effort to treat the most severe cases. One such drug is fluvoxamine. Traditionally used as an antidepressant, there's some evidence that this drug might help prevent serious disease in people who come down with COVID-19.
Fluvoxamine as a treatment for COVID-19
Fluvoxamine is an SSRI (selective serotonin reuptake inhibitor), which is commonly used to treat conditions like obsessive-compulsive disorder (OCD) and depression. These drugs work by reducing the breakdown of a chemical called serotonin in the brain, which is known to play an important role in mood. But the drug has also been found to play a role in quelling the immune response, which is one of the major contributors to severe COVID-19 (Sukhatme, 2021).
What the research shows
There have been a few clinical trials exploring the use of fluvoxamine as a treatment for COVID-19. In one small study performed in 2020, 152 people with early, mild cases of COVID-19 were treated with either fluvoxamine or a placebo. None of the patients who took fluvoxamine became sick enough to require hospitalization, while six people in the placebo group had to be hospitalized (Lenze, 2020).
A 2021 study of 113 people with coronavirus disease had similar results. Participants who got early treatment with fluvoxamine as soon as they were diagnosed were less likely to be hospitalized, be admitted to the ICU, or die from the disease compared to the group who did not (Seftel, 2021).
Large clinical trial data
Another study, which examined people over 3,000 people from Brazil who caught the coronavirus and had one or more underlying risk factors for severe disease, had similar results. 11% of patients treated with fluvoxamine had to be hospitalized, while 16% of those receiving the placebo had to be hospitalized. While those numbers might not sound impressive, that's a 30% reduction in the hospitalization rate for the fluvoxamine group (T.O.G.E.T.H.E.R. Trial, 2021). The results were so impressive that they stopped the trial early because fluvoxamine was clearly more effective than placebo.
Another, more recent study found that other similar medications may protect lung and kidney cells from being invaded by the coronavirus. Fluoxetine (Prozac; see Important Safety Information), another SSRI, has even been shown to provide protection against newer variants of the virus (Fred, 2021).
How could fluvoxamine help with COVID-19?
There are a few theories that explain why fluvoxamine might help prevent severe cases of COVID-19. Fluvoxamine binds to a receptor on our cells called sigma-1. Some research has shown that the virus uses this receptor to enter our cells, and blocking it prevents the virus from being able to spread throughout our bodies (Hashimoto, 2021). Other research seems to indicate that binding to the sigma-1 receptor helps our bodies "clean out" components that were damaged by the virus, reducing the amount of damage the virus causes and reducing the chance of severe disease (Brimson, 2021).
Fluvoxamine has also been shown to have anti-inflammatory properties that allow it to decrease the inflammatory response in areas like the brain and lungs, so that’s another reason it might be effective against severe COVID-19 (Grieb, 2021; Sukhatme, 2021).
Are there disadvantages to using fluvoxamine?
Fluvoxamine and other antidepressants can interact with other medications a person is taking. Also, the drug carries the risk of side effects, including appetite changes, nausea, headaches, decreased libido, sleepiness, anxiety, weight changes, and insomnia. Less common but serious side effects include bleeding, seizures, and suicidal ideation (Sohel, 2021).
While it may be a little while before the medical community reaches a consensus on whether or not to recommend this drug as a standard treatment for coronavirus, it's an exciting prospect, in a large part because fluvoxamine is relatively inexpensive (costing around $4 for 10 days of treatment). This makes it a more promising treatment option in countries that don't have access to widespread vaccination yet. Other treatments, like monoclonal antibodies, can cost upwards of $2,000 per dose.
There are currently multiple trials underway, and if their findings confirm previous studies, fluvoxamine may become a new standard of care.
DISCLAIMER
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Bestetti, R. B., Furlan-Daniel, R., & Silva, V. (2021). Pharmacological Treatment of Patients with Mild to Moderate COVID-19: A Comprehensive Review. International Journal of Environmental Research and Public Health, 18 (13), 7212. doi:10.3390/ijerph18137212. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34281149/
Brimson, J. M., Prasanth, M. I., Malar, D. S., Brimson, S., Thitilertdecha, P., & Tencomnao, T. (2021). Drugs that offer the potential to reduce hospitalization and mortality from SARS-CoV-2 infection: The possible role of the sigma-1 receptor and autophagy. Expert Opinion on Therapeutic Targets, 25 (6), 435–449. doi:10.1080/14728222.2021.1952987. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34236922/
Christensen, M., Tybring, G., Mihara, K., Yasui-Furokori, N., Carrillo, J. A., Ramos, S. I., et al. (2002). Low daily 10-mg and 20-mg doses of fluvoxamine inhibit the metabolism of both caffeine (cytochrome P4501A2) and omeprazole (cytochrome P4502C19). Clinical Pharmacology and Therapeutics, 71 (3), 141–152. doi:10.1067/mcp.2002.121788. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11907488/
Fred, M. S., Kuivanen, S., Ugurlu, H., Casarotto, P. C., Levanov, L., Saksela, K.,et al. (2021). Antidepressant and antipsychotic drugs reduce viral infection by SARS-CoV-2 and fluoxetine shows antiviral activity against the novel variants in vitro. bioRxiv 2020.03.22.436379; doi: 10.1101/2021. Retrieved from https://www.biorxiv.org/content/10.1101/2021.03.22.436379v1.full#ref-54 on Sep 1, 2021.
Grieb, P., & Rejdak, K. (2021). Are central nervous system drugs displaying anti-inflammatory activity suitable for early treatment of COVID-19?. Folia Neuropathologica, 59 (2), 113–120. doi:10.5114/fn.2021.107572. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34284539/
Hashimoto K. (2021). Repurposing of CNS drugs to treat COVID-19 infection: targeting the sigma-1 receptor. European Archives of Psychiatry and Clinical Neuroscience, 271 (2), 249–258. doi:10.1007/s00406-020-01231-x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33403480/
Hoertel, N., Sánchez-Rico, M., Cougoule, C., Gulbins, E., Kornhuber, J., Carpinteiro, A., et al. (2021). Repurposing antidepressants inhibiting the sphingomyelinase acid/ceramide system against COVID-19: current evidence and potential mechanisms. Molecular Psychiatry, 1–2. Advance online publication. doi:10.1038/s41380-021-01254-3. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34385600/
Lenze, E. J., Mattar, C., Zorumski, C. F., Stevens, A., Schweiger, J., Nicol, G. E., Miller, J. P., Yang, L., Yingling, M., Avidan, M. S., & Reiersen, A. M. (2020). Fluvoxamine vs Placebo and Clinical Deterioration in Outpatients With Symptomatic COVID-19: A Randomized Clinical Trial. Journal of the American Medical Association, 324 (22), 2292–2300. doi:10.1001/jama.2020.22760. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7662481/
Liu, X., Li, X., Zhang, C., Sun, M., Sun, Z., Xu, Y., & Tian, X. (2018). Efficacy and tolerability of fluvoxamine in adults with social anxiety disorder: A meta-analysis. Medicine, 97 (28), e11547. doi:10.1097/MD.0000000000011547. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29995828/
Marčec, R., & Likić, R. (2021). Could fluvoxamine keep COVID-19 patients out of hospitals and intensive care units?. Croatian Medical Journal, 62 (1), 95–100. doi:10.3325/cmj.2021.62.95. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7976881/
McDermott, M. M., & Newman, A. B. (2021). Remote Research and Clinical Trial Integrity During and After the Coronavirus Pandemic. Journal of the American Medical Association, 325 (19), 1935–1936. doi:10.1001/jama.2021.4609. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33885728/
Mercorelli, B., Palù, G., & Loregian, A. (2018). Drug Repurposing for Viral Infectious Diseases: How Far Are We?. Trends in microbiology, 26 (10), 865–876. doi:10.1016/j.tim.2018.04.004. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29759926/
Seftel, D., & Boulware, D. R. (2021). Prospective Cohort of Fluvoxamine for Early Treatment of Coronavirus Disease 19. Open Forum Infectious Diseases, 8 (2), ofab050. doi:10.1093/ofid/ofab050. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33623808/
Singh, T. U., Parida, S., Lingaraju, M. C., Kesavan, M., Kumar, D., & Singh, R. K. (2020). Drug repurposing approach to fight COVID-19. Pharmacological Reports : PR, 72 (6), 1479–1508. doi:10.1007/s43440-020-00155-6. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33885728/
Sohel AJ, Shutter MC, Molla M. Fluoxetine. (2021). StatPearls. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459223/
Stasi, C., Fallani, S., Voller, F., & Silvestri, C. (2020). Treatment for COVID-19: An overview. European Journal of Pharmacology, 889,
doi:10.1016/j.ejphar.2020.173644. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7548059/
Sukhatme, V. P., Reiersen, A. M., Vayttaden, S. J., & Sukhatme, V. V. (2021). Fluvoxamine: A Review of Its Mechanism of Action and Its Role in COVID-19. Frontiers in Pharmacology, 12,
doi:10.3389/fphar.2021.652688. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8094534/
Sultana, J., Crisafulli, S., Gabbay, F., Lynn, E., Shakir, S., & Trifirò, G. (2020). Challenges for Drug Repurposing in the COVID-19 Pandemic Era. Frontiers in Pharmacology, 11,
doi:10.3389/fphar.2020.588654. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33240091/
T.O.G.E.T.H.E.R. Trial, Reis, G., Silva, E., Silva, D., Thabane, L., Milagres, A., et al. (2021). Effect of Early Treatment with Fluvoxamine on Risk of Emergency Care and Hospitalization Among Patients with COVID-19: The TOGETHER Randomized Platform Clinical Trial. medRxiv. doi.org/10.1101/2021.08.19.21262323. Retrieved from https://www.medrxiv.org/content/10.1101/2021.08.19.21262323v2.full-text
U.S. Food and Drug Administration (FDA) (1994). Retrieved at https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/021519s003lbl.pdf on Sep 1, 2021.
How we reviewed this article
Current version
Gina Allegretti, MD
Yael Cooperman, MD
About the medical reviewer
