SSRI (Selective Serotonin Reuptake Inhibitor)
Selective serotonin reuptake inhibitor (SERT) with sigma-1 receptor agonism, potentially contributing to anxiolytic, pro-cognitive, and rapid-onset effects.
Obsessive-compulsive disorder (OCD)
Major depressive disorder (MDD), generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), post-stroke depression (PSD), irritability and compulsivity associated with autism spectrum disorder (ASD)
Oral immediate-release and controlled-release tablets (25 mg, 50 mg, 100 mg)
25–50 mg p.o. daily, titrating gradually to 50–300 mg/day as tolerated
50–300 mg/day
Half-life ~15 hours; potent inhibitor of CYP1A2 and CYP2C19; steady state in ~1 week
Nausea, sedation, sexual dysfunction, insomnia, gastrointestinal upset
Serotonin syndrome, hyponatremia, drug interactions due to CYP inhibition
Monitor for serotonin syndrome, early activation, gastrointestinal symptoms, and drug interactions, especially in polypharmacy
Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults with MDD and other psychiatric disorders
Fluvoxamine may reduce compulsive behaviors and irritability in patients with autism spectrum disorder (ASD), intellectual disability, or traumatic brain injury (TBI)-related disinhibition. Its sigma-1 receptor agonism may underlie rapid-onset anxiolytic, pro-cognitive, and sleep benefits, particularly in neuropsychiatric conditions. Use caution in elderly patients and those on multiple medications due to high interaction potential via CYP1A2 and CYP2C19 inhibition. Monitor closely for early activation, gastrointestinal symptoms, and serotonergic excess when combined with other serotonergic agents.