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Fluvoxamine

Also indexed as: Faurin®, Luvox®

Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) drug, related to Prozac®. It is used primarily to treat obsessive-compulsive disorder and is under investigation to treat depression.

Interactions with Dietary Supplements

5-Hydroxytryptophan (5-HTP) and L-tryptophan
Fluvoxamine works by increasing serotonin activity in the brain. 5-HTP and L-tryptophan are converted to serotonin in the brain, and taking them with fluvoxamine may increase fluvoxamine-induced side effects. Until more is known, 5-HTP and L-tryptophan should not be taken with any SSRI drug, including fluvoxamine.

Melatonin
Fluvoxamine has been shown to significantly raise the amount of melatonin in the blood after oral administration.1 Researchers suggest that fluvoxamine may inhibit elimination of melatonin, but the clinical significance of this finding is as yet unclear.

Interactions with Herbs

Ginkgo (Ginkgo biloba)
Ginkgo biloba extract (GBE) may reduce the side effects experienced by some persons taking SSRIs such as fluoxetine or sertraline. An open-label study with elderly, depressed persons found that 200–240 mg of GBE daily was effective in alleviating sexual side effects in both men and women taking SSRIs.2

One case study reported that 180–240 mg of GBE daily reduced genital anesthesia and sexual side effects secondary to fluoxetine use in a 37-year-old woman.3

St. John’s wort (Hypericum perforatum)
One report describes a case of serotonin syndrome in a patient who took St. John’s wort and trazodone, a weak SSRI drug.4 The patient experienced mental confusion, muscle twitching, sweating, flushing, and ataxia. In another case, a patient experienced grogginess, lethargy, nausea, weakness, and fatigue after taking one dose of paroxetine (Paxil®, an SSRI drug related to fluvoxamine) after ten days of St. John’s wort.5 Until more is known about interactions and adverse actions, people taking any SSRI drugs, including fluvoxamine, should avoid St. John’s wort, unless they are being closely monitored by a doctor.

Yohimbe (Pausinystalia yohimbe)
The alkaloid yohimbine from the African yohimbe tree affects the nervous system in a way that may complement fluvoxamine. One report studied depressed people who had not responded to fluvoxamine. When 5 mg of yohimbine was added three times each day, there was significant improvement. Some people required higher amounts of yohimbine before their depression improved. Because yohimbine can have side effects, it should only be taken under a doctor’s supervision. Yohimbine is a prescription drug, but standardized extracts of yohimbe that contain yohimbine are available as a supplement.

Interactions with Foods and Other Compounds

Alcohol
SSRI drugs, including fluvoxamine, may cause dizziness or drowsiness.6 Alcohol may intensify the drowsiness and increase the risk of accidental injury. People should avoid alcohol-containing products during fluvoxamine treatment.

Tobacco (Nicotiana species)
Smoking increases the metabolism of fluvoxamine, which may reduce effectiveness.7 People should avoid smoking while taking fluvoxamine.

Summary of Interactions for Fluvoxamine

Depletion or interference None known
Adverse interaction 5-HTP
L-tryptophan
St. John’s wort*
Tobacco
Side effect reduction/prevention Ginkgo
Supportive interaction Yohimbe*
Reduced drug absorption/bioavailability None known
Other (see text) Melatonin

For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

References:

1. Härtter S, Grözinger M, Weigmann H, et al. Increased bioavailability of oral melatonin after fluvoxamine coadministration. Clin Pharmacol Ther 2000;67:1–6.

2. Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther 1998;24:139–45.

3. Ellison JM, DeLuca P. Fluoxetine-induced genital anesthesia relieved by Ginkgo biloba extract. J Clin Psychiatry 1998;59:199–200.

4. Demott K. St. John’s wort tied to serotonin syndrome. Clin Psychiatr News 1998;26:28.

5. Gordon JB. SSRIs and St. John’s wort: possible toxicity? Am Fam Physician 1998;57:950.

6. Threlkeld DS, ed. Central Nervous System Drugs, Antidepressants, Selective Serotonin Reuptake Inhibitors. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Apr 1997, 264s.

7. Spigset O, Carleborg L, Hedenmalm K, Dahlqvist R. Effect of cigarette smoking on fluvoxamine pharmacokinetics in humans. Clin Pharmacol Ther 1995;58:399–403.