Luvox Indications and Dosage
- anxiety †
- autism †
- bulimia nervosa †
- depression †
- obsessive-compulsive disorder (OCD)
- panic disorder †
- posttraumatic stress disorder (PTSD) †
- premenstrual dysphoric disorder (PMDD) †
- schizophrenia †
- social phobia (social anxiety disorder) †
† non-FDA-approved indication
Luvox (Fluvoxamine) Indications and Dosage
For the treatment of various anxiety † disorders:
- for generalized anxiety † disorder (GAD) or social phobia (social anxiety disorder) † :
Oral dosage:
Adults: Initially, 50 mg PO at bedtime, then modify as needed. Increments of up to 50 mg can be made at intervals of 4 - 7 days as needed until therapeutic benefit is reached. Mean effective dose based on limited clinical trials is 200 mg/day, with a range of 50 - 300 mg/day. Total daily doses > 100 mg/day should be given in divided doses. If doses are unequal, the larger of the 2 doses should be given at bedtime.
Elderly: See adult dosage. The elderly may require a reduced initial dose and slower titration relative to a younger adult.
Adolescents 12 - 17 years: Initially, 25 mg PO once daily at bedtime. Increase as needed in 25 - 50 mg increments every 4 - 7 days up to a maximum of 300 mg/day PO. Total daily doses > 50 mg/day should be given in divided doses. If the 2 daily doses are not equal, the larger of the 2 doses should be given at bedtime.
Children 6 - 11 years: Initially, 25 mg PO once daily at bedtime. Increase as needed in 25 - 50 mg increments every 4 - 7 days up to a maximum of 250 mg/day PO. Total daily doses > 50 mg/day should be given in divided doses.
Children < 6 years: Safe and effective use has not been established.
- for the treatment of obsessive-compulsive disorder (OCD):
Oral dosage:
Adults: Initially, 50 mg PO at bedtime, then modify as needed. Increments of 50 mg can be made at intervals of 4 - 7 days until therapeutic benefit is reached. Usual dose is 100 - 200 mg/day, with a range of 50 - 300 mg/day. Total daily doses > 100 mg/day should be given in divided doses. If doses are unequal, the larger of the 2 doses should be given at bedtime.
Elderly: See adult dosage. The elderly may require a reduced initial dose and slower titration relative to a younger adult.
Adolescents 12 - 17 years: Initially, 25 mg PO once daily at bedtime. Increase as needed in 25 mg increments every 4 - 7 days up to a maximum of 300 mg/day PO. Total daily doses > 50 mg/day should be given in divided doses. If the 2 daily doses are not equal, the larger of the 2 doses should be given at bedtime.
Children 8 - 11 years: Initially, 25 mg PO once daily at bedtime. Increase as needed in 25 mg increments every 4 - 7 days up to a maximum of 200 mg/day PO. Total daily doses > 50 mg/day should be given in divided doses. If the 2 daily doses are not equal, the larger of the 2 doses should be given at bedtime.
Children < 8 years: Safe and effective use has not been established.
- for the treatment of panic disorder † :
Oral dosage:
Adults: Initially, 50 mg PO at bedtime for the first 4 - 7 days, followed by titration of 25 - 50 mg at 4 - 7 day intervals as needed to reach a therapeutic dose. Usual dose is 150 - 300 mg/day PO in single or divided doses for 6 - 8 weeks. Total daily doses > 100 mg/day should be given in divided doses. If doses are unequal, the larger of the 2 doses should be given at bedtime.
Elderly: See adult dosage. The elderly may require a reduced initial dose and slower titration relative to a younger adult.
- for the treatment of posttraumatic stress disorder (PTSD) † :
Oral dosage:
Adults: Initially, 25 - 50 mg PO at bedtime for the first 4 - 7 days, followed by dose increases of 25 - 50 mg at 4 - 7 day intervals as needed to reach a therapeutic dose. Usual dosage range 25 - 300 mg/day PO in single or divided doses for 3 - 12 weeks. Fluvoxamine has been effective for a wide variety of traumatic stressors, including combat. Total daily doses > 100 mg/day should be given in divided doses. If doses are unequal, the larger of the 2 doses should be given at bedtime.
Elderly: See adult dosage. Because of decreased clearance, the initial dose may require modification and slow and careful titration (relative to a younger adult).
For the treatment of major depression † :
NOTE: Generally, acute episodes of depression require several months of sustained pharmacologic therapy. Whether the dose needed to induce remission is identical to that needed for maintenance is unknown.
Oral dosage:
Adults: Although not an approved indication, the manufacturer recommends 50 mg PO at bedtime for the first 4 - 7 days, followed by titration of 25 - 50 mg at 4 - 7 day intervals up to a maximum of 150 mg/day. Doses of 50 - 300 mg/day PO in single or divided doses have been used. The average dose is 100 mg/day. Total daily doses > 100 mg/day should be given in divided doses. If doses are unequal, the larger of the 2 doses should be given at bedtime. In one double-blind study, response to fluvoxamine was superior to imipramine and less adverse reactions occurred in the fluvoxamine group relative to imipramine. Systematic evaluations of the SSRIs have shown that antidepressant efficacy is maintained for up to 1 year of active treatment.
Elderly: See adult dosage. The elderly may require a reduced initial dose and slower titration relative to a younger adult.
Adolescents 12 - 17 years: Initially, 25 mg PO once daily at bedtime. Increase dose in 25 mg increments every 4 - 7 days as tolerated up to a maximum of 300 mg/day PO. Total daily doses > 50 mg/day should be given in divided doses. If the 2 daily doses are not equal, the larger of the 2 doses should be given at bedtime.
Children 8 - 11 years: Initially, 25 mg PO once daily at bedtime. Increase as needed in 25 mg increments every 4 - 7 days up to a maximum of 200 mg/day PO. Total daily doses > 50 mg/day should be given in divided doses. If the 2 daily doses are not equal, the larger of the 2 doses should be given at bedtime.
Children < 8 years: Safe and effective use has not been established.
For the adjuvant treatment of schizophrenia † :
Oral dosage:
Adults: 100 mg PO once daily, used in conjunction with other agents used for schizophrenia. Total daily doses > 100 mg/day should be given in divided doses. If doses are unequal, the larger of the 2 doses should be given at bedtime.
Elderly: See adult dosage. Because of decreased clearance, the initial dose may require modification and slow and careful titration (relative to a younger adult).
For the treatment of autism † :
Oral dosage:
Adults: Although data are limited, doses ranging up to 150 mg/day PO have been used in a limited number of autistic adults. Total daily doses > 100 mg/day should be given in divided doses. If doses are unequal, the larger of the 2 doses should be given at bedtime.
For the treatment of bulimia nervosa † :
Oral dosage:
Adults: Initially, 50 mg PO at bedtime for the first 4 - 7 days, followed by titration of 25 - 50 mg at 4 - 7 day intervals as needed until therapeutic response; usual dose is 50 - 200 mg/day PO in single or divided doses for 4 - 12 weeks. Total daily doses > 100 mg/day should be given in divided doses. If doses are unequal, the larger of the 2 doses should be given at bedtime.
For the treatment of premenstrual dysphoric disorder (PMDD) † according to the criteria of the DSM-IV:
Oral dosage:
Adult females: Initially, 50 mg/day PO has been used, may titrate up to 100 mg PO once daily administered throughout the menstrual cycle.
Maximum Dosage Limits:
- Adults: 300 mg/day PO.
- Elderly: 300 mg/day PO; however, lower dosages are effective and may be better tolerated due to decreased drug clearance.
- Adolescents: 300 mg/day PO.
- Children >= 6 years: 250 mg/day PO.
- Children < 6 years: Safe and effective use has not been established.
Patients with hepatic impairment:
Hepatic impairment reduces fluvoxamine clearance by about 30%. A modified initial dose and modification of the rate of subsequent dosage titration are advisable.
Patients with renal impairment:
CrCl >= 5 ml/min: It appears that no dosage adjustments are needed. Dosages of 50 mg PO twice daily did not result in drug accumulation after 6 weeks of treatment in clinical trials.
CrCl < 5 ml/min: Specific guidelines for dosage adjustments are not available; it appears that no dosage adjustments are needed.
Intermittent hemodialysis:
Specific guidelines for dosage adjustments are not available; it appears that no dosage adjustments are needed. Fluvoxamine is unlikely to be removed by hemodialysis given its extensive tissue distribution.
† non-FDA-approved indication
[ Last revised: 2/19/2003 1:08:00 PM ]
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