Fluvoxamine

INTRODUCTION

Indications

Obsessive-compulsive disorder (OCD) (immediate and controlled release). Social anxiety disorder (SAD) (controlled release only). Unlabeled Use: Depression. Generalized anxiety disorder (GAD). Posttraumatic stress disorder (PSTD).

Action

Inhibits the reuptake of serotonin in the CNS. Therapeutic Effects: Decrease in obsessive-compulsive behaviors. Decrease in symptoms of social anxiety disorder.

Adverse Reactions/Side Effects

CNS: NEUROLEPTIC MALIGNANT SYNDROME, sedation, dizziness, drowsiness, headache, insomnia, nervousness, weakness, agitation, anxiety, apathy, emotional lability, manic reactions, mental depression, psychotic reactions, syncope. EENT: sinusitis. Resp: cough, dyspnea. CV: edema, hypertension, palpitations, postural hypotension, tachycardia, vasodilation. GI: constipation, diarrhea, dry mouth, dyspepsia, nausea, anorexia, dysphagia, ↑ liver enzymes, flatulence, weight gain (unusual), vomiting. GU: ↓ libido/sexual dysfunction. Derm: ↑ sweating. Metab: weight gain, weight loss. MS: hypertonia, myoclonus/twitching. Neuro: hypokinesia/hyperkinesia, tremor. Misc: SEROTONIN SYNDROME, allergic reactions, chills, flu-like symptoms, tooth disorder/caries, yawning.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for signs of neuroleptic malignant syndrome, including hyperthermia, diaphoresis, generalized muscle rigidity, altered mental status, tachycardia, changes in blood pressure (BP), and incontinence. Symptoms typically occur within 4–14 days after initiation of drug therapy, but can occur at any time during drug use. Report these signs to the physician immediately.

• Monitor and report signs of serotonin syndrome, including hyperthermia, rigidity, myoclonus, and autonomic instability with fluctuating vital signs and extreme agitation that may proceed to delirium and coma. Patients should not take fluvoxamine with other drugs that increase serotonin levels (e.g., MAO inhibitors).

• Be alert for increased depression and suicidal thoughts and ideology, especially when initiating drug treatment, and in children and teenagers. Notify physician or other mental health care professional immediately if patient exhibits worsening depression or expresses thoughts of suicide.

• Monitor other alterations in behavior or mental status, including nervousness, anxiety, agitation, apathy, emotional lability, and manic/psychotic reactions. Notify physician promptly if these symptoms develop.

• Assess BP periodically and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension) or symptomatic decreases in BP following changes in position (orthostatic hypotension). Document orthostatic hypotension and contact physician when systolic BP falls >20 mm Hg, or diastolic BP falls >10 mm Hg as patient assumes a more upright position.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to ...