Luvox for ocd
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Luvox for Obsessive-Compulsive Disorder (OCD)
Introduction to Luvox and OCD Treatment
Luvox (fluvoxamine maleate) is a selective serotonin reuptake inhibitor (SSRI) indicated for the treatment of obsessions and compulsions in patients with Obsessive-Compulsive Disorder (OCD) 123. OCD is characterized by recurrent and persistent ideas, thoughts, impulses, or images (obsessions) that are ego-dystonic and/or repetitive, purposeful, and intentional behaviors (compulsions) that are recognized by the person as excessive or unreasonable 123.
Efficacy and Usage
Luvox has been shown to be effective in reducing the symptoms of OCD in both adults and children aged 8-17 57. The efficacy of Luvox was established in two 10-week trials with obsessive-compulsive outpatients . However, the long-term effectiveness of Luvox beyond 10 weeks has not been systematically evaluated, and physicians are advised to periodically re-evaluate the long-term usefulness of the drug for individual patients .
Contraindications and Warnings
Drug Interactions
Luvox is contraindicated in patients with a history of hypersensitivity to fluvoxamine maleate and should not be co-administered with terfenadine, astemizole, or cisapride due to the risk of serious, sometimes fatal, reactions 123. These drugs are metabolized by the cytochrome P450 IIIA4 isoenzyme, and increased plasma concentrations can cause QT prolongation and torsades de pointes-type ventricular tachycardia 123.
MAOIs
Patients receiving another serotonin reuptake inhibitor in combination with monoamine oxidase inhibitors (MAOIs) have reported serious, sometimes fatal, reactions. Therefore, it is recommended that Luvox not be used in combination with an MAOI or within 14 days of discontinuing treatment with an MAOI 123.
Precautions
Activation of Mania/Hypomania
During premarketing studies, hypomania or mania occurred in approximately 1% of patients treated with fluvoxamine. This activation has also been reported in a small proportion of patients with major affective disorder treated with other marketed antidepressants. As with all antidepressants, Luvox should be used cautiously in patients with a history of mania 123.
Seizures
Seizures were reported in 0.2% of fluvoxamine-treated patients during premarketing studies. Luvox should be used cautiously in patients with a history of seizures and should be discontinued in any patient who develops seizures 123.
Suicide Risk
The possibility of a suicide attempt is inherent in patients with depressive symptoms, whether these occur in primary depression or in association with another primary disorder such as OCD. Close supervision of high-risk patients should accompany initial drug therapy, and prescriptions should be written for the smallest quantity of tablets consistent with good patient management to reduce the risk of overdose 123.
Drug Interactions
Benzodiazepines
Benzodiazepines metabolized by hepatic oxidation (e.g., alprazolam, midazolam, triazolam) should be used with caution because fluvoxamine reduces their clearance, potentially leading to increased plasma concentrations and decreased psychomotor performance and memory 123. The clearance of benzodiazepines metabolized by glucuronidation (e.g., lorazepam, oxazepam, temazepam) is unlikely to be affected by fluvoxamine 123.
Theophylline and Warfarin
The clearance of theophylline is decreased approximately three-fold when co-administered with fluvoxamine, necessitating a dose reduction to one-third of the usual daily maintenance dose 123. Similarly, warfarin plasma concentrations increased by 98% when co-administered with fluvoxamine, requiring monitoring of prothrombin time and adjustment of the anticoagulant dose 123.
Conclusion
Luvox is an effective treatment for OCD, but it requires careful management due to potential drug interactions and side effects. Physicians should monitor patients closely, especially those with a history of mania, seizures, or depressive symptoms. Regular re-evaluation of the drug's long-term usefulness is recommended to ensure optimal patient outcomes.
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