Fluvoxamine (Luvox): dosage, uses, side effects

You've been feeling depressed and anxious, perhaps experiencing symptoms of obsessive-compulsive disorder. These are all challenging emotions that can disrupt many aspects of your life. Your healthcare provider has recommended you start taking fluvoxamine (brand name Luvox), and you're wondering what to expect while taking this drug. 

In this article, we'll dig into fluvoxamine—what it does, how it works, its side effects, and any warnings you should be aware of before taking it. 

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Fluvoxamine is an antidepressant medicine that helps to balance your brain’s chemicals. The brand names for fluvoxamine are Luvox and Luvox CR. Luvox and generic fluvoxamine are available as immediate-release tablets. Luvox CR is an extended-release or controlled-release capsule that slowly releases the drug in a controlled way (NAMI, 2020).

Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) antidepressant. Serotonin is a chemical called a neurotransmitter that affects the brain and helps you balance your mood. Fluvoxamine treats obsessive-compulsive disorder, depression, and other mental conditions. It does this by keeping the amount of serotonin that's already there around for a more extended period, increasing serotonin's mood-balancing effects in the brain. 

Fluvoxamine is approved by the U.S. Food and Drug Administration (FDA) to treat obsessive-compulsive disorder (OCD) in anyone over the age of eight (NAMI, 2020). 

Obsessive-compulsive disorder is a condition in which you or your loved one has constant bothersome thoughts (obsessions) and the need to do certain actions over and over again (compulsions). 

Fluvoxamine can also be prescribed for other uses or what’s called “off-label.” Off-label means using an FDA-approved drug for an unapproved use to treat other conditions—a standard practice when a healthcare professional deems a medication to be the right treatment for a patient (FDA, nd).

Off-label uses of fluvoxamine include major depressive disorder (MDD), social anxiety disorder, post-traumatic stress disorder (PTSD), panic disorder, and eating disorders like binge-eating disorder and bulimia nervosa (NAMI, 2020).

When you first start taking fluvoxamine, you may show improvement in your appetite, energy levels, or sleep quality within the first two weeks of taking it. These signs typically indicate that fluvoxamine is working for you. It may take six to eight weeks for your obsessive-compulsive behaviors or depression to improve (NAMI, 2020).

Fluvoxamine is not a short-term treatment. It does not cure your symptoms; instead, it controls them. That means it's essential to keep taking the medication and working with your healthcare provider to see if it’s right for you.

All medications, including fluvoxamine, have side effects.

Some of the common side effects that generally do go away with time include (Ani Pharmaceuticals, 2019):

• Constipation 

• Diarrhea

• Dizziness

• Dry mouth

• Unusual taste in the mouth

• Nausea

• Weight loss

• Weakness

• Increased sweating

• Feeling tired 

• Feeling nervous or restless

• Sleepy

• Difficulty sleeping (insomnia)

• Inability to concentrate

Some other adverse effects may stay for as long as you take the medication. These can include erectile dysfunction, loss of libido, sexual dysfunction, and high blood pressure (NAMI, 2020). Let your healthcare provider know if any of these common side effects affect your quality of life. They may adjust your dose to find the right balance of fluvoxamine's side effects and its positive effects on your condition.

Children and teens taking fluvoxamine can experience some different side effects, including (Ani Pharmaceuticals, 2019): 

• Agitation or a substantial increase in activity

• Depression and sadness

• Rash

• Excessive gas

• Heavy menstrual periods

• Weight changes

• Slowed growth rate

Speak to your child’s or teen’s pediatric healthcare provider with any concerns you may have regarding their treatment and health.

Serious side effects

Serious side effects are not common but can occur. If you experience any of these symptoms, seek medical advice immediately or call 911 (Ani Pharmaceuticals, 2019):

• Abnormal bleeding, like nosebleeds, bleeding gums, coughing up or throwing up blood, bruising easily, or blood in your stool

• Angle-closure glaucoma, signified by symptoms of eye pain, vision changes, redness, or swelling in or around the eye

• Significant decrease in appetite or weight, especially in children and teens

• Mania, including intense excitement or euphoria

• Hyponatremia or low sodium levels, which can have symptoms like headache, weakness, fainting, and seizures

• Serotonin syndrome is when your serotonin levels are too high. It can cause shakiness, very high fever, diarrhea, rapid heartbeat, anxiety, muscle rigidity, muscle twitching, and seizures. Serotonin syndrome is a severe medical condition that requires immediate medical attention. If you have any of these symptoms, call your healthcare provider or head to the nearest emergency room.

This medication has a black box warning from the FDA (its most serious warning) for its potential to cause suicidal thoughts and behaviors in people under 24 years old (FDA, 2012).

Some people may have an allergic reaction to fluvoxamine, Luvox, Luvox CR, or the ingredients in fluvoxamine maleate. Mild allergic reaction symptoms include hives, itchiness, and redness. A severe allergic reaction consists of these life-threatening symptoms: Swelling in your body, especially in your mouth, tongue, and throat, and trouble breathing. This is a medical emergency. Call 911 or head to the nearest emergency room if you experience these while taking fluvoxamine (Ani Pharmaceuticals 2019).

This is not a complete list of all the side effects of fluvoxamine. Speak with your healthcare provider if you or your child experience new or worsening symptoms. If you feel you or your child needs to stop taking fluvoxamine due to its side effects, speak with your healthcare provider. Stopping fluvoxamine suddenly can cause serious symptoms, so it’s important to wean off the medication slowly if need be. 

Your dose depends on any underlying medical issues, your mental health diagnosis, and how severe your condition is. Your healthcare provider will usually start you on a low dose and adjust it as needed. It's essential to communicate with your healthcare provider about your symptom improvement and any side effects you may be experiencing.

Fluvoxamine comes in these dosages (Medscape, nd):

• Fluvoxamine and Luvox immediate-release tablets: 25 mg, 50 mg, and 100 mg 

• Luvox CR extended or controlled release capsules: 100 mg and 150 mg

Immediate-release fluvoxamine or Luvox tablets are usually taken twice a day, either with or without food. Luvox CR is taken once a day, usually at bedtime, with or without food. Extended-release or controlled release capsules must be swallowed whole and not crushed, broken, or chewed.

What happens if I miss a dose?

If you miss your dose of fluvoxamine, take it as soon as you remember. If it is close to the time of your next dose, skip that dose. Do not double your next dose. Do not take more or less than is prescribed to you. If you have questions about a missed dose, speak with your healthcare provider (Ani Pharmaceuticals, 2019).

If you suddenly stop taking your prescribed fluvoxamine, you may have discontinuation syndrome or withdrawal symptoms. These symptoms can include dizziness, headache, nausea, vomiting, tremors, ringing in your ears, insomnia, or tingling or prickling feelings on your skin (NAMI, 2020). 

Do not stop taking fluvoxamine on your own. If you skip doses, you may increase your risk of relapsing for your condition or developing withdrawal symptoms. If you want to stop taking fluvoxamine for any reason, your healthcare provider can help you lower your dose gradually.

Like all antidepressants, fluvoxamine carries a box warning from the FDA for its potential to cause suicidal thoughts or behaviors in children, teens, and young adults. If you or your child experience these changes, see your healthcare provider immediately (FDA, 2012). 

Some antidepressants, including fluvoxamine, may cause mania or hypomania. Bipolar disorder also causes depressive symptoms. When a person with bipolar disorder takes fluvoxamine off-label for depression, they may suddenly switch to mania with intense euphoria, pressured speech, racing thoughts, and irritable mood (NAMI, 2020). 

Pregnant people who take fluvoxamine have a small risk of premature delivery. There is a minimal risk (less than 1%) of newborn babies born with persistent pulmonary hypertension or severe breathing problems if you take an SSRI like fluvoxamine during pregnancy. If you become pregnant while taking fluvoxamine, call your healthcare provider immediately. This medication is found in breastmilk. If you plan on breastfeeding your baby, discuss your plans with your healthcare provider (NAMI, 2020).

Have your eyes examined before you take fluvoxamine, as this medication can cause angle-closure glaucoma. This eye condition is caused by a blockage of eye fluids, which increases eye pressure and can result in a loss of vision. If you notice eye pain, swelling, or redness in or around your eye, changes in vision like seeing halos or rings around lights, or nausea, go to the nearest emergency room (Ani Pharmaceuticals, 2019).

If you are having any type of surgery, including dental surgery, let your surgeon know that you are taking fluvoxamine (Ani Pharmaceuticals, 2019).

Fluvoxamine, like other antidepressants, can cause sleepiness. Do not drive or use equipment that can harm you until you know how fluvoxamine affects you. It's also best to avoid alcohol while taking fluvoxamine. Both have sedating qualities and can cause extreme drowsiness when they interact with each other.

This is not a complete list of precautions with fluvoxamine. Speak with your healthcare provider before starting this medication and take it only as prescribed.

Fluvoxamine, Luvox, or Luvox CR may interact with prescribed medications, over-the-counter and illicit drugs, supplements, and herbs you or your child take. Some of these may increase the severity of the side effects or decrease the effectiveness of fluvoxamine.

Medications you should not take with fluvoxamine

If you take any of the following, your healthcare provider may choose another medication to treat your or your child’s obsessive-compulsive disorder (Ani Pharmaceuticals, 2019): 

• Ramelteon (Rozerem) for insomnia

• Tizanidine (Zanaflex), a muscle relaxant

• Pimozide (Orap) or thioridazine, antipsychotics

• Alosetron (Lotronex). 

You cannot take fluvoxamine with a monoamine oxidase inhibitor (MAOI), such as (Ani Pharmaceuticals, 2019):  

• Isocarboxazid (Marplan)

• Linezolid (Zyvox)

• Methylene blue

• Phenelzine (Nardil)

• Selegiline (Eldepryl, Emsam, Zelapar)

• Tranylcypromine (Parnate)

You should wait at least two weeks since stopping an MAOI before starting fluvoxamine. Likewise, if you just stopped taking fluvoxamine, you will need to wait for at least two weeks before starting an MAOI.

Medications that interact with fluvoxamine

One of the more severe potential side effects of taking fluvoxamine with other medications is serotonin syndrome. When the neurotransmitter serotonin builds up in your body, it may cause agitation, anxiety, diarrhea, fever, hallucinations, very fast heartbeat, high or low blood pressure, vomiting, muscle rigidity, muscle twitching, and seizures. Call your healthcare provider immediately if you experience any of these symptoms. Call 911 or go to your nearest emergency room if your symptoms worsen (Ani Pharmaceuticals, 2019).

These medications and supplements can cause serotonin syndrome when combined with fluvoxamine (Ani Pharmaceuticals, 2019): 

• Other SSRIs like sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac)

• Serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine (Cymbalta)

• Tricyclic antidepressants like amitriptyline (Elavil) 

• Lithium, a medicine to treat bipolar disorder

• Migraine medications called triptans

• Prescription pain relievers tramadol and fentanyl

• Amphetamines (whether prescribed or illicit)

• The herbal supplement St. John’s wort 

• The nutritional supplement tryptophan

Fluvoxamine can worsen bleeding if you are taking blood-thinning drugs. These include prescribed anticoagulants like warfarin (Coumadin) and over-the-counter pain relievers like aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen (Aleve) or ibuprofen (Advil or Motrin). Taking these with fluvoxamine can cause abnormal bleeding (Ani Pharmaceuticals, 2019).

Fluvoxamine increases drug levels and effects of many medications. These include (Ani Pharmaceuticals, 2019):

• Benzodiazepines used to treat anxiety like alprazolam (Xanax), diazepam (Valium), and midazolam

• Beta-blockers for high blood pressure like propranolol (Inderal) or metoprolol (Lopressor)

• Theophylline, a drug used to treat asthma and relax airways

• Anticonvulsants or antiseizure drugs like carbamazepine (Tegretol) and phenytoin (Dilantin)

• Antipsychotics like olanzapine (Zyprexa), clozapine (Clozaril), aripiprazole (Abilify), and quetiapine (Seroquel)

• Mexiletine (Mexitil), a drug used to treat abnormalities in heart rhythms

• Methadone (Dolophine), a drug used to relieve pain or treat addiction

Fluvoxamine may decrease the effects of clopidogrel (Plavix), an anticoagulant.

Cough suppressants and diuretics can also interact with fluvoxamine (Ani Pharmaceuticals, 2019).

Let your healthcare provider know all of the medicines you take to lower your risk of a severe interaction when taking fluvoxamine.

Your healthcare provider is an essential partner with you in your overall health. Keep your appointments and let them know how you or your child feel when taking fluvoxamine, especially with dose adjustments. 

You may want to keep a list of all your prescribed and regularly used over-the-counter medications, as well as the vitamins and supplements you take. Share this list with your healthcare provider whenever you need to add another medication so that you can work together to prevent the risk of an adverse drug reaction.

Fluvoxamine may help you control the symptoms of your condition but will not cure it. It may take up to eight weeks before you feel better when taking this medication. Continue to take fluvoxamine as directed by your healthcare provider.

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Current version

July 13, 2021

Written by

Tobi Ash, MBA, RN, BSN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.