Fluvoxamine cardiovascular

SSRIs are widely used for treatment of depression, as well as, for example, panic disorders and obsessive—compulsive disorder. These dmgs are well recognized as clinically effective antidepressants having an improved side-effect profile as compared to the TCAs and irreversible MAO inhibitors. Indeed, these dmgs lack the anticholinergic, cardiovascular, and sedative effects characteristic of TCAs. Their main adverse effects include nervousness /anxiety, nausea, diarrhea or constipation, insomnia, tremor, dizziness, headache, and sexual dysfunction. The most commonly prescribed SSRIs for depression are fluoxetine (31), fluvoxamine (32), sertraline (52), citalopram (53), and paroxetine (54). SSRIs together represent about one-fifth of total worldwide antidepressant unit sales. 

Tricyclic drugs have, as the name implies, a three-ring structure, and interfere with reuptake of norepinephrine and/or serotonin into axon terminals. Tricyclic drugs include imipramine (Tofranil), amitriptyline (Elavil), clomipramine (Anafranil), and nortriptyline (Pamelor, Aventil). Tricyclics have the occasional but unfortunate cardiovascular side effects of arrhythmia and postural hypotension. Newer, nontricyclic antidepressants have been developed that are collectively referred to as SSRIs. These have a potent and selective action on serotonin, and lack the cardiovascular side effects of the tricyclics. These include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and fluvoxamine (Luvox). A fifth SSRI, citalopram (Celexa) has been used in Europe and has recently been approved in the United States. Venlafaxine (Effexor) blocks reuptake of norepinephrine and serotonin, while bupropion (Wellbutrin) acts on both dopamine and norepinephrine. 

A slight, clinically unimportant reduction in heart rate has been reported with fluvoxamine (11,12). There has been one report of supraventricular tachycardia in a woman with no previous cardiovascular disease, but the association with fluvoxamine was unclear since there was no rechallenge (SEDA-16, 9). 

Robinson JF, Doogan DP. A placebo controlled study of the cardiovascular effects of fluvoxamine and clovoxamine in human volunteers. Br J Clin Pharmacol 1982 4(6) 805-8. 

The SSRIs include fluoxetine, citalopram, sertraline, paroxetine, es-citalopram, and fluvoxamine. The SSRIs have a low affinity for his-taminic, a i-adrenergic, and muscarinic receptors, and therefore produce fewer anticholinergic and cardiovascular adverse effects than the TCAs, and are not associated with weight gain. The most... 

The multiple-dose elimination half-life of fluvoxamine was 17.4 and 25.9 hours in the elderly as compared to 13.6 and 15.6 hours in younger subjects at steady state for 50- and 100-mg doses, respectively. The safety of fluvoxamine has not been adequately studied in the elderly and patients with cardiovascular disease. Dosage should be titrated slowly during initiation of fluvoxamine therapy in elderly patients. 

A study in 11 healthy subjects found that paroxetine 20 mg daily for 16 days had no effect on the response to a 6-mg dose of subcutaneous sumatriptan, as measured by prolactin levels. The sumatriptan levels remained unaltered, its cardiovascular effects were unchanged and no clinically significant adverse effects occurred. Other studies report that the concurrent use of sumatriptan and SSRIs (fluoxetine 20 to 60 mg daily, fluvoxamine 200 mg daily, paroxetine 20 to 50 mg daily, sertraline 50 to 100 mg daily) was successful and uneventful. No adverse effects have been noted in 148 other patients. However, a case report describes a 65-year-old woman who had been taking paroxetine 20 mg [daily] for a number of years, who developed confusion, strange behaviour, sinus tachycardia, hypertension and hyperthermia shortly after starting sumatriptan. The serotonin syndrome was diagnosed, and she recovered completely on withdrawal of the two drugs. ... 

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