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Luvox

Fluvoxamine (sold as Luvox®, Faverin® and Fevarin®) is a selective serotonin reuptake inhibitor. It is used primarily to treat depression, anxiety and OCD. more...

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Although its effects are similar to other SSRIs, it acts on the body's neurochemistry differently. For this reason, fluvoxamine can be of benefit to patients who experience unusual or limiting side-effects from other antidepressants. Fluvoxamine also appears to cause fewer side-effects than other SSRIs, particularly in relation to loss of sex-drive.

Fluvoxamine has the shortest half-life of all the SSRIs. Its mean serum half-life is 15 hours after a single dose, and 17 to 22 hours after repeated doses.

Fluvoxamine causes many drug-drug interactions due to inhibition of metabolism mediated by several cytochrome P450 oxidases. Examples of substances that have higher serum levels when administered together with fluvoxamine include caffeine, clozapine, olanzapine, tricyclic antidepressants, diazepam, alprazolam, propranolol, warfarin and methadone.

Effective dosage

For depression and anxiety, dosage normally starts at 50 milligrams per day, rising to 100 milligrams after a few days. It may be raised after evaluation of the effects by a doctor.

Fluvoxamine is generally only effective for OCD at 150 milligrams and above, and dosages can reach 300 milligrams or more for some patients.

Historical Relevance

In 1999, fluvoxamine came under great public scrutiny after it was discovered that Eric Harris, one of the two teenaged shooters involved in the Columbine High School massacre, had been taking the drug as treatment for depression. Many immediately pointed fingers at fluvoxamine and its manufacturer Solvay Pharmaceuticals (which sells fluvoxamine under the widely known brandname Luvox), since Solvay's own clinical trials indicated the drug had the propensity to induce "mania" in 4% of the youth who took it. Solvay, while acknowledging the risks inherent in taking an SSRI medication like fluvoxamine, downplayed any role the drug may have had in the killings. The American Psychiatric Association (A.P.A.) took a similar stance; Rodrigo Munoz, M.D., President of the A.P.A., said: "Despite a decade of research, there is little valid evidence to prove a causal relationship between the use of anti-depressant medications and destructive behavior. On the other hand, there is ample evidence that undiagnosed and untreated mental illness exacts a heavy toll on those who suffer from these disorders as well as those around them." It was also pointed out by many that Luvox was often safer than the other SSRI medications available--for example, fluoxetine (Prozac) caused mania in 6% of youth tested on the drug (versus fluvoxamine's 4%). Nonetheless, the reputation of Luvox was irreparably damaged. Sales fell, and Solvay withdrew the medication from the U.S. market in 2002; the company maintains, however, that this move had nothing to do with the safety profile of the fluvoxamine, which they still sell in many countries around the world. In the United States, fluvoxamine can only be purchased generically.

Read more at Wikipedia.org


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Drugs for major depression not much difference in effectiveness
From Healthfacts, 11/1/05

Ever wonder what makes doctors choose one antidepressant drug over another when they all appear to be about the same? Why, for example, would a doctor prescribe Paxil over Zoloft or Prozac or Celexa? All are in the same family of drugs called "second-generation antidepressants," and they work in a similar way. The FDA is no help because the agency requires only that each drug company prove its drug is better than nothing (a placebo). Unfortunately for the public, the FDA does not require the drug companies to prove their drugs are better than the competing drugs.

If any head-to-head comparison trials are done, they are conducted and published years after the drugs have been on the market. In the meantime, the drug companies have plenty of time and money to convince doctors and the public that their products are superior to the competition. Nine drugs make up the second generation antidepressants. In addition to four mentioned above, other brand names are Lexapro, Luvox, Serzone, Desyrel, and Effexor.

To determine whether any of these antidepressant drugs stand out from the rest for the treatment of major depression, a review of all relevant trials was conducted by Richard A. Hansen, PhD, and colleagues at the University of North Carolina at Chapel Hill. The reviewers found 46 head-to-head comparison trials. They also assessed 24 other types of studies, as well as trials in which an antidepressant was compared with a placebo.

When their findings were published recently in Annals of Internal Medicine, Hansen and colleagues showed there are only minimal differences in efficacy between the second-generation antidepressants for the treatment of major depression. In fact, 88% of the comparative trials found no difference between these antidepressants by any outcome measure. There were, however, differences in adverse effects. Also, the trials varied in quality and the length of time spent following the participants.

Since there are minimal differences in efficacy, the decision as to which drug to take should be based on the one with the fewest adverse effects. But the reviewers acknowledged difficulties in making such a determination because only 13% of the trials reported the adverse reactions properly.

96% of all the antidepressant drug studies in this review were sponsored by or had at least one author affiliated with a pharmaceutical company, according to Hansen and colleagues. The review, however, was funded by several government grants.

Suggestions From Worst Pills, Best Pills:

The popular drug-reference book entitled, Worst Pills, Best Pills, advises people to check the side effects of their current medications before going on antidepressant drug therapy. The authors of this book, subtitled, "A Consumer's Guide to Avoiding Drug-Induced Death or Illness," note that depression can be a side effect of numerous prescription medications, including some antihypertension drugs, antibiotics, acne drugs, corticosteroids, and diet drugs.

In 2004, the FDA issued a public health advisory warning that risk of suicidal thoughts and actions are increased in adults and children with the use of Celexa, Prozac, Serzone, Paxil, Zoloft, and Lexapro. Best Pills, Worst Pills advises readers not to use Lexapro because there is no significant difference between this drug and Celexa, and the latter drug is about to be available in a less expensive generic version, citalopram.

Also, there is inadequate information regarding the use of these second-generation drugs in people over the age of 60 years. Because they are underrepresented in the FDA-required clinical trials, older people's risk of adverse effects is unclear and may not be as low as it appears to be for younger adults.

To reduce the adverse effects of any antidepressant, Worst Pills, Best Pills advises people to start with a dose of one-third to one-half the usual adult dose (15-25 milligrams a day at bedtime) and increase the dose slowly, knowing that it may take three weeks for the drug to take effect.

COPYRIGHT 2005 Center for Medical Consumers, Inc.
COPYRIGHT 2005 Gale Group

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