Description
Rocona Pharmacodynamics
Receptor binding studies have shown that fluvoxamine is a potent serotonin reuptake inhibitor both in vitro and in vivo with minimal affinity for serotonin receptors. Its ability to bind to alpha- and beta-adrenoreceptors, histamine, m-choline or dopamine receptors is negligible.
Fluvoxamine has a high affinity for Q receptors, acting as their agonist.
Indications
– Depression of different genesis;
– Obsessive-compulsive disorders.
Contraindications
– Concomitant use with tizanidine and monoamine oxidase inhibitors (MAO inhibitors).
Treatment with fluvoxamine may be initiated:
– 2 weeks after discontinuation of an irreversible MAO inhibitor;
– The day after discontinuation of a reversible MAO inhibitor (e.g., moclobemide, linezolid).
The time interval between discontinuation of fluvoxamine and initiation of therapy with any MAOI inhibitor should be at least one week.
– concomitant use with ramelteon (see section “Interaction with other medicinal products”);
– hypersensitivity to the active substance or any of the drug components.
Dosage and administration
- Tablets fluvoxamine should be taken orally, without chewing, with water. The tablet may be divided into two equal parts.
- Depression
- Adults
- The recommended starting dose for adults is 50 mg or 100 mg (once in the evening). After 3-4 weeks of therapy, the dose should be reviewed and adjusted according to clinical experience with the drug. A gradual increase in dose to the effective dose is recommended.
- The effective daily dose, usually 100 mg, is adjusted individually depending on the patient’s response to treatment. The daily dose may be as high as 300 mg. Daily doses over 150 mg are recommended to be divided into 2 or 3 doses. The selection of the minimum effective maintenance dose should be done with caution on an individual basis.
- According to the official WHO recommendations, treatment with antidepressants should be continued for at least 6 months of remission after a depressive episode. To prevent recurrences of depression, it is recommended to take 100 mg of the drug once a day, daily.
- Dates
- Because of a lack of clinical experience, fluvoxamine is not recommended for the treatment of depression in children under 18 years of age.
- Obsessive-compulsive disorder (OCD)
- Adults
- The recommended starting dose for adults is 50 mg of the drug daily for 3-4 days. The effective daily dose is usually 100 mg to 300 mg. Doses should be increased gradually until the effective daily dose is achieved, which should not exceed 300 mg in adults. Doses up to 150 mg may be taken once daily, preferably in the evening. Daily doses over 150 mg are recommended to be divided into 2 or 3 doses.
- If there is a good therapeutic response to the drug, treatment may be continued with an individually tailored daily dose. If improvement is not achieved after 10 weeks, treatment with fluvoxamine should be reconsidered. To date, no systemic studies have been organized to answer the question of how long treatment with fluvoxamine can be maintained, but obsessive-compulsive disorder is chronic, and therefore it may be considered appropriate to extend fluvoxamine treatment beyond 10 weeks in patients who respond well to the drug. The selection of the minimum effective maintenance dose should be done with caution on a case-by-case basis. The need for treatment should be reassessed periodically. Some clinicians recommend concomitant psychotherapy in patients who respond well to pharmacotherapy. Long-term efficacy (more than 24 weeks) has not been confirmed.
- Children over 8 years of age and adolescents
- In children over 8 years of age and adolescents, there are limited data on use in doses greater than 100 mg twice daily for 10 weeks. The starting dose for children over 8 years of age and adolescents is 25 mg/day for a single dose, preferably before bedtime. The dose should be increased by 25 mg to the tolerated dose every 4 to 7 days until an effective daily dose is reached. The effective dose is usually 50 to 200 mg/day, the maximum dose in children should not exceed 200 mg/day. Daily doses over 50 mg are recommended to be divided into two doses, and if the two doses received are unequal, the larger dose should be taken before bedtime.
- Withdrawal syndrome after discontinuation of fluvoxamine
- Abrupt withdrawal of the drug should be avoided. When treatment with fluvoxamine is discontinued, the dose should be gradually reduced over a minimum of 1-2 weeks to reduce the risk of withdrawal (see Side Effects and Precautions). If intolerable symptoms occur after dose reduction or after withdrawal of treatment, consideration may be given to resuming treatment at the previously recommended dose.
