fluvoxamine

In many countries (e.g., Australia,{{cite web|url=https://www.nps.org.au/medical-info/medicine-finder/luvox-tablets|title=Luvox Tablets|website=NPS MedicineWise|access-date=22 October 2018|archive-date=22 October 2018|archive-url=https://web.archive.org/web/20181022153450/https://www.nps.org.au/medical-info/medicine-finder/luvox-tablets|url-status=live}} the United Kingdom, and Russia{{cite web|title=Summary of Full Prescribing Information: Fluvoxamine|url=http://www.rlsnet.ru/mnn_index_id_307.htm|website=Drug Registry of Russia (RLS) Drug Compendium|access-date=21 March 2015|language=ru|archive-date=2 April 2015|archive-url=https://web.archive.org/web/20150402162017/http://www.rlsnet.ru/mnn_index_id_307.htm|url-status=live}}) it is commonly used for major depressive disorder. Fluvoxamine is also approved in the United States for obsessive–compulsive disorder (OCD), and social anxiety disorder.{{cite web|url=https://www.empr.com/home/news/luvox-cr-approved-for-ocd-and-sad/|title=Luvox CR approved for OCD and SAD|date=29 February 2008|website=MPR|access-date=2 March 2019|archive-date=28 August 2021|archive-url=https://web.archive.org/web/20210828090440/https://www.empr.com/home/news/luvox-cr-approved-for-ocd-and-sad/|url-status=live}} In Japan, it is also approved to treat OCD, social anxiety disorder and major depressive disorder.{{cite web|url=https://www.astellas.com/en/corporate/news/detail/luvox-receives-approval-for-so.html|title=2005 News Releases|website=Astellas Pharma|access-date=16 September 2018|archive-date=16 September 2018|archive-url=https://web.archive.org/web/20180916235231/https://www.astellas.com/en/corporate/news/detail/luvox-receives-approval-for-so.html|url-status=dead}}{{cite web|url=https://www.medscape.com/viewarticle/514804|title=International Approvals: Ebixa, Depromel/Luvox, M-Vax|website=www.medscape.com|access-date=16 September 2018|archive-date=29 October 2020|archive-url=https://web.archive.org/web/20201029173810/https://www.medscape.com/viewarticle/514804|url-status=live}} Fluvoxamine is indicated for children and adolescents with OCD.{{cite web | date = March 2005 | title = Fluvoxamine Product Insert | url = https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/022235lbl.pdf | work = Jazz Pharmaceuticals, Inc. | publisher = U.S. Food and Drug Administration | access-date = 4 November 2022 | archive-date = 4 November 2022 | archive-url = https://web.archive.org/web/20221104055928/https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/022235lbl.pdf | url-status = live }} The NICE guidelines in the United Kingdom have, as of 2005, authorized its use for obsessive-compulsive disorder in adults and adolescents of any age and children over the age of 7.{{medcn|date=April 2024}}

There is evidence that fluvoxamine is effective for generalised social anxiety in adults, although, as with other SSRIs, some of the results may be compromised by having been funded by pharmaceutical companies.{{cite journal | vauthors = Williams T, Hattingh CJ, Kariuki CM, Tromp SA, van Balkom AJ, Ipser JC, Stein DJ | title = Pharmacotherapy for social anxiety disorder (SAnD) | journal = The Cochrane Database of Systematic Reviews | volume = 10 | issue = 10 | pages = CD001206 | date = October 2017 | pmid = 29048739 | pmc = 6360927 | doi = 10.1002/14651858.CD001206.pub3 }}{{cite journal |vauthors=Liu X, Li X, Zhang C, Sun M, Sun Z, Xu Y, Tian X |title=Efficacy and tolerability of fluvoxamine in adults with social anxiety disorder: A meta-analysis |journal=Medicine (Baltimore) |volume=97 |issue=28 |pages=e11547 |date=July 2018 |pmid=29995828 |pmc=6076099 |doi=10.1097/MD.0000000000011547 |url=}} Of the SSRIs, however, fluvoxamine, paroxetine and sertraline do appear consistent as viable treatments for generalised social anxiety.Williams, T., McCaul, M., Schwarzer, G., Cipriani, A., Stein, D. J., & Ipser, J. (2020). Pharmacological treatments for social anxiety disorder in adults: a systematic review and network meta-analysis. Acta neuropsychiatrica, 32(4), 169–176. https://doi.org/10.1017/neu.2020.6 {{Webarchive|url=https://web.archive.org/web/20240907193632/https://www.cambridge.org/core/journals/acta-neuropsychiatrica/article/abs/pharmacological-treatments-for-social-anxiety-disorder-in-adults-a-systematic-review-and-network-metaanalysis/38FA011F8B7B205A8714F57528DF59A4 |date=7 September 2024 }}Davidson J. R. (2003). Pharmacotherapy of social phobia. Acta psychiatrica Scandinavica. Supplementum, (417), 65–71. https://doi.org/10.1034/j.1600-0447.108.s417.7.x {{Webarchive|url=https://web.archive.org/web/20240907193630/https://onlinelibrary.wiley.com/doi/10.1034/j.1600-0447.108.s417.7.x |date=7 September 2024 }}

Fluvoxamine is also effective for treating a range of anxiety disorders in children and adolescents, including generalized anxiety disorder, social anxiety disorder, panic disorder and separation anxiety disorder.{{cite journal |date=3 November 2022 |title=Antidepressants for children and teenagers: what works for anxiety and depression? |url=https://evidence.nihr.ac.uk/collection/antidepressants-for-children-and-teenagers-what-works-anxiety-depression/ |journal=NIHR Evidence |type=Plain English summary |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_53342 |s2cid=253347210 |url-access=subscription |access-date=7 November 2022 |archive-date=5 November 2022 |archive-url=https://web.archive.org/web/20221105153958/https://evidence.nihr.ac.uk/collection/antidepressants-for-children-and-teenagers-what-works-anxiety-depression/ |url-status=live }}{{cite journal | vauthors = Boaden K, Tomlinson A, Cortese S, Cipriani A | title = Antidepressants in Children and Adolescents: Meta-Review of Efficacy, Tolerability and Suicidality in Acute Treatment | journal = Frontiers in Psychiatry | volume = 11 | pages = 717 | date = 2 September 2020 | pmid = 32982805 | pmc = 7493620 | doi = 10.3389/fpsyt.2020.00717 | doi-access = free }}{{cite journal | vauthors = Correll CU, Cortese S, Croatto G, Monaco F, Krinitski D, Arrondo G, Ostinelli EG, Zangani C, Fornaro M, Estradé A, Fusar-Poli P, Carvalho AF, Solmi M | title = Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review | journal = World Psychiatry | volume = 20 | issue = 2 | pages = 244–275 | date = June 2021 | pmid = 34002501 | pmc = 8129843 | doi = 10.1002/wps.20881 }}

The drug works long-term, and retains its therapeutic efficacy for at least one year.{{cite journal | vauthors = Wilde MI, Plosker GL, Benfield P | title = Fluvoxamine. An updated review of its pharmacology, and therapeutic use in depressive illness | journal = Drugs | volume = 46 | issue = 5 | pages = 895–924 | date = November 1993 | pmid = 7507038 | doi = 10.2165/00003495-199346050-00008 | s2cid = 195691900 }}

The average therapeutic dose for fluvoxamine is 100 to 300 mg/day, with 300 mg being the upper daily limit normally recommended. Obsessive-compulsive disorder, however, often requires higher doses; doses of up to 450 mg/day may be prescribed in this case.Seibell PJ, Hamblin RJ, Hollander E.

Obsessive-compulsive disorder: Overview and standard treatment strategies. Psychiatric Annals. 2015 Jun 1;45(6):297-302.Rivas-Vazquez, R.A. and Blais, M.A., 1997. Selective serotonin reuptake inhibitors and atypical antidepressants: A review and update for psychologists. Professional Psychology: Research and Practice, 28(6), p.526.Middleton, R., Wheaton, M.G., Kayser, R. and Simpson, H.B., 2019. Treatment resistance in obsessive-compulsive disorder. Treatment resistance in psychiatry: risk factors, biology, and management, pp.165-177. The (off-label) upper daily limits for other serotonin-reuptake inhibitors used in the treatment of obsessive-compulsive disorder, by analogy, are 400mg for sertraline,Ninan PT, Koran LM, Kiev A, Davidson JR, Rasmussen SA, Zajecka JM, Robinson DG, Crits-Christoph P, Mandel FS, Austin C. High-dose sertraline strategy for nonresponders to acute treatment for obsessive-compulsive disorder: a multicenter double-blind trial. J Clin Psychiatry. 2006 Jan;67(1):15-22. doi: 10.4088/jcp.v67n0103. PMID 16426083. 100 mg for paroxetine, 120 mg for both fluoxetine and citalopram, 60 mg for escitalopram and 300 mg for clomipramine.{{Cite web|url=https://psychopharmacologyinstitute.com/section/adequate-treatment-trials-in-ocd-fda-approvals-and-maximal-dosing-2523-4887|title=Psychopharmacology Institute|website=psychopharmacologyinstitute.com}}Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB; American Psychiatric Association. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. 2007 Jul;164(7 Suppl):5-53. PMID 17849776.

In any case with fluvoxamine, treatment is generally begun at 50 mg and increased in 50 mg increments every 4 to 7 days until a therapeutic optimum is reached.Figgitt, D.P. and McClellan, K.J., 2000. Fluvoxamine: an updated review of its use in the management of adults with anxiety disorders. Drugs, 60, pp.925-954.

Fluvoxamine's side-effect profile is very similar to other SSRIs. Gastrointestinal side effects are characteristic of those receiving treatment with fluvoxamine.{{cite web |title=Product Information Luvox |work=TGA eBusiness Services |publisher=Abbott Australasia Pty Ltd |date=15 January 2013 |access-date=21 October 2013 |url=https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-07140-3 |archive-date=9 October 2017|archive-url=https://web.archive.org/web/20171009014348/https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-07140-3 |url-status=live}}{{cite web |title=Fluvoxamine Maleate tablet, coated prescribing information |work=DailyMed |publisher=U.S. National Library of Medicine |date=14 December 2018 |url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7ecd83ec-88f5-4f85-9cc2-9068375d8820 |access-date=28 November 2019 |archive-date=19 October 2020 |archive-url=https://web.archive.org/web/20201019235438/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7ecd83ec-88f5-4f85-9cc2-9068375d8820 |url-status=live}}{{cite book |veditors=Rossi S |isbn=978-0-9805790-9-3 |title=Australian Medicines Handbook |place=Adelaide |publisher=The Australian Medicines Handbook Unit Trust |year=2013 |edition=2013}}{{cite book |isbn=978-0-85711-084-8 |title=British National Formulary (BNF) |last1=Joint Formulary Committee |year=2013 |publisher=Pharmaceutical Press |location=London, UK |edition=65th |url-access=registration |url=https://archive.org/details/bnf65britishnati0000unse}}{{cite book |isbn=978-0-470-97948-8 |title=The Maudsley prescribing guidelines in psychiatry |vauthors=Taylor D, Paton C, Shitij K |year=2012 |publisher=Wiley-Blackwell |location=West Sussex}}{{cite web |title=Faverin 100 mg film-coated tablets – Summary of Product Characteristics (SPC) |work=electronic Medicines Compendium |publisher=Abbott Healthcare Products Limited |date=14 May 2013 |access-date=21 October 2013 |url-status=live |url=http://www.medicines.org.uk/emc/medicine/22124/SPC/Faverin+100+mg+film-coated+tablets/ |archive-date=21 October 2013 |archive-url=https://web.archive.org/web/20131021042737/http://www.medicines.org.uk/emc/medicine/22124/SPC/Faverin+100+mg+film-coated+tablets/}}

Common side effects occurring with 1–10% incidence:

{{div col |colwidth=20em}}

• Abdominal pain
• Agitation
• Anxiety
• Asthenia (weakness)
• Constipation
• Diarrhea
• Dizziness
• Dyspepsia (indigestion)
• Headache
• Hyperhidrosis (excess sweating)
• Insomnia
• Loss of appetite
• Malaise
• Nausea
• Nervousness
• Palpitations
• Restlessness
• Sexual dysfunction (including delayed ejaculation, erectile dysfunction, decreased libido, etc.)
• Somnolence (drowsiness)
• Tachycardia (high heart rate)
• Tremor
• Vomiting
• Weight loss
• Xerostomia (dry mouth)
• Yawning

{{div col end}}

Uncommon side effects occurring with 0.1–1% incidence:

{{div col |colwidth=30em}}

• Arthralgia
• Confusional state
• Cutaneous hypersensitivity reactions (e.g. oedema [buildup of fluid in the tissues], rash, pruritus)
• Extrapyramidal side effects (e.g. dystonia, parkinsonism, tremor, etc.)
• Hallucination
• Orthostatic hypotension

{{div col end}}

Rare side effects occurring with 0.01–0.1% incidence:

{{div col |colwidth=32em}}

• Abnormal hepatic (liver) function
• Galactorrhoea (expulsion of breast milk unrelated to pregnancy or breastfeeding)
• Mania
• Photosensitivity (being abnormally sensitive to light)
• Seizures

{{div col end}}

{{div col |colwidth=30em}}

• Akathisia{{snd}} a sense of inner restlessness that presents itself with the inability to stay still
• Bed-wetting
• Bone fractures
• Dysgeusia
• Ecchymoses
• Glaucoma
• Haemorrhage
• Hyperprolactinaemia (elevated plasma prolactin levels leading to galactorrhoea, amenorrhoea [cessation of menstrual cycles], etc.)
• Hyponatraemia
• Mydriasis
• Neuroleptic malignant syndrome – practically identical presentation to serotonin syndrome except with a more prolonged onset
• Paraesthesia
• Serotonin syndrome – a potentially fatal condition characterised by abrupt onset muscle rigidity, hyperthermia (elevated body temperature), rhabdomyolysis, mental status changes (e.g. coma, hallucinations, agitation), etc.
• Suicidal ideation and behaviour
• Syndrome of inappropriate antidiuretic hormone secretion
• Urinary incontinence
• Urinary retention
• Violence towards others{{cite magazine |title=Top Ten Legal Drugs Linked to Violence |magazine=Time |date=7 January 2011 |access-date=10 September 2014 |url=https://healthland.time.com/2011/01/07/top-ten-legal-drugs-linked-to-violence/ |vauthors=Szalavitz M |archive-date=21 September 2014 |archive-url=https://web.archive.org/web/20140921052039/http://healthland.time.com/2011/01/07/top-ten-legal-drugs-linked-to-violence/ |url-status=live }}
• Weight changes
• Withdrawal symptoms

{{div col end}}

File:Luvox.jpg

Fluvoxamine inhibits the following cytochrome P450 enzymes:{{cite book| vauthors = Ciraulo DA, Shader RI | veditors = Ciraulo DA, Shader RI | title=Pharmacotherapy of Depression|year=2011|publisher=Springer|isbn=978-1-60327-435-7|page=49 |edition= 2nd |doi=10.1007/978-1-60327-435-7}}{{cite book | isbn = 978-0-07-162442-8 | title = Goodman and Gilman's The Pharmacological Basis of Therapeutics | edition = 12th | vauthors = Brunton L, Chabner B, Knollman B | year = 2010 | publisher = McGraw-Hill Professional | location = New York | title-link = Goodman and Gilman's The Pharmacological Basis of Therapeutics }}{{cite journal | vauthors = Baumann P | title = Pharmacokinetic-pharmacodynamic relationship of the selective serotonin reuptake inhibitors | journal = Clinical Pharmacokinetics | volume = 31 | issue = 6 | pages = 444–469 | date = December 1996 | pmid = 8968657 | doi = 10.2165/00003088-199631060-00004 | s2cid = 31923953 }}{{cite journal | vauthors = DeVane CL, Gill HS | title = Clinical pharmacokinetics of fluvoxamine: applications to dosage regimen design | journal = The Journal of Clinical Psychiatry | volume = 58 | issue = Suppl 5 | pages = 7–14 | year = 1997 | pmid = 9184622 }}{{cite journal | vauthors = DeVane CL | title = Translational pharmacokinetics: current issues with newer antidepressants | journal = Depression and Anxiety | volume = 8 | issue = Suppl 1 | pages = 64–70 | year = 1998 | pmid = 9809216 | doi = 10.1002/(SICI)1520-6394(1998)8:1+<64::AID-DA10>3.0.CO;2-S | s2cid = 22297498 | doi-access = free }}{{cite journal | vauthors = Bondy B, Spellmann I | title = Pharmacogenetics of antipsychotics: useful for the clinician? | journal = Current Opinion in Psychiatry | volume = 20 | issue = 2 | pages = 126–130 | date = March 2007 | pmid = 17278909 | doi = 10.1097/YCO.0b013e328017f69f | s2cid = 23859992 }}{{cite journal | vauthors = Kroon LA | title = Drug interactions with smoking | journal = American Journal of Health-System Pharmacy | volume = 64 | issue = 18 | pages = 1917–1921 | date = September 2007 | pmid = 17823102 | doi = 10.2146/ajhp060414 }}{{cite web| vauthors = Waknine Y| title = Prescribers Warned of Tizanidine Drug Interactions| work = Medscape News| publisher = Medscape| date = 13 April 2007| url = http://www.medscape.com/viewarticle/555194_print| access-date = 1 February 2008| archive-date = 21 February 2013| archive-url = https://web.archive.org/web/20130221020721/http://www.medscape.com/viewarticle/555194_print| url-status = live}}{{cite web|url=https://www.mayoclinic.org/drugs-supplements/fluvoxamine-oral-route/precautions/drg-20066874?p=1|title=Fluvoxamine (Oral Route) Precautions|website=Mayo Clinic|access-date=2 November 2018|archive-date=6 March 2019|archive-url=https://web.archive.org/web/20190306043631/https://www.mayoclinic.org/drugs-supplements/fluvoxamine-oral-route/precautions/drg-20066874?p=1|url-status=live}}{{Excessive citations inline|date=April 2024}}

• CYP1A2 (strongly) which metabolizes agomelatine, amitriptyline, caffeine, clomipramine, clozapine, duloxetine, haloperidol, imipramine, phenacetin, tacrine, tamoxifen, theophylline, olanzapine, etc.
• CYP3A4 (moderately) which metabolizes alprazolam, aripiprazole, clozapine, haloperidol, quetiapine, pimozide, ziprasidone, etc.{{cite journal | vauthors = Hemeryck A, Belpaire FM | title = Selective serotonin reuptake inhibitors and cytochrome P-450 mediated drug-drug interactions: an update | journal = Current Drug Metabolism | volume = 3 | issue = 1 | pages = 13–37 | date = February 2002 | pmid = 11876575 | doi = 10.2174/1389200023338017 }}
• CYP2D6 (weakly) which metabolizes aripiprazole, chlorpromazine, clozapine, codeine, fluoxetine, haloperidol, olanzapine, oxycodone, paroxetine, perphenazine, pethidine, risperidone, sertraline, thioridazine, zuclopenthixol, etc.{{cite journal|title=Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers|journal=FDA|date=26 May 2021|url=https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and-drug-interactions-table-substrates-inhibitors-and-inducers|access-date=25 December 2020|archive-date=4 November 2020|archive-url=https://web.archive.org/web/20201104173036/https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and-drug-interactions-table-substrates-inhibitors-and-inducers|url-status=live}}
• CYP2C9 (moderately) which metabolizes nonsteroidal anti-inflammatory drugs, phenytoin, sulfonylureas, etc.
• CYP2C19 (strongly) which metabolizes clonazepam, diazepam, phenytoin, etc.
• CYP2B6 (weakly) which metabolizes bupropion, cyclophosphamide, sertraline, tamoxifen, valproate, etc.

By so doing, fluvoxamine can increase serum concentration of the substrates of these enzymes.

Fluvoxamine may also elevate plasma levels of olanzapine by approximately two times.{{cite journal | vauthors = Spina E, de Leon J | title = Metabolic drug interactions with newer antipsychotics: a comparative review | journal = Basic & Clinical Pharmacology & Toxicology | volume = 100 | issue = 1 | pages = 4–22 | date = January 2007 | pmid = 17214606 | doi = 10.1111/j.1742-7843.2007.00017.x | doi-access = free }} Combined olanzapine and fluvoxamine, which may cause increased sedation,{{cite journal | vauthors = Bogetto F, Bellino S, Vaschetto P, Ziero S | title = Olanzapine augmentation of fluvoxamine-refractory obsessive-compulsive disorder (OCD): a 12-week open trial | journal = Psychiatry Research | volume = 96 | issue = 2 | pages = 91–98 | date = October 2000 | pmid = 11063782 | doi = 10.1016/s0165-1781(00)00203-1 | s2cid = 43395897 }} should be used cautiously and controlled clinically and by therapeutic drug monitoring to avoid olanzapine induced adverse effects and/or intoxication.{{cite journal | vauthors = Hiemke C, Peled A, Jabarin M, Hadjez J, Weigmann H, Härtter S, Modai I, Ritsner M, Silver H | title = Fluvoxamine augmentation of olanzapine in chronic schizophrenia: pharmacokinetic interactions and clinical effects | journal = Journal of Clinical Psychopharmacology | volume = 22 | issue = 5 | pages = 502–506 | date = October 2002 | pmid = 12352274 | doi = 10.1097/00004714-200210000-00010 | s2cid = 38073367 }}{{cite web |date=23 November 2020 |title=Movox |url=https://www.nps.org.au/medicine-finder/movox-tablets |access-date=4 November 2022 |website=NPS MedicineWise |archive-date=4 November 2022 |archive-url=https://web.archive.org/web/20221104034758/https://www.nps.org.au/medicine-finder/movox-tablets |url-status=live }}

The plasma levels of oxidatively metabolized benzodiazepines (e.g., triazolam, midazolam, alprazolam and diazepam) are likely to be increased when co-administered with fluvoxamine. However, the clearance of benzodiazepines metabolized by glucuronidation (e.g., lorazepam; oxazepam, which is coincidentally a metabolite of diazepam;{{cite journal | vauthors = Dinis-Oliveira RJ | title = Metabolic profile of oxazepam and related benzodiazepines: clinical and forensic aspects | journal = Drug Metabolism Reviews | volume = 49 | issue = 4 | pages = 451–463 | date = November 2017 | pmid = 28903606 | doi = 10.1080/03602532.2017.1377223 | s2cid = 4528255 }} temazepam){{cite web|url=http://paindr.com/wp-content/uploads/2015/10/Revised-BZD_-9-30.pdf|title=Benzodiazepine Metabolism and Pharmacokinetics|vauthors=Raouf M|date=2016|veditors=Fudin J|access-date=16 September 2018|archive-date=12 July 2018|archive-url=https://web.archive.org/web/20180712232038/http://paindr.com/wp-content/uploads/2015/10/Revised-BZD_-9-30.pdf|url-status=live}}{{cite journal | vauthors = Peppers MP | title = Benzodiazepines for alcohol withdrawal in the elderly and in patients with liver disease | journal = Pharmacotherapy | volume = 16 | issue = 1 | pages = 49–57 | date = 1996 | pmid = 8700792 | doi = 10.1002/j.1875-9114.1996.tb02915.x | s2cid = 1389910 }} are not affected by fluvoxamine and may be safely taken alongside fluvoxamine should concurrent treatment with a benzodiazepine be necessary.{{cite web|url=http://www.mylan.ca/-/media/mylanca/documents/english/product%20pdf/pdfs%20dec%202015/luvox-pm-2016.01.08.pdf|title=fluvoxamine maleate: PRODUCT MONOGRAPH|date=2016|access-date=16 September 2018|archive-date=16 September 2018|archive-url=https://web.archive.org/web/20180916130322/http://www.mylan.ca/-/media/mylanca/documents/english/product%20pdf/pdfs%20dec%202015/luvox-pm-2016.01.08.pdf|url-status=live}} Additionally, it appears that benzodiazepines metabolized by nitro-reduction (clonazepam, nitrazepam) may also, in a somewhat similar vein, be unlikely to be affected by fluvoxamine.{{cite web|url=http://www.medsafe.govt.nz/profs/datasheet/l/luvoxtab.pdf|title=Luvox Data Sheet|date=2017|publisher=Medsafe, New Zealand|access-date=16 September 2018|archive-date=29 March 2018|archive-url=https://web.archive.org/web/20180329045516/http://www.medsafe.govt.nz/profs/datasheet/l/luvoxtab.pdf|url-status=dead}}{{cite web |title=Faverin Tablets |url=https://www.nps.org.au/medicine-finder/faverin-tablets |access-date=4 November 2022 |website=NPS MedicineWise |date=July 2022 |archive-date=4 November 2022 |archive-url=https://web.archive.org/web/20221104201934/https://www.nps.org.au/medicine-finder/faverin-tablets |url-status=live }}

Using fluvoxamine and alprazolam together can increase alprazolam plasma concentrations.{{cite journal | vauthors = Suzuki Y, Shioiri T, Muratake T, Kawashima Y, Sato S, Hagiwara M, Inoue Y, Shimoda K, Someya T | title = Effects of concomitant fluvoxamine on the metabolism of alprazolam in Japanese psychiatric patients: interaction with CYP2C19 mutated alleles | journal = European Journal of Clinical Pharmacology | volume = 58 | issue = 12 | pages = 829–833 | date = April 2003 | pmid = 12698310 | doi = 10.1007/s00228-003-0563-9 | s2cid = 32559753 }} If alprazolam is coadministered with fluvoxamine, the initial alprazolam dose should be reduced to the lowest effective dose.{{cite book|url=https://books.google.com/books?id=AmQlBAAAQBAJ&pg=PA131|title=Psychiatric Drugs in Children and Adolescents: Basic Pharmacology and Practical Applications|vauthors=Gerlach M, Warnke A, Greenhill L|publisher=Springer-Verlag Wien|year=2014|isbn=978-3-7091-1500-8|pages=131|access-date=21 May 2020|archive-date=10 January 2023|archive-url=https://web.archive.org/web/20230110041817/https://books.google.com/books?id=AmQlBAAAQBAJ&pg=PA131|url-status=live}}{{cite journal | vauthors = Fleishaker JC, Hulst LK | title = A pharmacokinetic and pharmacodynamic evaluation of the combined administration of alprazolam and fluvoxamine | journal = European Journal of Clinical Pharmacology | volume = 46 | issue = 1 | pages = 35–39 | date = 1994 | pmid = 8005185 | doi = 10.1007/bf00195913 | s2cid = 2161450 }}

Fluvoxamine and ramelteon coadministration is not indicated.{{cite journal | vauthors = Obach RS, Ryder TF | title = Metabolism of ramelteon in human liver microsomes and correlation with the effect of fluvoxamine on ramelteon pharmacokinetics | journal = Drug Metabolism and Disposition | volume = 38 | issue = 8 | pages = 1381–1391 | date = August 2010 | pmid = 20478852 | doi = 10.1124/dmd.110.034009 | s2cid = 8421997 }}{{cite journal | vauthors = Pandi-Perumal SR, Spence DW, Verster JC, Srinivasan V, Brown GM, Cardinali DP, Hardeland R | title = Pharmacotherapy of insomnia with ramelteon: safety, efficacy and clinical applications | journal = Journal of Central Nervous System Disease | volume = 3 | pages = 51–65 | date = 12 April 2011 | pmid = 23861638 | pmc = 3663615 | doi = 10.4137/JCNSD.S1611 }}

Fluvoxamine has been observed to increase serum concentrations of mirtazapine, which is mainly metabolized by CYP1A2, CYP2D6, and CYP3A4, by three- to four-fold in humans.{{cite journal | vauthors = Anttila AK, Rasanen L, Leinonen EV | title = Fluvoxamine augmentation increases serum mirtazapine concentrations three- to fourfold | journal = The Annals of Pharmacotherapy | volume = 35 | issue = 10 | pages = 1221–1223 | date = October 2001 | pmid = 11675851 | doi = 10.1345/aph.1A014 | s2cid = 44807359 }} Caution and adjustment of dosage as necessary are warranted when combining fluvoxamine and mirtazapine.

Fluvoxamine seriously affects the pharmacokinetics of tizanidine and increases the intensity and duration of its effects. Because of the potentially hazardous consequences, the concomitant use of tizanidine with fluvoxamine, or other potent inhibitors of CYP1A2, should be avoided.{{cite journal | vauthors = Granfors MT, Backman JT, Neuvonen M, Ahonen J, Neuvonen PJ | title = Fluvoxamine drastically increases concentrations and effects of tizanidine: a potentially hazardous interaction | journal = Clinical Pharmacology and Therapeutics | volume = 75 | issue = 4 | pages = 331–341 | date = April 2004 | pmid = 15060511 | doi = 10.1016/j.clpt.2003.12.005 | s2cid = 25781307 }}

When a beta-blocker is required, atenolol,{{cite journal | vauthors = Perucca E, Gatti G, Spina E | title = Clinical pharmacokinetics of fluvoxamine | journal = Clinical Pharmacokinetics | volume = 27 | issue = 3 | pages = 175–190 | date = September 1994 | pmid = 7988100 | doi = 10.2165/00003088-199427030-00002 | s2cid = 22472247 }} pindolol{{cite journal | vauthors = Zanardi R, Serretti A, Rossini D, Franchini L, Cusin C, Lattuada E, Dotoli D, Smeraldi E | title = Factors affecting fluvoxamine antidepressant activity: influence of pindolol and 5-HTTLPR in delusional and nondelusional depression | journal = Biological Psychiatry | volume = 50 | issue = 5 | pages = 323–330 | date = September 2001 | pmid = 11543734 | doi = 10.1016/s0006-3223(01)01118-0 | s2cid = 22692759 }}{{cite journal | vauthors = Sluzewska A, Szczawinska K | title = The effects of pindolol addition to fluvoxamine and buspirone in chronic mild stress model of depression. | journal = Behavioural Pharmacology | date = May 1996 | volume = 7 | pages = 105 }}{{cite journal | vauthors = Mundo E, Guglielmo E, Bellodi L | title = Effect of adjuvant pindolol on the antiobsessional response to fluvoxamine: a double-blind, placebo-controlled study | journal = International Clinical Psychopharmacology | volume = 13 | issue = 5 | pages = 219–224 | date = September 1998 | pmid = 9817627 | doi = 10.1097/00004850-199809000-00005 | s2cid = 23946424 }} and, possibly, metoprolol{{cite journal | vauthors = Belpaire FM, Wijnant P, Temmerman A, Rasmussen BB, Brøsen K | title = The oxidative metabolism of metoprolol in human liver microsomes: inhibition by the selective serotonin reuptake inhibitors | journal = European Journal of Clinical Pharmacology | volume = 54 | issue = 3 | pages = 261–264 | date = May 1998 | pmid = 9681670 | doi = 10.1007/s002280050456 | s2cid = 28105445 }}{{cite journal | vauthors = Xu ZH, Xie HG, Zhou HH | title = In vivo inhibition of CYP2C19 but not CYP2D6 by fluvoxamine | journal = British Journal of Clinical Pharmacology | volume = 42 | issue = 4 | pages = 518–521 | date = October 1996 | pmid = 8904628 | pmc = 2042705 | doi = 10.1046/j.1365-2125.1996.45319.x | doi-broken-date = 9 December 2024 }}{{cite journal | vauthors = Belpaire FM, Wijnant P, Tammerman A, Bogaert M, Rasmussen B, Brosen K | title = Inhibition of the oxidative metabolism of metoprolol by selective serotonin reuptake inhibitors in human liver microsomes. | journal = Fundamental and Clinical Pharmacology | date = 1997 | volume = 2 | issue = 11 | pages = 147 }} may be safer choices than propranolol, as the latter's metabolism is seriously, potentially dangerously, inhibited by fluvoxamine.{{cite journal | vauthors = van Harten J | title = Overview of the pharmacokinetics of fluvoxamine | journal = Clinical Pharmacokinetics | volume = 29 | issue = Suppl 1| pages = 1–9 | date = 1995 | pmid = 8846617 | doi = 10.2165/00003088-199500291-00003 | s2cid = 71812133 }} Indeed, fluvoxamine may increase propranolol blood-levels by five-fold.{{cite journal | vauthors = Muscatello MR, Spina E, Bandelow B, Baldwin DS | title = Clinically relevant drug interactions in anxiety disorders | journal = Human Psychopharmacology | volume = 27 | issue = 3 | pages = 239–253 | date = May 2012 | pmid = 22311403 | doi = 10.1002/hup.2217 | s2cid = 11592004 }}

Clomipramine increases fluvoxamine levels and, conversely-likewise, fluvoxamine increases clomipramine levels (thereby its serotoninergic potential) and inhibits its metabolism to its strongly-noradrenergic metabolite, norclomipramine.{{cite journal | vauthors = Szegedi A, Wetzel H, Leal M, Härtter S, Hiemke C | title = Combination treatment with clomipramine and fluvoxamine: drug monitoring, safety, and tolerability data | journal = The Journal of Clinical Psychiatry | volume = 57 | issue = 6 | pages = 257–264 | date = June 1996 | pmid = 8666564 | doi = }}{{cite journal | vauthors = Hardy NE, Walkup JT | title = Clomipramine in Combination with Fluvoxamine: A Potent Medication Combination for Severe or Refractory Pediatric OCD | journal = Journal of the Canadian Academy of Child and Adolescent Psychiatry | volume = 30 | issue = 4 | pages = 273–277 | date = November 2021 | pmid = 34777510 | pmc = 8561855 | doi = }}

Fluvoxamine is a potent selective serotonin reuptake inhibitor with around 100-fold affinity for the serotonin transporter over the norepinephrine transporter. It has negligible affinity for the dopamine transporter or any other site, with the sole exception of the σ₁ receptor.{{cite journal | vauthors = Hashimoto K | title = Sigma-1 receptors and selective serotonin reuptake inhibitors: clinical implications of their relationship | journal = Central Nervous System Agents in Medicinal Chemistry | volume = 9 | issue = 3 | pages = 197–204 | date = September 2009 | pmid = 20021354 | doi = 10.2174/1871524910909030197 }} It behaves as a potent agonist at this receptor and has the highest affinity (36 nM) of any SSRI for doing so. This may contribute to its antidepressant and anxiolytic effects and may also afford it some efficacy in treating the cognitive symptoms of depression.{{cite journal | vauthors = Hindmarch I, Hashimoto K | title = Cognition and depression: the effects of fluvoxamine, a sigma-1 receptor agonist, reconsidered | journal = Human Psychopharmacology | volume = 25 | issue = 3 | pages = 193–200 | date = April 2010 | pmid = 20373470 | doi = 10.1002/hup.1106 | s2cid = 26491662 }} It increases concentrations of the neurosteroid allopregnanolone, which may also contribute to its anxiolytic effects.{{Cite journal |last=Uzunova |first=V |date=March 17, 1998 |title=Increase in the cerebrospinal fluid content of neurosteroids in patients with unipolar major depression who are receiving fluoxetine or fluvoxamine |journal=Proceedings of the National Academy of Sciences of the United States of America |volume=95 |issue=6 |pages=3239–3244 |doi=10.1073/pnas.95.6.3239 |doi-access=free |pmid=9501247 |pmc=19726 |bibcode=1998PNAS...95.3239U }} Unlike some other SSRIs, fluvoxamine's metabolites are pharmacologically neutral.{{cite journal | vauthors = Hrdina PD | title = Pharmacology of serotonin uptake inhibitors: focus on fluvoxamine | journal = Journal of Psychiatry & Neuroscience | volume = 16 | issue = 2 Suppl 1 | pages = 10–18 | date = July 1991 | pmid = 1931931 | pmc = 1188307 }}

Literature reviews have stated that fluvoxamine is metabolized primarily by CYP2D6 and to a minor extent by CYP1A2.{{cite journal | vauthors = Altamura AC, Caldiroli A, Buoli M | title = Pharmacokinetic evaluation of fluvoxamine for the treatment of anxiety disorders | journal = Expert Opin Drug Metab Toxicol | volume = 11 | issue = 4 | pages = 649–660 | date = April 2015 | pmid = 25728382 | doi = 10.1517/17425255.2015.1021331 | url = }}{{cite journal | vauthors = Wyska E | title = Pharmacokinetic considerations for current state-of-the-art antidepressants | journal = Expert Opin Drug Metab Toxicol | volume = 15 | issue = 10 | pages = 831–847 | date = October 2019 | pmid = 31526279 | doi = 10.1080/17425255.2019.1669560 | url = }} However, CYP2D6 poor metabolizers do not have considerably higher fluvoxamine levels than extensive metabolizers. The Australian Therapeutic Goods Administration (TGA) label (last revised 2023) states that the specific enzymes involved in fluvoxamine are not definitively known and that in vitro data suggest that it is mainly metabolized by CYP1A2 and may also be metabolized by CYP3A4 and CYP2C19 to a much lesser extent.

Fluvoxamine was developed by Kali-Duphar, part of Solvay Pharmaceuticals, Belgium, now Abbott Laboratories, and introduced as Floxyfral in Switzerland in 1983.{{cite book|title=Sittig's Pharmaceutical Manufacturing Encyclopedia|year=2008|publisher=William Andrew|isbn=978-0-8155-1526-5|page=1699|url=http://www.armchairpatriot.com/Encyclopedias/Encyclopedia-Pharmaceutical%20Manufacturing%20%283rd%20edition%29/15265_v02_04.pdf|edition=3rd|access-date=17 October 2013|archive-date=14 October 2013|archive-url=https://web.archive.org/web/20131014042521/http://www.armchairpatriot.com/Encyclopedias/Encyclopedia-Pharmaceutical%20Manufacturing%20%283rd%20edition%29/15265_v02_04.pdf|url-status=dead}} It was approved by the U.S. Food and Drug Administration (FDA) in 1994, and introduced as Luvox in the US.{{cite journal | vauthors = Leslie LK, Newman TB, Chesney PJ, Perrin JM | title = The Food and Drug Administration's deliberations on antidepressant use in pediatric patients | journal = Pediatrics | volume = 116 | issue = 1 | pages = 195–204 | date = July 2005 | pmid = 15995053 | pmc = 1550709 | doi = 10.1542/peds.2005-0074 }} In India, it is available, among several other brands, as Uvox by Abbott.{{cite web|title=Brand Index―Fluvoxamine India |url=http://www.drugsupdate.com/brand/showavailablebrands/184 |access-date=18 October 2013 |archive-url=https://web.archive.org/web/20131019151123/http://www.drugsupdate.com/brand/showavailablebrands/184 |archive-date=19 October 2013 |url-status=dead }} It was one of the first SSRI antidepressants to be launched, and is prescribed in many countries to patients with major depression.{{cite journal | vauthors = Omori IM, Watanabe N, Nakagawa A, Cipriani A, Barbui C, McGuire H, Churchill R, Furukawa TA | title = Fluvoxamine versus other anti-depressive agents for depression | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD006114 | date = March 2010 | volume = 2013 | pmid = 20238342 | pmc = 4171125 | doi = 10.1002/14651858.CD006114.pub2 }} It was the first SSRI, a non-TCA drug, approved by the U.S. FDA specifically for the treatment of OCD.{{cite web|title=OCD Medication |url=http://www.brainphysics.com/medications.php |access-date=17 October 2013 |archive-url=https://web.archive.org/web/20131014072454/http://www.brainphysics.com/medications.php |archive-date=14 October 2013 |url-status=dead }} At the end of 1995, more than ten million patients worldwide had been treated with fluvoxamine.{{cite web | year = 1999 | title = Fluvoxamine Product Monograph | url = https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/021519s003lbl.pdf | access-date = 15 September 2018 | archive-date = 27 October 2020 | archive-url = https://web.archive.org/web/20201027214646/https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/021519s003lbl.pdf | url-status = live }}{{failed verification|reason=no discussion of ten million patients|date=November 2019}} Fluvoxamine was the first SSRI to be registered for the treatment of obsessive compulsive disorder in children by the FDA in 1997.{{cite web | title = Luvox Approved For Obsessive Compulsive Disorder in Children and Teens | url = http://www.pslgroup.com/dg/2261a.htm | access-date = 8 February 2014 | archive-url = https://web.archive.org/web/20090116004424/http://www.pslgroup.com/dg/2261a.htm | archive-date = 16 January 2009 | url-status = dead }} In Japan, fluvoxamine was the first SSRI to be approved for the treatment of depression in 1999{{cite journal | vauthors = Higuchi T, Briley M | title = Japanese experience with milnacipran, the first serotonin and norepinephrine reuptake inhibitor in Japan | journal = Neuropsychiatric Disease and Treatment | volume = 3 | issue = 1 | pages = 41–58 | date = February 2007 | pmid = 19300537 | pmc = 2654524 | doi = 10.2147/nedt.2007.3.1.41 | doi-access = free }}{{cite HMDB|author1-link=David S. Wishart|url=http://www.hmdb.ca/metabolites/HMDB0014322|title=Showing metabocard for Fluvoxamine (HMDB0014322)}} and was later in 2005 the first drug to be approved for the treatment of social anxiety disorder.{{cite web | title = Solvay's Fluvoxamine maleate is first drug approved for the treatment of social anxiety disorder in Japan | url = https://www.fdanews.com/articles/81585-solvay-s-fluvoxamine-maleate-is-first-drug-approved-for-treatment-of-social-anxiety-disorder-in-japan | access-date = 15 September 2018 | archive-date = 15 September 2018 | archive-url = https://web.archive.org/web/20180915122310/https://www.fdanews.com/articles/81585-solvay-s-fluvoxamine-maleate-is-first-drug-approved-for-treatment-of-social-anxiety-disorder-in-japan | url-status = live }} Fluvoxamine was the first SSRI approved for clinical use in the United Kingdom.{{cite book | isbn = 978-0-7020-4293-5 | title = Clinical Pharmacy and Therapeutics | year = 2007 | orig-year = 1994 | publisher = Churchill Livingstone Elsevier | location = Edinburgh | edition = 4th | veditors = Walker R, Whittlesea C }} Manufacturers include BayPharma, Synthon, and Teva, among others.{{cite web |title=Fluvoxamine |url=https://www.drugbank.ca/drugs/DB00176 |website=www.drugbank.ca |access-date=22 October 2019 |archive-date=4 November 2019 |archive-url=https://web.archive.org/web/20191104161742/https://www.drugbank.ca/drugs/DB00176 |url-status=live }}

A 2022 review concluded that according to low-certainty evidence, fluvoxamine may slightly decrease all-cause mortality by day 28 and potentially reduce the risk of hospitalization or death in outpatients with mild COVID-19.{{cite journal |vauthors=Nyirenda JL, Sofroniou M, Toews I, Mikolajewska A, Lehane C, Monsef I, Abu-Taha A, Maun A, Stegemann M, Schmucker C |title=Fluvoxamine for the treatment of COVID-19 |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=9 |pages=CD015391 |date=September 2022 |pmid=36103313 |pmc=9473347 |doi=10.1002/14651858.CD015391 |type=Systematic review}} While early studies have suggested potential benefits for fluvoxamine as an anti-inflammatory agent and a possible impact on reducing cytokine storms, further studies did not confirm this expected benefit on COVID-19 patients.{{cite journal | vauthors = Bhuta S, Khokher W, Kesireddy N, Iftikhar S, Beran A, Mhanna M, Patel NJ, Patel M, Burmeister C, Assaly R | title = Fluvoxamine in Nonhospitalized Patients With Acute COVID-19 Infection and the Lack of Efficacy in Reducing Rates of Hospitalization, Mechanical Ventilation, and Mortality in Placebo-Controlled Trials: A Systematic Review and Meta-Analysis | journal = American Journal of Therapeutics | volume = 29 | issue = 3 | pages = e298–e304 | date = 2022 | pmid = 35383578 | doi = 10.1097/MJT.0000000000001496 | s2cid = 247978477 | doi-access = free }}{{cite journal | vauthors = Asadi Anar M, Foroughi E, Sohrabi E, Peiravi S, Tavakoli Y, Kameli Khouzani M, Behshood P, Shamshiri M, Faridzadeh A, Keylani K, Langari SF, Ansari A, Khalaji A, Garousi S, Mottahedi M, Honari S, Deravi N | title = Selective serotonin reuptake inhibitors: New hope in the fight against COVID-19 | journal = Frontiers in Pharmacology | volume = 13 | issue = | pages = 1036093 | date = 2022 | pmid = 36532776 | pmc = 9748354 | doi = 10.3389/fphar.2022.1036093 | doi-access = free }} A cytokine storm refers to an excessive immune response characterized by a release of large amounts of pro-inflammatory cytokines.{{cite journal | vauthors = Hu B, Huang S, Yin L | title = The cytokine storm and COVID-19 | journal = Journal of Medical Virology | volume = 93 | issue = 1 | pages = 250–256 | date = January 2021 | pmid = 32592501 | pmc = 7361342 | doi = 10.1002/jmv.26232 }}

In May 2022, based on a review of available scientific evidence, the U.S. Food and Drug Administration (FDA) chose not to issue an emergency use authorization covering the use of fluvoxamine to treat COVID-19, saying that, at the time, the data was not sufficient to conclude that fluvoxamine may be effective in treating non-hospitalized people with COVID-19 to prevent serious illness or hospitalization. The agency stated that study results suggest that further clinical trials may be warranted.{{cite news |title=FDA declines to authorize common antidepressant as COVID treatment |url=https://www.reuters.com/business/healthcare-pharmaceuticals/fda-declines-authorize-common-antidepressant-covid-treatment-2022-05-16/ |access-date=18 May 2022 |work=Reuters |date=16 May 2022 |archive-date=17 May 2022 |archive-url=https://web.archive.org/web/20220517202625/https://www.reuters.com/business/healthcare-pharmaceuticals/fda-declines-authorize-common-antidepressant-covid-treatment-2022-05-16/ |url-status=live }}{{cite tech report |type=Memorandum |title=Memorandum Explaining Basis for Declining Request for Emergency Use Authorization of Fluvoxamine Maleate |id=4975580 |institution=Food and Drug Administration |date=16 May 2022 |url=https://www.accessdata.fda.gov/drugsatfda_docs/nda/2020/EUA%20110%20Fluvoxamine%20Decisional%20Memo_Redacted.pdf |archive-url=https://web.archive.org/web/20220517001646/https://www.accessdata.fda.gov/drugsatfda_docs/nda/2020/EUA%20110%20Fluvoxamine%20Decisional%20Memo_Redacted.pdf |archive-date=17 May 2022 |url-status=live}} {{PD-notice}}

Reviews published in 2024 indicate that clinical trials have shown fluvoxamine to be more effective than a placebo in reducing clinical deterioration and hospitalization in COVID-19 patients, particularly those taking 200 mg or more daily.{{cite journal |vauthors=Deng J, Moskalyk M, Zuo QK, Garcia C, Abbas U, Ramaraju HB, Rayner D, Park YJ, Heybati K, Zhou F, Lohit S |title=Evaluating fluvoxamine for the outpatient treatment of COVID-19: A systematic review and meta-analysis |journal=Rev Med Virol |volume=34 |issue=1 |pages=e2501 |date=January 2024 |pmid=38148036 |doi=10.1002/rmv.2501|doi-access=free }}{{cite journal |vauthors=Prasanth MI, Wannigama DL, Reiersen AM, Thitilertdecha P, Prasansuklab A, Tencomnao T, Brimson S, Brimson JM |title=A systematic review and meta-analysis, investigating dose and time of fluvoxamine treatment efficacy for COVID-19 clinical deterioration, death, and Long-COVID complications |journal=Sci Rep |volume=14 |issue=1 |pages=13462 |date=June 2024 |pmid=38862591 |pmc=11166997 |doi=10.1038/s41598-024-64260-9 |bibcode=2024NatSR..1413462P |url=}}{{cite journal |vauthors=Zhou Q, Zhao G, Pan Y, Zhang Y, Ni Y |title=The efficacy and safety of fluvoxamine in patients with COVID-19: A systematic review and meta-analysis from randomized controlled trials |journal=PLOS ONE |volume=19 |issue=5 |pages=e0300512 |date=2024 |pmid=38753761 |pmc=11098472 |doi=10.1371/journal.pone.0300512 |doi-access=free |bibcode=2024PLoSO..1900512Z |url=}}

Fluvoxamine is a common finding in waters near human settlement. Christensen et al. 2007 finds it is "very toxic to aquatic organisms" by European Union standards.

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|{{*}} {{cite journal | vauthors = Chia MA, Lorenzi AS, Ameh I, Dauda S, Cordeiro-Araújo MK, Agee JT, Okpanachi IY, Adesalu AT | title = Susceptibility of phytoplankton to the increasing presence of active pharmaceutical ingredients (APIs) in the aquatic environment: A review | journal = Aquatic Toxicology | volume = 234 | pages = 105809 | date = May 2021 | pmid = 33780670 | doi = 10.1016/j.aquatox.2021.105809 | publisher = Elsevier | bibcode = 2021AqTox.23405809C | s2cid = 232419482 }}

|{{*}} {{cite journal | vauthors = Christensen AM, Faaborg-Andersen S, Ingerslev F, Baun A | title = Mixture and single-substance toxicity of selective serotonin reuptake inhibitors toward algae and crustaceans | journal = Environmental Toxicology and Chemistry | volume = 26 | issue = 1 | pages = 85–91 | date = January 2007 | pmid = 17269464 | doi = 10.1897/06-219R.1 | publisher = John Wiley & Sons, Inc. (Society of Environmental Toxicology and Chemistry (SETAC)) | s2cid = 6562531 | doi-access = free | bibcode = 2007EnvTC..26...85C }}

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