Fluvoxamine long-term effects

Paroxetine and placebo had similar tolerability, whereas clomipramine was less well tolerated, with more patients withdrawn from treatment as a result of emergent adverse events. Holland et al. (1994) reported on the effects of long-term treatment with fluvoxamine in patients who had completed a double-blind study. Patients who were transferred from placebo to fluvoxamine and those who continued taking fluvoxamine showed continued improvement in efficacy parameters. 

Fluoxetine, paroxetine, fluvoxamine, and citalopram, as well as clomipramine, have been shown in placebo-controlled, double-blind studies to be safe and effective antipanic drugs for shortterm PD therapy. Evidence also is accumulating to suggest that these drugs may be effective for long-term panic treatment, but more data are needed to confirm this. 

SSRIs with shorter half-lives, such as fluvoxamine and paroxetine (qv), have a higher incidence of withdrawal symptoms than long-acting ones, but withdrawal effects have been reported, albeit rarely, after withdrawal of fluoxetine (qv) (SEDA-20, 8) (76) and citalopram (77). Patients taking high doses, long-term treatment, or both are at increased risk of developing withdrawal symptoms (76,78). 

The diversity of the SSRIs is evident not only in their chemical structures, but also in their pharmacokinetic profiles. Fluoxetine has an elimination half-fife of 2 to 3 days (4 to 5 days with multiple dosing). The single-dose hah-hfe of norfluoxetine, the active metabolite, is 7 to 9 days. Paroxetine and sertrahne have half-lives of approximately 24 hours. Unlike paroxetine, sertraline has an active metabolite, but the metabohte contributes minimally to the pharmacologic effects. Escitalopram has a half-life of approximately 30 hours. Peak plasma concentrations of citalopram are observed within 2 to 4 hours after dosing, and the elimination half-life is about 30 hours. The SSRIs, with the exception of fluvoxamine, escitalopram, and citalopram, are extensively bound to plasma proteins (94% to 99%). The SSRIs are extensively distributed to the tissues, and aU, with the possible exception of citalopram, may have a nonlinear pattern of drug accumulation with long-term administration. ... 

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