1
|
Deng J, Moskalyk M, Zuo QK, Garcia C, Abbas U, Ramaraju HB, Rayner D, Park YJ, Heybati K, Zhou F, Lohit S. Evaluating fluvoxamine for the outpatient treatment of COVID-19: A systematic review and meta-analysis. Rev Med Virol 2024; 34:e2501. [PMID: 38148036 DOI: 10.1002/rmv.2501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/11/2023] [Indexed: 12/28/2023]
Abstract
This systematic review and meta-analysis of randomised controlled trials (RCTs) aimed to evaluate the efficacy, safety, and tolerability of fluvoxamine for the outpatient management of COVID-19. We conducted this review in accordance with the PRISMA 2020 guidelines. Literature searches were conducted in MEDLINE, EMBASE, International Pharmaceutical Abstracts, CINAHL, Web of Science, and CENTRAL up to 14 September 2023. Outcomes included incidence of hospitalisation, healthcare utilization (emergency room visits and/or hospitalisation), mortality, supplemental oxygen and mechanical ventilation requirements, serious adverse events (SAEs) and non-adherence. Fluvoxamine 100 mg twice a day was associated with reductions in the risk of hospitalisation (risk ratio [RR] 0.75, 95% confidence interval [CI] 0.58-0.97; I 2 = 0%) and reductions in the risk of healthcare utilization (RR 0.68, 95% CI 0.53-0.86; I 2 = 0%). While no increased SAEs were observed, fluvoxamine 100 mg twice a day was associated with higher treatment non-adherence compared to placebo (RR 1.61, 95% CI 1.22-2.14; I 2 = 53%). In subgroup analyses, fluvoxamine reduced healthcare utilization in outpatients with BMI ≥30 kg/m2 , but not in those with lower BMIs. While fluvoxamine offers potential benefits in reducing healthcare utilization, its efficacy may be most pronounced in high-risk patient populations. The observed non-adherence rates highlight the need for better patient education and counselling. Future investigations should reassess trial endpoints to include outcomes relating to post-COVID sequelaes. Registration: This review was prospectively registered on PROSPERO (CRD42023463829).
Collapse
Affiliation(s)
- Jiawen Deng
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Myron Moskalyk
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Qi Kang Zuo
- UBC Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cristian Garcia
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Umaima Abbas
- Schulich School of Medicine & Dentistry (Windsor), Western University, Windsor, Ontario, Canada
| | | | - Daniel Rayner
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ye-Jean Park
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kiyan Heybati
- Mayo Clinic Alix School of Medicine (Jacksonville), Mayo Clinic, Jacksonville, Florida, USA
| | - Fangwen Zhou
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Simran Lohit
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Vatvani AD, Kurniawan A, Hariyanto TI. Efficacy and Safety of Fluvoxamine as Outpatient Treatment for Patients With Covid-19: A Systematic Review and Meta-analysis of Clinical Trials. Ann Pharmacother 2023; 57:1389-1397. [PMID: 37002592 PMCID: PMC10067701 DOI: 10.1177/10600280231162243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Fluvoxamine may be beneficial for the management of coronavirus disease 2019 (Covid-19) because of its effect on the sigma-1 receptor. Available evidence from randomized clinical trials (RCTs) has shown conflicting results. OBJECTIVE This study sought to analyze the efficacy and safety of fluvoxamine as an outpatient treatment for Covid-19. METHODS Using specific keywords, we comprehensively go through the potential articles on PubMed, Scopus, Europe PMC, and ClinicalTrials.gov sources until February 1, 2023. We collected all published clinical trials on fluvoxamine and Covid-19. We were using Review Manager 5.4 to conduct statistical analysis. RESULTS We include a total of 6 trials. Our pooled analysis revealed that fluvoxamine did not offer any significant benefit when compared with placebo in reducing the risk of clinical deterioration (risk ratio [RR] = 0.83; 95% CI: 0.65-1.06, P = 0.14, I2 = 29%), and hospitalization (RR = 0.80; 95% CI: 0.62-1.04, P = 0.09, I2 = 0%) of Covid-19 outpatients. The serious adverse events did not differ significantly between the 2 groups. CONCLUSIONS AND RELEVANCE This study indicates that although safe, fluvoxamine was not effective for outpatient treatment of Covid-19. Until more evidence can be obtained from larger RCTs, our study did not encourage the use of fluvoxamine as routine management for patients with Covid-19.
Collapse
Affiliation(s)
| | - Andree Kurniawan
- Department of Internal Medicine,
Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
| | | |
Collapse
|
3
|
Zhang F, Gong W, Cui Z, Li J, Lu Y. Rhabdomyolysis in a male adolescent associated with monotherapy of fluvoxamine. Eur J Hosp Pharm 2023; 30:302-304. [PMID: 36460460 PMCID: PMC10447953 DOI: 10.1136/ejhpharm-2022-003533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Abstract
Rhabdomyolysis is a syndrome resulting from striated muscular breakdown, which may occur due to drug therapy with agents such as selective serotonin reuptake inhibitors (SSRIs). Although studies have shown that fluvoxamine can rarely cause myalgia, there are no reported cases of rhabdomyolysis due to fluvoxamine monotherapy. Here we describe a case of rhabdomyolysis due to fluvoxamine monotherapy for obsessive-compulsive disorder. The young adolescent developed pain in the extremities, and an increase in serum creatine kinase (CK) and myoglobin during fluvoxamine treatment. These adverse reactions were reversed immediately after the medicine was changed to another SSRI-sertraline. This is the first reported case of fluvoxamine-associated rhabdomyolysis. It is advisable to determine serum CK levels before starting fluvoxamine treatment, and then at regular intervals, to avoid the occurrence of severe acute kidney injury with possible life-threatening complications.
Collapse
Affiliation(s)
- Furong Zhang
- Department of Pharmacy, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenting Gong
- Department of Pharmacy, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhou Cui
- Department of Pharmacy, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Li
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanyuan Lu
- Department of Pharmacy, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
4
|
Mahgoub Y, Abdelhady S, Elmarasi O, Franklin BR. The Potential Role of Fluvoxamine in Clozapine-Associated Constipation: A Case Report and Literature Review. J Clin Psychopharmacol 2023; 43:456-458. [PMID: 37683236 DOI: 10.1097/jcp.0000000000001729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
|
5
|
Yu CL, Carvalho AF, Thompson T, Tsai TC, Tseng PT, Hsu CW, Tu YK, Yang SN, Hsu TW, Yeh TC, Liang CS. Trial Sequential Analysis and Updated Meta-Analysis of Fluvoxamine on Clinical Deterioration in Adult Patients with Symptomatic COVID-19 Infection. Int J Environ Res Public Health 2023; 20:ijerph20054088. [PMID: 36901099 PMCID: PMC10002389 DOI: 10.3390/ijerph20054088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 05/26/2023]
Abstract
Preliminary meta-analyses suggested that fluvoxamine was effective in treating COVID-19 infection. However, the reliability of this evidence has not yet been examined. MEDLINE, CENTRAL, EMBASE, PsycINFO, and ClinicalTrials.gov were searched to identify any randomized controlled trials (RCTs) from the inception of the databases to 5 February 2023. We used trial sequential analysis (TSA) to examine the reliability of the current existing evidence on the benefits of fluvoxamine on COVID-19 infection. The primary outcome was clinical deterioration, as defined in the original study (reported as odds ratio (OR), with 95% confidence intervals), and the secondary outcome was hospitalization. In the TSA, we used the relative risk reduction thresholds of 10, 20, and 30%. The updated meta-analysis of the five RCTs showed that fluvoxamine was not associated with lower odds of clinical deterioration when compared with a placebo (OR: 0.81; 0.59-1.11). The effect of fluvoxamine lay within the futility boundary (i.e., lack of effect) when using a 30% relative risk reduction threshold. The effect estimates lay between the superiority and futility boundary using the 10% and 20% threshold, and the required size of information was not reached for these two thresholds. The effect of fluvoxamine on the odds of hospitalization was not statistically significant (0.76; 0.56-1.03). In conclusion, there is no reliable evidence that fluvoxamine, when compared to a placebo, reduces the relative risk of clinical deterioration among adult patients with COVID-19 infection by 30%, and a relative risk reduction of 20% or 10% is still uncertain. The role of fluvoxamine as a COVID-19 treatment cannot be justified.
Collapse
Affiliation(s)
- Chia-Ling Yu
- Department of Pharmacy, Chang-Gung Memorial Hospital, Linkou 244, Taiwan
| | - Andre F. Carvalho
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC 3220, Australia
| | - Trevor Thompson
- Centre for Chronic Illness and Ageing, University of Greenwich, London SE10 9LS, UK
| | - Tzu-Cheng Tsai
- Department of Pharmacy, Chang-Gung Memorial Hospital, Linkou 244, Taiwan
| | - Ping-Tao Tseng
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung 811, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei 106, Taiwan
| | - Szu-Nian Yang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Centre, Taipei 112, Taiwan
- Department of Psychiatry, Armed Forces Taoyuan General Hospital, Taoyuan 325, Taiwan
- Graduate Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Tien-Wei Hsu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Centre, Taipei 114, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Centre, Taipei 112, Taiwan
- Department of Psychiatry, National Defense Medical Centre, Taipei 114, Taiwan
| |
Collapse
|
6
|
McCarthy MW, Naggie S, Boulware DR, Lindsell CJ, Stewart TG, Felker GM, Jayaweera D, Sulkowski M, Gentile N, Bramante C, Singh U, Dolor RJ, Ruiz-Unger J, Wilson S, DeLong A, Remaly A, Wilder R, Collins S, Dunsmore SE, Adam SJ, Thicklin F, Hanna G, Ginde AA, Castro M, McTigue K, Shenkman E, Hernandez AF. Effect of Fluvoxamine vs Placebo on Time to Sustained Recovery in Outpatients With Mild to Moderate COVID-19: A Randomized Clinical Trial. JAMA 2023; 329:296-305. [PMID: 36633838 PMCID: PMC9857647 DOI: 10.1001/jama.2022.24100] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023]
Abstract
Importance The effectiveness of fluvoxamine to shorten symptom duration or prevent hospitalization among outpatients with mild to moderate symptomatic COVID-19 is unclear. Objective To evaluate the efficacy of low-dose fluvoxamine (50 mg twice daily) for 10 days compared with placebo for the treatment of mild to moderate COVID-19 in the US. Design, Setting, and Participants The ongoing Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV-6) platform randomized clinical trial was designed to test repurposed medications in outpatients with mild to moderate COVID-19. A total of 1288 participants aged 30 years or older with test-confirmed SARS-CoV-2 infection and experiencing 2 or more symptoms of acute COVID-19 for 7 days or less were enrolled between August 6, 2021, and May 27, 2022, at 91 sites in the US. Interventions Participants were randomized to receive 50 mg of fluvoxamine twice daily for 10 days or placebo. Main Outcomes and Measures The primary outcome was time to sustained recovery (defined as the third day of 3 consecutive days without symptoms). There were 7 secondary outcomes, including a composite outcome of hospitalization, urgent care visit, emergency department visit, or death through day 28. Results Among 1331 participants who were randomized (median age, 47 years [IQR, 38-57 years]; 57% were women; and 67% reported receiving ≥2 doses of a SARS-CoV-2 vaccine), 1288 completed the trial (674 in the fluvoxamine group and 614 in the placebo group). The median time to sustained recovery was 12 days (IQR, 11-14 days) in the fluvoxamine group and 13 days (IQR, 12-13 days) in the placebo group (hazard ratio [HR], 0.96 [95% credible interval, 0.86-1.06], posterior P = .21 for the probability of benefit [determined by an HR >1]). For the composite outcome, 26 participants (3.9%) in the fluvoxamine group were hospitalized, had an urgent care visit, had an emergency department visit, or died compared with 23 participants (3.8%) in the placebo group (HR, 1.1 [95% credible interval, 0.5-1.8], posterior P = .35 for the probability of benefit [determined by an HR <1]). One participant in the fluvoxamine group and 2 participants in the placebo group were hospitalized; no deaths occurred in either group. Adverse events were uncommon in both groups. Conclusions and Relevance Among outpatients with mild to moderate COVID-19, treatment with 50 mg of fluvoxamine twice daily for 10 days, compared with placebo, did not improve time to sustained recovery. These findings do not support the use of fluvoxamine at this dose and duration in patients with mild to moderate COVID-19. Trial Registration ClinicalTrials.gov Identifier: NCT04885530.
Collapse
Affiliation(s)
| | - Susanna Naggie
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
- Department of Medicine, School of Medicine, Duke University, Durham, North Carolina
| | - David R. Boulware
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis
| | | | - Thomas G. Stewart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
- Now with School of Data Science, University of Virginia, Charlottesville
| | - G. Michael Felker
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
- Department of Medicine, School of Medicine, Duke University, Durham, North Carolina
| | - Dushyantha Jayaweera
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida
| | - Mark Sulkowski
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland
| | - Nina Gentile
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Carolyn Bramante
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis
| | - Upinder Singh
- Departments of Internal Medicine and Microbiology and Immunology, School of Medicine, Stanford University, Stanford, California
| | - Rowena J. Dolor
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
- Department of Medicine, School of Medicine, Duke University, Durham, North Carolina
| | | | - Sybil Wilson
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | - Allison DeLong
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | - April Remaly
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | - Rhonda Wilder
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | - Sean Collins
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah E. Dunsmore
- National Center for Advancing Translational Sciences, Bethesda, Maryland
| | - Stacey J. Adam
- Foundation for the National Institutes of Health, Bethesda, Maryland
| | | | - George Hanna
- Biomedical Advanced Research and Development Authority, Washington, DC
| | - Adit A. Ginde
- Department of Emergency Medicine, University of Colorado, Denver
| | - Mario Castro
- Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of Missouri, Kansas City, Kansas
| | - Kathleen McTigue
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Elizabeth Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville
| | - Adrian F. Hernandez
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
- Department of Medicine, School of Medicine, Duke University, Durham, North Carolina
| |
Collapse
|
7
|
Dobrodeeva V, Abdyrahmanova A, Astafeva D, Smirnova D, Cumming P, De Sousa A, Davydkin I, Yashikhina A, Shnayder N, Nasyrova R. Pharmacogenetic Aspects of COVID-19 Management and Post-COVID-19 Depression Treatment with Fluvoxamine. Psychiatr Danub 2022; 34:25-30. [PMID: 36170697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Quarantine measures with self-isolation of varying duration have been significant psychosocial stressors in the context of the COVID-19 pandemic. The serotonin selective reuptake inhibitor fluvoxamine has been considered as a prophylaxis against depression in early COVID-19 patients, with additional benefits apparently arising from its antiviral activity. In this narrative review, we draw attention to the body of evidence showing efficacy of fluvoxamine in protecting against depressive disorders in COVID-19 patients, while also attenuating the severity of COVID-19 disease, with a notable reduction in the need for intubation and lower mortality. We consider this potential two-fold action of fluvoxamine in the light of its pharmacogenetic and pharmacological profiles. SUBJECTS AND METHODS Full-text publications in English and Russian in Google Scholar, PubMed, NCBI, Web of Science, and E-Library databases were selected by keywords, solitary and in combination (fluvoxamine, COVID-19, depression, anxiety, antidepressants, adverse reactions) for the period from March 01, 2020 to June 06, 2022. We also analyzed the full-text publications in English and Russian language reporting adverse reactions caused by fluvoxamine use for the period from 2012 to 2022. RESULTS The literature search yielded 10 papers reporting on the efficacy fluvoxamine in relieving depressive symptoms in COVID-19 patients, and 3 papers on its effect on medical outcome. The preponderance of data indicated a dual therapeutic action of fluvoxamine, and our further literature investigation was informative about drug-drug interactions and genetic factors moderating the antidepressant efficacy of fluvoxamine. CONCLUSIONS Patients with COVID-19 seeking psychopharmacological treatment for depressive symptoms must be informed of the benefits and risks of fluvoxamine use. Several lines of findings indicate this agent to possess an additional antiviral action. However, optimal dosage regimens and the trade-off with drug-drug interactions remain unclear. Pharmacogenetic testing may assist in evidence-based optimization of fluvoxamine dosages in the context of COVID-19 infection with comorbid depression.
Collapse
Affiliation(s)
- Vera Dobrodeeva
- Institute of Personalized Psychiatry and Neurology, Shared Core Facilities, V.M. Bekhterev National, Medical Research Centre for Psychiatry and Neurology, Saint Petersburg, Russia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Wu PE, Austin E, Leong D. Fluvoxamine for symptomatic outpatients with COVID-19. CMAJ 2022; 194:E258. [PMID: 35045990 PMCID: PMC8863199 DOI: 10.1503/cmaj.220011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Peter E Wu
- Division of General Internal Medicine and Geriatrics (Wu), University Health Network; Division of Clinical Pharmacology and Toxicology (Wu), Department of Medicine, University of Toronto; Division of Emergency Medicine (Austin), St. Michael's Hospital; Ontario Poison Centre (Austin), Hospital for Sick Children; Department of Pharmacy (Leong), University Health Network, Toronto, Ont.
| | - Emily Austin
- Division of General Internal Medicine and Geriatrics (Wu), University Health Network; Division of Clinical Pharmacology and Toxicology (Wu), Department of Medicine, University of Toronto; Division of Emergency Medicine (Austin), St. Michael's Hospital; Ontario Poison Centre (Austin), Hospital for Sick Children; Department of Pharmacy (Leong), University Health Network, Toronto, Ont
| | - Derek Leong
- Division of General Internal Medicine and Geriatrics (Wu), University Health Network; Division of Clinical Pharmacology and Toxicology (Wu), Department of Medicine, University of Toronto; Division of Emergency Medicine (Austin), St. Michael's Hospital; Ontario Poison Centre (Austin), Hospital for Sick Children; Department of Pharmacy (Leong), University Health Network, Toronto, Ont
| |
Collapse
|
9
|
Lenze EJ, Mattar C, Zorumski CF, Stevens A, Schweiger J, Nicol GE, Miller JP, Yang L, Yingling M, Avidan MS, Reiersen AM. Fluvoxamine vs Placebo and Clinical Deterioration in Outpatients With Symptomatic COVID-19: A Randomized Clinical Trial. JAMA 2020; 324:2292-2300. [PMID: 33180097 PMCID: PMC7662481 DOI: 10.1001/jama.2020.22760] [Citation(s) in RCA: 357] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Coronavirus disease 2019 (COVID-19) may lead to serious illness as a result of an excessive immune response. Fluvoxamine may prevent clinical deterioration by stimulating the σ-1 receptor, which regulates cytokine production. OBJECTIVE To determine whether fluvoxamine, given during mild COVID-19 illness, prevents clinical deterioration and decreases the severity of disease. DESIGN, SETTING, AND PARTICIPANTS Double-blind, randomized, fully remote (contactless) clinical trial of fluvoxamine vs placebo. Participants were community-living, nonhospitalized adults with confirmed severe acute respiratory syndrome coronavirus 2 infection, with COVID-19 symptom onset within 7 days and oxygen saturation of 92% or greater. One hundred fifty-two participants were enrolled from the St Louis metropolitan area (Missouri and Illinois) from April 10, 2020, to August 5, 2020. The final date of follow-up was September 19, 2020. INTERVENTIONS Participants were randomly assigned to receive 100 mg of fluvoxamine (n = 80) or placebo (n = 72) 3 times daily for 15 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical deterioration within 15 days of randomization defined by meeting both criteria of (1) shortness of breath or hospitalization for shortness of breath or pneumonia and (2) oxygen saturation less than 92% on room air or need for supplemental oxygen to achieve oxygen saturation of 92% or greater. RESULTS Of 152 patients who were randomized (mean [SD] age, 46 [13] years; 109 [72%] women), 115 (76%) completed the trial. Clinical deterioration occurred in 0 of 80 patients in the fluvoxamine group and in 6 of 72 patients in the placebo group (absolute difference, 8.7% [95% CI, 1.8%-16.4%] from survival analysis; log-rank P = .009). The fluvoxamine group had 1 serious adverse event and 11 other adverse events, whereas the placebo group had 6 serious adverse events and 12 other adverse events. CONCLUSIONS AND RELEVANCE In this preliminary study of adult outpatients with symptomatic COVID-19, patients treated with fluvoxamine, compared with placebo, had a lower likelihood of clinical deterioration over 15 days. However, the study is limited by a small sample size and short follow-up duration, and determination of clinical efficacy would require larger randomized trials with more definitive outcome measures. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04342663.
Collapse
Affiliation(s)
- Eric J. Lenze
- Department of Psychiatry, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Caline Mattar
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Charles F. Zorumski
- Department of Psychiatry, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Angela Stevens
- Department of Psychiatry, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Julie Schweiger
- Department of Psychiatry, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Ginger E. Nicol
- Department of Psychiatry, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - J. Philip Miller
- Division of Biostatistics, Informatics Institute, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Lei Yang
- Department of Psychiatry, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Michael Yingling
- Department of Psychiatry, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Michael S. Avidan
- Department of Anesthesiology, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Angela M. Reiersen
- Department of Psychiatry, School of Medicine, Washington University in St Louis, St Louis, Missouri
| |
Collapse
|
10
|
Affiliation(s)
- Shigeru Morishita
- Department of Psychiatry, Kawasaki Medical School, 577 Matsushima, Kurashiki-city, 701-0192 Okayama, Japan.
| | | |
Collapse
|
11
|
Rice T, Friedman S, Tatum J, Weiss-Goldman N, Kufert Y, Coffey BJ. Optimizing Clozapine Benefit While Minimizing Adverse Effects with Concomitant Fluvoxamine Treatment in an Adolescent with Schizoaffective Disorder. J Child Adolesc Psychopharmacol 2019; 29:66-71. [PMID: 30681385 DOI: 10.1089/cap.2018.29159.bjc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Timothy Rice
- 1 Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Jasmine Tatum
- 1 Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Yael Kufert
- 1 Icahn School of Medicine at Mount Sinai, New York, New York
| | - Barbara J Coffey
- 2 Department of Psychiatry and Behavioral Science, Miller School of Medicine, University of Miami, Miami, Florida
| |
Collapse
|
12
|
Abstract
BACKGROUND No meta-analysis for estimating the comprehensive efficacy and tolerability of fluvoxamine in patients with social anxiety disorder (SAD) has been published. OBJECTIVE To investigate the efficacy and tolerability of fluvoxamine in adults with SAD, trials meeting the following criteria were identified: population: ≥18 years of age with a diagnosis of SAD; intervention: fluvoxamine; study design: placebo-controlled randomized controlled trials (RCTs); outcomes: efficacy and tolerability outcomes. METHODS We conducted a comprehensive search of PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov for RCTs on January 3, 2018. Review Manager 5.3 and Stata Version 12.0 software were used for all statistical analyses. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated for continuous variables, and odds ratios (ORs) with 95% CIs were calculated for dichotomous variables. Cochrane Collaboration's risk of bias tool was used to assess the likelihood of risk of bias. Efficacy was assessed by mean changes in the Liebowitz Social Anxiety scale (LSAS) total score and the Clinical Global Impression Severity of Illness (CGI-S) score as well as the response rate. Tolerability was mainly assessed by the discontinuation rate due to adverse events (AEs) and the incidence of most frequent treatment-emergent AEs (TEAEs). RESULTS This meta-analysis included 5 RCTs. Mean changes in LSAS total and CGI-S scores were both significantly greater in patients treated with fluvoxamine than those treated with placebo (LSAS: MD = 11.90, 95% CI = 8.09-15.71, P < .001; CGI-S: MD = 0.52, 95% CI = 0.33-0.72, P < .001). Response rate was higher in fluvoxamine group as compared with placebo (OR = 1.71, 95% CI = 1.30-2.24, P < .001). Additionally, mean change in the Sheehan disability scale score was significantly greater in fluvoxamine group than placebo group (OR = 2.11, 95% CI = 1.03-3.18, P < .001). The discontinuation rate due to AEs was higher in patients that received fluvoxamine compared to those received placebo (OR = 5.99, 95% CI = 2.24-15.99, P < .001), as was the incidence of overall TEAEs (any AE) (OR = 2.66, 95% CI = 1.77-4.02, P < .001). However, the incidence of serious AEs was not significantly different between the 2 groups (OR = 0.99, 95% CI = 0.25-3.89, P = .99). CONCLUSION Fluvoxamine was found to be effective in adult patients with SAD, with acceptable tolerability.
Collapse
Affiliation(s)
- Xue Liu
- Department of Gynaecology and Obstetrics, China-Japan Union Hospital of Jilin University
| | - Xinyuan Li
- Department of Neurology, Neuroscience Centre
| | - Congxiao Zhang
- Department of Stomatology, The First Teaching Hospital of Jilin University
| | - Mingze Sun
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ziqian Sun
- Department of Gynaecology and Obstetrics, China-Japan Union Hospital of Jilin University
| | - Yanan Xu
- Department of Gynaecology and Obstetrics, China-Japan Union Hospital of Jilin University
| | - Xiujuan Tian
- Department of Gynaecology and Obstetrics, China-Japan Union Hospital of Jilin University
| |
Collapse
|
13
|
Abstract
Objective: To report a case of severe serotonergic symptoms following the addition of oxycodone to fluvoxamine. Case Summary: A 70-year-old woman developed severe serotonergic features, including confusion, nausea, fever, clonus, hyperreflexia, hypertonia, shivering, and tachycardia, following the addition of oxycodone 40 mg twice daily to fluvoxamine 200 mg/day, easily fulfilling diagnostic criteria for serotonin syndrome. Discontinuation of the offending drugs resulted in resolution of her symptoms over 48 hours, and no other cause of the syndrome was identified. Use of the Naranjo probability scale indicated a probable relationship between the serotonergic symptoms and the addition of oxycodone to fluvoxamine therapy. Discussion: Serotonin syndrome is a serious adverse reaction usually due to interactions with serotonergic drugs. There have been only 3 previous reports involving oxycodone. Most previous reports of serotonin syndrome involving analgesics have been associated with meperidine, dextromethorphan, and tramadol. Unlike these synthetic opioids, however, oxycodone does not inhibit the reuptake of serotonin. In addition, there are a number of other possible pharmacologic mechanisms for the interaction we observed. Conclusions: Monitoring for serotonergic adverse events should be done when oxycodone is given to patients receiving serotonin-reuptake inhibitors.
Collapse
|
14
|
Singman EL, Hocum B, Yohannan J, Pearson V. Fluvoxamine-associated oscillopsia and a role for personalized medication dosing. Drug Metab Pers Ther 2015; 30:271-275. [PMID: 26351962 DOI: 10.1515/dmpt-2015-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/22/2015] [Indexed: 06/05/2023]
Abstract
A 60-year-old woman reported horizontal "shimmering" movement while reading crossword puzzles when using fluvoxamine, bupropion, quetiapine, lithium, and levothyroxine. This visual disturbance, likely oscillopsia, started after the fluvoxamine was added and waned as the fluvoxamine was tapered, disappearing after the drug was discontinued. Genetic testing to explore how the patient metabolizes these medications combined with YouScript® interaction analysis suggest that she may have had abnormally high plasma concentrations of fluvoxamine during this time. Oscillopsia may be a novel dose-dependent side effect of fluvoxamine. Genetic testing combined with YouScript has the potential to discover novel drug side effects, elucidate drug interactions and guide future prescribing decisions.
Collapse
|
15
|
Minaiyan M, Hajhashemi V, Rabbani M, Fattahian E, Mahzouni P. Evaluation of anti-colitic effect of fluvoxamine against acetic acid-induced colitis in normal and reserpinized depressed rats. Eur J Pharmacol 2014; 746:293-300. [PMID: 25460023 DOI: 10.1016/j.ejphar.2014.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/08/2014] [Accepted: 11/12/2014] [Indexed: 12/28/2022]
Abstract
High prevalence of psychological comorbidities such as depression and anxiety in patients with inflammatory bowel disease (IBD) supports the premise that adding an anti-depressant drug with known anti-inflammatory effect to the medical treatment have beneficial effect in the course of the underlying disease. Colitis was induced by intracolonic instillation of 2 ml of 4% v/v acetic acid solution in rats. Anti-colitic effect of fluvoxamine was evaluated in two categories: A: normal rats, B: reserpinized (6 mg/kg, i.p.) depressed rats. In group A, fluvoxamine (2.5, 5, 10 mg/kg, i.p.) was administered 2 h after induction of colitis and in group B: reserpine (6 mg/kg, i.p.) was administered 1 h prior to colitis induction and then fluvoxamine (2.5, 5, 10 mg/kg, i.p.) was administered 2 h after colitis induction. Dexamethasone (1 mg/kg) was used as reference drug. All the treatments continued daily for five days. The effect was assessed on the basis of macroscopic score, biochemical (myeloperoxidase) changes and histopathological studies. Results showed that fluvoxamine (2.5 and 5 mg/kg) and dexamethasone treatment markedly reduced disease severity in both reserpinized and non-reserpinized rats as indicated by reduction in macroscopic and microscopic colonic damages while reserpine adversely exacerbated the colitis damage. Myeloperoxidase activity which was increased following colitis induction was also decreased. The findings of this study elucidate the anti-colitic and anti-inflammatory properties of fluvoxamine and so introduced it as a good candidate to treat depressive symptoms in people comorbid to IBD.
Collapse
MESH Headings
- Animals
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/adverse effects
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Antidepressive Agents, Second-Generation/administration & dosage
- Antidepressive Agents, Second-Generation/therapeutic use
- Antipsychotic Agents/administration & dosage
- Antipsychotic Agents/adverse effects
- Antipsychotic Agents/therapeutic use
- Colitis, Ulcerative/drug therapy
- Colitis, Ulcerative/immunology
- Colitis, Ulcerative/pathology
- Colitis, Ulcerative/psychology
- Colon/drug effects
- Colon/enzymology
- Colon/immunology
- Colon/pathology
- Depression/complications
- Depression/drug therapy
- Dexamethasone/therapeutic use
- Disease Models, Animal
- Dose-Response Relationship, Drug
- Drug Resistance
- Fluvoxamine/administration & dosage
- Fluvoxamine/adverse effects
- Fluvoxamine/therapeutic use
- Gastrointestinal Agents/administration & dosage
- Gastrointestinal Agents/adverse effects
- Gastrointestinal Agents/therapeutic use
- Intestinal Mucosa/drug effects
- Intestinal Mucosa/enzymology
- Intestinal Mucosa/immunology
- Intestinal Mucosa/pathology
- Male
- Neutrophil Infiltration
- Peroxidase/antagonists & inhibitors
- Peroxidase/chemistry
- Peroxidase/metabolism
- Random Allocation
- Rats, Wistar
- Reserpine/administration & dosage
- Reserpine/adverse effects
- Reserpine/therapeutic use
Collapse
Affiliation(s)
- Mohsen Minaiyan
- Department of Pharmacology and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Valiollah Hajhashemi
- Department of Pharmacology and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Rabbani
- Department of Pharmacology and Isfahan Pharmaceutical Sciences Research Center, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ehsan Fattahian
- Department of Pharmacology and Physiology, School of Medicine, Shahrekord University of Medical Sciences, P.O. Box 8815774667, Shahrekord, Iran.
| | - Parvin Mahzouni
- Department of Clinical Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
16
|
Takahashi C, Goto E, Taira S, Kataoka N, Nishihara M, Katsumata T, Goto I, Takiuchi H. [Serotonin syndrome in a patient with small cell lung cancer]. Gan To Kagaku Ryoho 2013; 40:1059-1061. [PMID: 23986051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The patient was a 67-year-old male who had been treated for several years with 150 mg fluvoxamine maleate due to depression. He visited our hospital with primary symptoms of swelling of the right upper extremity and dyspnea in August, XXXX. As a result of examinations, he was diagnosed with stage IIIB extended small cell lung cancer(T4N3M0). One course of carboplatin/etoposide(CBDCA/VP-16)therapy was started on October 1. Since the tumor size was reduced, thoracic effusion disappeared, and superior vena cava syndrome was alleviated, the therapy was changed to cisplatin/irinotecan (CDDP/CPT-11)on October 23, and the 3rd course was initiated on November 22. Anxiety and tremor appeared on the 4th day of the 3rd course and because they were exacerbated, and myoclonus appeared, a diagnosis of serotonin syndrome was made on the 38th day, and the administration of fluvoxamine maleate was discontinued. The symptoms were alleviated after the discontinuation, and the 4th course could be implemented. In this patient, serotonin syndrome was considered to have been induced by serotonin secretion promoted by the CDDP administration, and by serotonin in the brain increasing abnormally due to the SSRI.
Collapse
|
17
|
Niitsu T, Fujisaki M, Shiina A, Yoshida T, Hasegawa T, Kanahara N, Hashimoto T, Shiraishi T, Fukami G, Nakazato M, Shirayama Y, Hashimoto K, Iyo M. A randomized, double-blind, placebo-controlled trial of fluvoxamine in patients with schizophrenia: a preliminary study. J Clin Psychopharmacol 2012; 32:593-601. [PMID: 22926591 DOI: 10.1097/jcp.0b013e3182664cfc] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Cognitive impairments in schizophrenia are associated with suboptimal psychosocial performance. Several lines of evidence have suggested that endoplasmic reticulum protein sigma-1 receptors were involved in cognitive impairments in patients with schizophrenia and that the sigma-1 receptor agonist fluvoxamine was effective in treating cognitive impairments in animal models of schizophrenia and in some patients with schizophrenia. A randomized, double-blind, placebo-controlled, parallel trial of fluvoxamine adjunctive therapy in patients with schizophrenia was performed. A total of 48 patients with chronic schizophrenia were enrolled. Subjects were randomly assigned to an 8-week administration of add-on fluvoxamine (n = 24, titrated up to 150 mg/d) or placebo (n =24) in a total 12-week double-blind trial. The primary outcome measure was the Cambridge Neuropsychological Test Automated Battery (CANTAB), assessing visual memory, working memory, attention, and executive function. The secondary outcome measures were the Positive and Negative Syndrome Scale, the Scale for the Assessment of Negative Symptoms, the Quality of Life Scale, and the Montgomery-Åsberg Depression Rating Scale. Fluvoxamine was well tolerated. No significant time × group interaction effects were observed in the scores of the CANTAB, Positive and Negative Syndrome Scale, Scale for the Assessment of Negative Symptoms, Quality of Life Scale, or the Montgomery-Åsberg Depression Rating Scale. However, in secondary analyses, the change from baseline to end point on the Spatial Working Memory strategy score (executive function) of CANTAB improved in the fluvoxamine group. This study suggests no major benefit of fluvoxamine adjunctive therapy to improve cognitive impairments in patients with schizophrenia. Nevertheless, a further study using a large sample size will be needed to confirm the secondary analyses findings.
Collapse
Affiliation(s)
- Tomihisa Niitsu
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Kurose K, Hiratsuka K, Ishiwata K, Nishikawa J, Nonen S, Azuma J, Kato M, Wakeno M, Okugawa G, Kinoshita T, Kurosawa T, Hasegawa R, Saito Y. Genome-wide association study of SSRI/SNRI-induced sexual dysfunction in a Japanese cohort with major depression. Psychiatry Res 2012; 198:424-9. [PMID: 22445761 DOI: 10.1016/j.psychres.2012.01.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 01/19/2012] [Accepted: 01/21/2012] [Indexed: 12/14/2022]
Abstract
Sexual dysfunction is a major side effect of selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs). We conducted a genome-wide association study to identify the genetic factors contributing to the risk of SSRI/SNRI-induced sexual dysfunction by testing 186 320 single nucleotide polymorphism (SNP) markers in a cohort of 201 Japanese major depression patients including 36 with sexual dysfunction induced by SSRI (paroxetine or fluvoxamine) or SNRI (milnacipran). The Cochran-Armitage trend test showed that 11 SNPs, tightly clustered in a distinct region on chromosome 14q21.3, were associated with SSRI/SNRI-induced sexual dysfunction at a genome-wide significance level after false discovery rate (FDR) correction, and the strongest SNP association was with rs1160351 (P=3.04 × 10(-7), risk ratio=2.92, 95% confidence interval (CI)=1.79-4.76). These SNPs mapped to the intronic region of the MDGA2 gene. A Manhattan plot showed that the strong association peak remained in MDGA2 after adjustment for sex and age in a multivariable logistic regression analysis although P values increased slightly and became non-significant. Replication studies with larger sample sizes are required to validate this exploratory study, but our findings may provide insights into the genetic basis of sexual dysfunction induced by SSRI/SNRI.
Collapse
Affiliation(s)
- Kouichi Kurose
- Division of Medicinal Safety Science, National Institute of Health Sciences, Tokyo, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Kawano T, Kosuge T, Takagi S, Shimoyama A, Harunari N, Tahara Y, Suzuki N. [First death case of serotonin syndrome in Japan induced by fluvoxamine and tandospirone]. Chudoku Kenkyu 2011; 24:305-310. [PMID: 22338341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We experienced the first death case of the serotonin syndrome in Japan caused by fluvoxamine and tandospirone. A 15-year-old man was transported to our hospital for shock, muscle hypertonia and hyperthermia after cardiopulmonary arrest. His serum concentrations of fluvoxamine and tandospirone were 3,554 ng/mL and 698 ng/mL respectively after 24 hours from oral intake. He was dead in spite of intensive treatments. The progress of the serotonin syndrome is usually rapid. So, it should be monitored appropriately a patient with serotonin syndrome. If he has hyperthermia, immediate paralysis should be induced. We should aware of the serotonin syndrome a case of overdose on a serotonergic agent.
Collapse
Affiliation(s)
- Takahisa Kawano
- Department of Critical Care Medicine, University of Fukui Hospital
| | | | | | | | | | | | | |
Collapse
|
20
|
Peitl MV, Prološčić J, Blažević-Zelić S, Skarpa-Usmiani I, Peitl V. Symptoms of agitated depression and/or akathisia. Psychiatr Danub 2011; 23:108-110. [PMID: 21448111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Akathisia is a syndrome characterized by the unpleasant sensation of "inner" restlessness that manifests itself in the inability of sitting still or not moving. Many types of medicaments can cause akathisia as an adverse event of their use and they include: antipsychotics, antidepressants, antiemetics, antihistamines, and psychoactive substances. We will present the case of a 50 year old patient, treated on two occasions for psychotic depression. During the second hospitalization it is possible that antipsychotic treatment combined with an antidepressant caused akathisia or there were symptoms of agitated depression and akathisia present at the same time, which is very difficult to determine in everyday clinical practice. We can conclude that in this case, as in many others, akathisia as a possible adverse effect of psychopharmacs was very hard to identify. Therefore, it is necessary to have akathisia in mind when using certain medicaments, especially when combining several that use the same enzymatic system and consequently raise levels of at least one of them.
Collapse
MESH Headings
- Affective Disorders, Psychotic/diagnosis
- Affective Disorders, Psychotic/drug therapy
- Affective Disorders, Psychotic/psychology
- Akathisia, Drug-Induced/diagnosis
- Akathisia, Drug-Induced/drug therapy
- Akathisia, Drug-Induced/psychology
- Anticonvulsants/therapeutic use
- Antidepressive Agents, Second-Generation/adverse effects
- Antidepressive Agents, Second-Generation/therapeutic use
- Antipsychotic Agents/adverse effects
- Antipsychotic Agents/therapeutic use
- Benzodiazepines/adverse effects
- Benzodiazepines/therapeutic use
- Depressive Disorder/diagnosis
- Depressive Disorder/drug therapy
- Depressive Disorder/psychology
- Diagnosis, Differential
- Diagnostic Errors
- Dibenzothiazepines/therapeutic use
- Drug Interactions
- Drug Therapy, Combination
- Fluvoxamine/adverse effects
- Fluvoxamine/therapeutic use
- Humans
- Male
- Middle Aged
- Olanzapine
- Psychomotor Agitation/diagnosis
- Psychomotor Agitation/drug therapy
- Psychomotor Agitation/psychology
- Quetiapine Fumarate
- Valproic Acid/therapeutic use
Collapse
Affiliation(s)
- Marija Vučić Peitl
- Psychiatric Clinic of University Hospital Centre Rijeka, Cambierieva 17/7, 51000 Rijeka, Croatia.
| | | | | | | | | |
Collapse
|
21
|
Pratheesh PJ, Praharaj SK, Srivastava A. Euprolactinemic gynecomastia and galactorrhea with risperidone-fluvoxamine combination. Psychopharmacol Bull 2011; 44:70-73. [PMID: 22506441 PMCID: PMC5044559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Risperidone is associated with hyperprolactinemia and its consequent symptoms such as gynecomastia, galactorrhea and sexual dysfunction in adults, and less so in adolescents. Rarely, serotonin reuptake inhibitors are also associated with such adverse effects. We report a case of gynecomastia and galactorrhea in an adolescent male while on a combination of risperidone and fluvoxamine, although the serum prolactin was within normal range.
Collapse
Affiliation(s)
- P J Pratheesh
- Department of Psychiatry, Kasturba Medical College, Manipal, Karnataka, India
| | | | | |
Collapse
|
22
|
Vlatka BM, Branka AM, Branimir M. Ecchymoses as an adverse effect of fluvoxamine treatment in an adolescent girl. Gen Hosp Psychiatry 2010; 32:e9-e10. [PMID: 20633737 DOI: 10.1016/j.genhosppsych.2010.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 12/30/2009] [Accepted: 01/05/2010] [Indexed: 11/27/2022]
|
23
|
Kato M. [Possibility of a pharmacogenetic approach for prediction and personalized medication in major depressive disorder treatment]. Nihon Shinkei Seishin Yakurigaku Zasshi 2010; 30:83-92. [PMID: 20491282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The introduction of antidepressant drugs has revolutionized the treatment of mood disorders. However, even though sufficient doses of ADs have been used to treat depressive symptoms for sufficient periods, the treatment efficacy is considerably incomplete. The genetically determined investigation of pharmacological responses would be helpful to evaluate the best therapeutic tool for each depressed patient. However, the growing body of research in this field and heterogeneity across those studies could make it difficult for these candidates to be translated into treatment recommendations. Among other issues, the variety of ethnicity and therapeutic agents could play an important role as a confounder in pharmacogenetic results. To contribute to personalized medication for depression we should clarify the complicated, effect of these confounders. My colleagues and I reviewed the difference in genetic influence on antidepressant response between Asians and Caucasians based on a meta-analysis of pharmacogenetic studies. My colleagues and I also performed a randomized clinical trial (RCT) in Japanese subjects, "fluvoxamine vs paroxetine vs milnacipran," stratified by interesting genetic factors. The results showed that a pharmacogenetic approach could contribute, at least partially, to predict antidepressant response and personalized medication in depression with consideration of possible confounders.
Collapse
Affiliation(s)
- Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, 570-8506, Japan.
| |
Collapse
|
24
|
Suzuki Y, Fukui N, Watanabe J, Ono S, Sugai T, Tsuneyama N, Someya T. [Customized pharmacotherapies in schizophrenia]. Nihon Shinkei Seishin Yakurigaku Zasshi 2010; 30:77-81. [PMID: 20491281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
When predicting the effects of medication for psychiatric diseases and their side effects based on genetic information, there are many things to consider besides just genetic information, including the index to be evaluated. We have shown before that it is important to simultaneously analyze both pharmacokinetic factors such as the blood concentration and pharmacodynamic factors such as the site of drug action, when searching for genetic information that can be used to predict the treatment effects of fluvoxamine for depression and its side effects. For example, we have shown that there exists a specific concentration that can be used to predict remission in the treatment of depression with fluvoxamine (Fukui et al, 2008); however, it is considered that without a sufficient examination of such factors besides genetic information, it is difficult to predict the effects using just genetic information. On the other hand, the situation is more complex with medication for schizophrenia. Although it appears that consensus has been obtained in that the goal of medication for depression is remission, the goal of medication for schizophrenia is not clear and it cannot be said that prediction studies on the effects have been sufficiently conducted using genetic information. Therefore, at our facility, focusing on metabolic anomalies due to antipsychotics, QT prolongation, and hyperprolactinemia, which have become issues in recent years, a prediction study on side effects was conducted. Because such side effects can be quantified, in comparison with the effects study, it is advantageously simple to examine the relationship with genetic information. However, in the course of this study, we discovered that there was a gender difference in terms of glycolipid metabolic anomalies, that antipsychotics particularly extended the QT interval during nighttime, and that prolactine following the administration of antipsychotics temporally increased before declining again a few weeks later. We believe that when examining the relationship between side effects and genetic information, the genetic information may not be sufficiently utilized unless the analysis is performed after obtaining a better understanding of the characteristics of such side effects.
Collapse
Affiliation(s)
- Yutaro Suzuki
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, 757, Asahimachidori-ichibancho, Niigata, 951-8510 Japan.
| | | | | | | | | | | | | |
Collapse
|
25
|
Shchepotin IB, Zotov AS, Dobzhenko MN. [Selective serotonin reuptake inhibitors and mammary pathologies]. Vopr Onkol 2010; 56:393-397. [PMID: 20968014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
|
26
|
Ständer S, Böckenholt B, Schürmeyer-Horst F, Weishaupt C, Heuft G, Luger TA, Schneider G. Treatment of chronic pruritus with the selective serotonin re-uptake inhibitors paroxetine and fluvoxamine: results of an open-labelled, two-arm proof-of-concept study. Acta Derm Venereol 2009; 89:45-51. [PMID: 19197541 DOI: 10.2340/00015555-0553] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic pruritus is difficult to treat and requires the evaluation of new therapeutic modalities. We initiated an open-labelled, two-arm prospective, proof-of-concept study applying two selective serotonin re-uptake inhibitors on a long-term basis. Paroxetine and fluvoxamine were tested in a total of 72 pruritic patients (27 men, 45 women, age range 28-88 years, mean age 59.2 years). The reduction in pruritus was evaluated by analysis of visual analogue scores and determination of the maximal antipruritic effect (maximal percentual reduction in pruritus). Forty-nine of 72 patients (68.0%) experienced a weak (n=9), good (n=16) or very good (n=24) antipruritic effect. Statistical analysis proved the efficacy of paroxetine and fluvoxamine with no significant difference. The best response was observed in patients with pruritus due to atopic dermatitis, systemic lymphoma and solid carcinoma. Chronic scratch lesions healed completely in 14/31 patients and partially in 17/31 patients. Adverse drug effects were observed in 70.8% of patients, resulting in discontinuation of treatment in 18 patients. These results support previous reports of high antipruritic potency of selective serotonin re-uptake inhibitors, which are a good alternative treatment modality in chronic pruritus. This should be confirmed in future double-blind studies.
Collapse
Affiliation(s)
- Sonja Ständer
- Department of Dermatology, Clinical Neurodermatology, University of Münster, Münster, Germany.
| | | | | | | | | | | | | |
Collapse
|
27
|
Extended-release fluvoxamine (Luvox CR). Med Lett Drugs Ther 2008; 50:50-1. [PMID: 18583947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
28
|
Takahashi T, Mitsuya H, Murata T, Murayama J, Wada Y. Opposite effects of SSRIs and tandospirone in the treatment of REM sleep behavior disorder. Sleep Med 2008; 9:317-9. [PMID: 17644482 DOI: 10.1016/j.sleep.2007.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 05/01/2007] [Accepted: 05/14/2007] [Indexed: 11/18/2022]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia defined by intermittent loss of electromyographic atonia during REM sleep with emergence of complex and vigorous behaviors. Although the efficacy of several agents for treating RBD has been reported, a rationale for medication has not been established and the exact pathophysiological mechanisms of RBD are uncertain. We encountered a patient with idiopathic RBD that dramatically improved with selective serotonin reuptake inhibitors (SSRIs) and deteriorated with a 5-HT1A partial agonist, tandospirone. We report on the effects of these serotonin-modulating agents, which yield clues to a possible pharmacological approach to RBD.
Collapse
Affiliation(s)
- Tetsuya Takahashi
- Department of Neuropsychiatry, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan.
| | | | | | | | | |
Collapse
|
29
|
Miyamoto S, Miyake N, Ogino S, Endo T, Yamaguchi N. Successful treatment of Meige's syndrome induced by risperidone and fluvoxamine with olanzapine monotherapy in schizophrenia. Psychiatry Clin Neurosci 2007; 61:702-3. [PMID: 18081639 DOI: 10.1111/j.1440-1819.2007.01739.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
30
|
Parish JM. Violent dreaming and antidepressant drugs: or how paroxetine made me dream that I was fighting Saddam Hussein. J Clin Sleep Med 2007; 3:529-31. [PMID: 17803018 PMCID: PMC1978339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- James M Parish
- Sleep Disorders Center, Division of Pulmonary Medicine, Mayo Clinic Hospital, Phoenix, AZ 85054, USA.
| |
Collapse
|
31
|
Abstract
Although there are reports on their use for the treatment of enuresis, we present three pediatric cases with serotonin-selective reuptake inhibitor (SSRI)-induced enuresis. Because SSRIs continue to be commonly prescribed in the pediatric population, the need to monitor for the possibility of enuresis precipitated by SSRIs is increasingly important.
Collapse
Affiliation(s)
- Sabri Hergüner
- Department of Child and Adolescent Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | | | | | | |
Collapse
|
32
|
Jakob F, Wolf J. EPMS Under Antidepressive Therapy With Fluvoxamine and Concomitant Antibiotic Therapy With Clindamycin. Pharmacopsychiatry 2007; 40:129. [PMID: 17541891 DOI: 10.1055/s-2007-973834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
33
|
Asakura S, Tajima O, Koyama T. Fluvoxamine treatment of generalized social anxiety disorder in Japan: a randomized double-blind, placebo-controlled study. Int J Neuropsychopharmacol 2007; 10:263-74. [PMID: 16573847 DOI: 10.1017/s1461145706006602] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Revised: 02/16/2006] [Accepted: 02/20/2006] [Indexed: 11/07/2022] Open
Abstract
The efficacy of selective serotonin reuptake inhibitors (SSRIs) for the treatment of social anxiety disorder (SAD) has been reported in the USA and Europe. However, no clinical investigation has been done with SSRIs in Japanese patients with SAD. This study was performed to determine the effectiveness and safety of fluvoxamine for generalized SAD (GSAD) in Japanese patients. In this double-blind study, patients meeting DSM-IV criteria for GSAD were randomized to receive treatment with fluvoxamine or placebo for 10 wk. Fluvoxamine treatment was initiated at 50 mg/d, and increased by 50 mg weekly to a maximum of 150 or 300 mg/d. The primary efficacy outcome was mean change from baseline on the Liebowitz Social Anxiety Scale - Japanese Version (LSAS-J) total score. The secondary outcomes were response according to the Clinical Global Impressions - Global Improvement (CGI-I) score and three domains of the Sheehan Disability Scale (SDS; used to assess psychosocial impairment). A total of 176 fluvoxamine-treated patients and 89 placebo-treated patients were eligible for the efficacy analysis. At week 10, the fluvoxamine-treated patients had a significantly greater reduction in the LSAS-J total score compared with placebo-treated patients (p=0.0197), with significantly more fluvoxamine recipients being at least much improved on the CGI-I scale compared with placebo-treated patients (p=0.024). Fluvoxamine-treated patients also had better responses on the SDS compared with placebo-treated patients (p=0.0208). Fluvoxamine was safe and well tolerated. These results suggest that fluvoxamine is effective for the treatment of Japanese patients with GSAD.
Collapse
Affiliation(s)
- Satoshi Asakura
- Health Administration Center and Department of Psychiatry, Hokkaido University School of Medicine, Sapporo, Hokkaido, Japan.
| | | | | |
Collapse
|
34
|
Abstract
BACKGROUND Motivation to change has been shown to predict treatment outcome in various areas of mental health but has never been examined in obsessive compulsive disorder (OCD). The purpose of this report is to present the first use of the University of Rhode Island Change Assessment (URICA) in an OCD pharmacotherapy sample and to determine whether motivation to change predicts degree of treatment response in this group. METHODS The sample consisted of 32 outpatients diagnosed with OCD who completed an open-label 10-week trial of fluvoxamine. Participants completed the URICA at baseline. OCD symptom severity was rated at baseline and end of treatment. RESULTS While overall readiness was not related to change in severity, high scores on the Precontemplation subscale (indicating greater resistance to changing OC behaviors) were associated with less change pre- to post-treatment. CONCLUSIONS Preliminary findings indicate that greater resistance to change is associated with less improvement in OCD symptom severity following pharmacotherapy. As this is the first use of the URICA as a predictor of OCD response, future research should further examine the role of motivation to change in treatment outcome in a larger OCD sample.
Collapse
Affiliation(s)
- Anthony Pinto
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA.
| | | | | | | |
Collapse
|
35
|
Hori S, Matsuo N, Yamamoto A, Hazui T, Yagi H, Nakano M, Suzuki Y, Miki A, Ohtani H, Sawada Y. Piloerection induced by replacing fluvoxamine with milnacipran. Br J Clin Pharmacol 2007; 63:665-71. [PMID: 17324248 PMCID: PMC2000592 DOI: 10.1111/j.1365-2125.2006.02838.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AIMS To present a case of piloerection after replacing fluvoxamine maleate with milnacipran hydrochloride, and to analyse this effect based on receptor occupancy theory. METHODS A 40-year-old female with a 3-year history of panic disorder was prescribed fluvoxamine 50 mg day(-1) in addition to clorazepate dipotassium and sulpiride. Depression was not improved and she complained of fatigue, lack of energy and drowsiness. These symptoms worsened within a few days of an increase in the dose of fluvoxamine to 50 mg twice daily. Since an interaction between fluvoxamine and tizanidine, prescribed by another clinic, was suspected, fluvoxamine was replaced with milnacipran 50 mg day(-1). Although her drowsiness improved, she complained of piloerection throughout her body. This symptom gradually abated within a week and when the dosage of milnacipran was increased to 100 mg day(-1) at 2 months, no further piloerection occurred. We calculated the changes in alpha(1)-adrenoceptor occupancy by endogenous norepinephrine during treatment with the usual doses of milnacipran, fluvoxamine and imipramine by using pharmacokinetic and pharmacodynamic parameters obtained from the literature. RESULTS The ratios of alpha(1)-adrenoceptor occupancy by endogenous norepinephrine during the treatment with milnacipran, fluvoxamine and imipramine to that without drug were estimated to be 7.13, 1.00 and 4.12, respectively. The alpha(1)-adrenoceptor occupancy by endogenous norepinephrine was increased in a dose-dependent manner by milnacipran, whereas fluvoxamine had essentially no effect. CONCLUSIONS The piloerection observed after the replacement of fluvoxamine with milnacipran in this patient appears to have been due to an increase in the alpha(1)-adrenoceptor occupancy by endogenous norepinephrine induced by milnacipran.
Collapse
Affiliation(s)
- Satoko Hori
- Laboratory of Drug Informatics, Graduate School of Pharmaceutical SciencesTokyo
| | | | | | | | | | | | | | - Akiko Miki
- Laboratory of Drug Informatics, Graduate School of Pharmaceutical SciencesTokyo
| | - Hisakazu Ohtani
- Laboratory of Drug Informatics, Graduate School of Pharmaceutical SciencesTokyo
| | - Yasufumi Sawada
- Laboratory of Drug Informatics, Graduate School of Pharmaceutical SciencesTokyo
- Graduate School of Interdisciplinary Information Studies, The University of TokyoTokyo
| |
Collapse
|
36
|
|
37
|
Abstract
Some behavioral side effects of selective serotonin reuptake inhibitor (SSRI) antidepressants have been known for a long time. Since the introduction of these drugs in the 1990s, publications have regularly reported behavioral side effects in children and adolescents, including excitation, motor restlessness, social disinhibition, and above all self-injurious ideation and behavior. Clinical trials provide only limited data. Although these data suggest that some self-injurious and suicidal behavior may indeed occur in children and adolescents receiving SSRIs, they are too disparate to specify the frequency of these acts. Clinical trials provide useful data about drug efficacy, but their methodology is inappropriate for determining the frequency of such side effects. SSRI and suicidality: the data are difficult to read. Although some epidemiologic data suggest that SSRIs may increase the risk of occurrence of self-injurious and suicidal behavior in children and adolescents, other epidemiologic data show that the rate of suicide mortality in children and adolescents has decreased since the introduction of SSRIs. No known mechanism explains how SSRIs might increase the risk of these behavioral side effects. It is clear, however, that these effects are not particular to children and adolescents but may also be observed among adults. SSRIs must be used rationally and carefully in children and adolescents. They should not be administered routinely in youth with obsessive-compulsive or depressive disorders. Their use should be reserved for severe disorders or when psychotherapy alone has been shown to be inadequate, and when they are used, efficacy and side effects must be monitored carefully and frequently.
Collapse
Affiliation(s)
- Daniel Bailly
- Service hospitalo-universitaire de psychiatrie, Hôpital Sainte-Marguerite, Marseille (13).
| |
Collapse
|
38
|
Shapira B, Nemets B, Trachtenberg A, Belmaker RH. Phenytoin as an augmentation for SSRI failures: a small controlled study. J Affect Disord 2006; 96:123-6. [PMID: 16814397 DOI: 10.1016/j.jad.2006.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Revised: 05/24/2006] [Accepted: 05/24/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lithium augmentation of antidepressant effects in patients unimproved on antidepressants is well documented. We hypothesized that phenytoin, reported to have antimanic, antidepressant and prophylactic effects on affective disorder, might also augment in SSRI failures. METHODS Twenty five patients were recruited and twenty had data sufficient for analysis between phenytoin and placebo in depression ratings. RESULTS No effect was found. LIMITATIONS This study was a small study. CONCLUSIONS Lithium's ability to augment in antidepressant failures may not be shared with the anticonvulsant mood stabilizers.
Collapse
Affiliation(s)
- B Shapira
- Schonbaum Depression Department, Herzog Hospital, Jerusalem, Israel
| | | | | | | |
Collapse
|
39
|
Uno T, Shimizu M, Yasui-Furukori N, Sugawara K, Tateishi T. Different effects of fluvoxamine on rabeprazole pharmacokinetics in relation to CYP2C19 genotype status. Br J Clin Pharmacol 2006; 61:309-14. [PMID: 16487224 PMCID: PMC1885025 DOI: 10.1111/j.1365-2125.2005.02556.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIMS Rabeprazole is known to be a substrate of CYP2C19. Our objective was to evaluate the possible effect of an inhibitor of CYP2C19, fluvoxamine, and compare the inhibitory effect of fluvoxamine on the metabolism of rabeprazole between CYP2C19 genotypes. METHODS A two-way randomized double-blind, placebo-controlled crossover study was performed. Twenty-one volunteers, of whom seven were homozygous extensive metabolizers (EMs), eight were heterozygous EMs and six were poor metabolizers (PMs) for CYP2C19, received two 6-day courses of either fluvoxamine 50 mg or placebo daily in a randomized fashion with a single oral dose of rabeprazole 20 mg on day 6 in all cases. Plasma concentrations of rabeprazole and its metabolite rabeprazole thioether were monitored up to 24 h after dosing. RESULTS During placebo administration, the mean AUCs(0,infinity) of rabeprazole in homozygous EMs, heterozygous EMs and PMs were 882 (95% CI, 602, 1162) ng ml-1h , 1214 (975, 1453) ng ml-1 h and 2762 (2482, 3042) ng ml-1 h (P<0.001), respectively. Fluvoxamine treatment increased AUC(0,infinity) of rabeprazole and rabeprazole thioether by 2.8-fold (P<0.001) and 5.1-fold (P<0.01) in homozygous EMs, and by 1.7-fold (P<0.01) and 2.6-fold (P<0.01) in heterozygous EMs, and significantly prolonged the elimination half-life of rabeprazole and rabeprazole thioether in homozygous EMs and in heterozygous EMs, whereas no difference in any pharmacokinetic parameters was found in PMs. There was a significant difference in fluvoxamine-mediated percentage increase in AUC(0,infinity) of rabeprazole and rabeprazole thioether between CYP2C19 genotypes. CONCLUSIONS The present study indicates that there are significant drug interactions between rabeprazole and fluvoxamine in EMs of CYP2C19. It is predominantly involved in rabeprazole and rabeprazole thioether metabolism in EMs. Therefore, CYP2C19 is the key determinant of rabeprazole disposition in EMs.
Collapse
Affiliation(s)
- Tsukasa Uno
- Department of Clinical Pharmacology, Hirosaki University School of Medicine, Japan.
| | | | | | | | | |
Collapse
|
40
|
Ke CL, Chen CC, Lin CT, Chen GS, Chai CY, Cheng ST. Fluvoxamine-induced bullous eruption mimicking hand-foot syndrome and intertrigo-like eruption: rare cutaneous presentations and elusive pathogenesis. J Am Acad Dermatol 2006; 55:355-6. [PMID: 16844531 DOI: 10.1016/j.jaad.2005.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Revised: 07/23/2005] [Accepted: 08/04/2005] [Indexed: 11/16/2022]
|
41
|
Abstract
Hypersalivation has been reported as a side effect of atypical antipsychotics such as clozapine and olanzapine. As it is very common for antipsychotics to cause dry mouth due to anticholinergic effects, hypersalivation seems to be paradoxical. We present the case of a 34-year-old Japanese man with delusional disorder, somatic type (DSM-IV). He had chronic neck pain as well as somatic hallucination with hypochondriacal delusion for 4 years. Since combination therapy with atypical antipsychotics and selective serotonin reuptake inhibitors (SSRIs) has been introduced in the treatment of refractory psychiatric disorders such as schizophrenia, olanzapine (10 mg/day) was added to fluvoxamine treatment (200 mg/day) in this case. Subsequently, hypersalivation was induced without any extrapyramidal symptoms. It is suggested that hypersalivation was an adverse effect of olanzapine. Possible interaction olanzapine with fluvoxamine might increase the risk of the adverse effect. When combination therapy of atypical antipsychotics and SSRI is introduced, it should be used cautiously with careful observation. Underlying pharmacological and clinical problems will be discussed.
Collapse
Affiliation(s)
- Takafumi Hori
- Department of Psychiatry, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan.
| | | | | | | |
Collapse
|
42
|
|
43
|
Spivak B, Strous RD, Shaked G, Shabash E, Kotler M, Weizman A. Reboxetine versus fluvoxamine in the treatment of motor vehicle accident-related posttraumatic stress disorder: a double-blind, fixed-dosage, controlled trial. J Clin Psychopharmacol 2006; 26:152-6. [PMID: 16633143 DOI: 10.1097/01.jcp.0000203195.65710.f0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Motor vehicle accidents (MVAs) are a leading cause of posttraumatic stress disorder (PTSD) in the general population. Alterations in norepinephrine and serotonin systems have been proposed as mechanisms involved in the pathophysiology of the condition, with treatment directed at these neurotransmitter systems. Reboxetine, a selective norepinephrine reuptake inhibitor, exhibits high affinity and selectivity for the human norepinephrine transporter. Inasmuch as PTSD may be associated with dysregulation of noradrenergic activity, the present double-blind randomized clinical trial intended to evaluate reboxetine's efficacy in the management of MVA-related PTSD and to compare its efficacy with a medication commonly used in PTSD, the selective serotonin reuptake inhibitor fluvoxamine. METHODS Forty patients with MVA-related PTSD attending a local community mental health outpatient clinic were randomized to receive a fixed dose of either reboxetine (8 mg/d) or fluvoxamine (150 mg/d) in a double-blind fashion for a period of 8 weeks. RESULTS At baseline and at study end point, the 2 subgroups demonstrated no statistical differences in scores on PTSD, depression, and anxiety rating scales. Both medications led to significant improvements in all clinical scales measured. Nine patients receiving reboxetine and 3 receiving fluvoxamine withdrew from the study because of side effects. CONCLUSIONS Study observations indicate comparable efficacy of reboxetine and fluvoxamine in the management of MVA-related PTSD despite reboxetine's selective noradrenergic activity. Reboxetine appears to be at least as effective as fluvoxamine and may offer an alternative management option in this often difficult-to-treat and disabling condition. A lower and flexible reboxetine dosing schedule will be recommended for future research to improve its tolerability in PTSD patients.
Collapse
Affiliation(s)
- Baruch Spivak
- Ness-Ziona Mental Health Center, Ness-Ziona, Israel.
| | | | | | | | | | | |
Collapse
|
44
|
Suzuki Y, Sawamura K, Someya T. Polymorphisms in the 5-hydroxytryptamine 2A receptor and CytochromeP4502D6 genes synergistically predict fluvoxamine-induced side effects in japanese depressed patients. Neuropsychopharmacology 2006; 31:825-31. [PMID: 16205777 DOI: 10.1038/sj.npp.1300919] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
5-Hydroxytryptamine (5-HT) receptors are thought to be associated with the gastrointestinal side effects induced by selective serotonin reuptake inhibitors. CytochromeP450 (CYP) 2D6 may also be associated with the side effects induced by fluvoxamine, since the plasma fluvoxamine concentration depends on a CYP2D6 gene polymorphism. This study investigated whether 5-HT receptor and CYP2D6 gene polymorphisms could predict the occurrence of the side effects. The effects of 5-HT receptor and CYP2D6 gene polymorphisms on the incidence of gastrointestinal side effects induced by fluvoxamine were investigated in 100 depressed outpatients who gave written consent to participate in the study. The patients visited every 2 weeks until the week 12 end point and the fluvoxamine dose was changed in response to their clinical symptoms. All side effects, including the gastrointestinal side effects, were assessed at each visit. Polymerase chain reaction was used to determine A-1438G of the 5-HT2A receptor, C195T and Pro16Ser of the 5-HT3A receptor, Tyr129Ser of the 5-HT3B receptor, and the *5 and *10 alleles of CYP2D6. Both the A-1438G polymorphism of the 5-HT2A receptor gene and the CYP2D6 gene polymorphism had significant effects on the incidence of gastrointestinal side effects. Cox regression was used to analyze the combination effect of the two polymorphisms on the gastrointestinal side effects. Cox regression analysis showed that lower metabolizers (LMs) of CYP2D6 with the G/G genotype of the 5-HT2A A-1438G polymorphism had a 4.242-fold (P = 0.009) and LMs with the A/G genotype had a 4.147-fold (P = 0.004) higher risk of developing gastrointestinal side effects than normal metabolizers with the A/A genotype. The 5-HT3A and 3B gene polymorphisms had no significant effects on the incidence of gastrointestinal side effects. 5-HT2A receptor and CYP2D6 gene polymorphisms had a synergistic effect for the prediction of fluvoxamine-induced gastrointestinal side effects.
Collapse
Affiliation(s)
- Yutaro Suzuki
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | | | | |
Collapse
|
45
|
Abstract
Selective serotonin [5-hydroxytryptamine (5-HT)] reuptake inhibitors (SSRIs) and the 5-HT noradrenaline reuptake inhibitor, venlafaxine, are mainstays in treatment for depression. The highly specific actions of SSRIs of enhancing serotonergic neurotransmission appears to explain their benefit, while lack of direct actions on other neurotransmitter systems is responsible for their superior safety profile compared with tricyclic antidepressants. Although SSRIs (and venlafaxine) have similar adverse effects, certain differences are emerging. Fluvoxamine may have fewer effects on sexual dysfunction and sleep pattern. SSRIs have a cardiovascular safety profile superior to that of tricyclic antidepressants for patients with cardiovascular disease; fluvoxamine is safe in patients with cardiovascular disease and in the elderly. A discontinuation syndrome may develop upon abrupt SSRI cessation. SSRIs are more tolerable than tricyclic antidepressants in overdose, and there is no conclusive evidence to suggest that they are associated with an increased risk of suicide. Although the literature suggests that there are no clinically significant differences in efficacy amongst SSRIs, treatment decisions need to be based on considerations such as patient acceptability, response history and toxicity.
Collapse
Affiliation(s)
- H G M Westenberg
- Department of Psychiatry,University Medical Centre, Utrecht, The Netherlands
| | | |
Collapse
|
46
|
Arias B, Serretti A, Lorenzi C, Gastó C, Catalán R, Fañanás L. Analysis of COMT gene (Val 158 Met polymorphism) in the clinical response to SSRIs in depressive patients of European origin. J Affect Disord 2006; 90:251-6. [PMID: 16356553 DOI: 10.1016/j.jad.2005.11.008] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Revised: 11/08/2005] [Accepted: 11/09/2005] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES There is convincing evidence of interactions between serotonergic and dopaminergic systems and it seems that an increase of dopamine concentration in the whole brain could be a limiting factor for the antidepressant like effect of antidepressants. The COMT gene might be a good candidate for explaining some aspects of the pharmacological response to SSRIs. METHODS The aim of our study was to analyse the Val 158 Met functional polymorphism on COMT gene and clinical response (4 weeks) and clinical remission (6/8 and 12 weeks) in two samples of depressive patients (DSM-IV) treated with SSRIs of Italian and Spanish origin. Clinical outcome was measured using 21 items Hamilton scale, weekly in the Italian sample (along 6 weeks) and monthly in the Spanish one (along 12 weeks). RESULTS No overall effect of genotype or genotypextime interaction was detected. However, we observed a genotypextime interaction on HDRS decrease for citalopram treatment (F((4.6,317.5)) = 3.38, P = 0.007) in the Spanish sample. No clear effect was observed in the Italian sample. The three samples were pooled in order to test if carrying the Met/Met genotype confers an increased risk for non-remission at 6-8 weeks. The results showed that Met/Met carriers have an odds ratio of 2.21 (95% CI [1.20-4.12]) for non-remission (chi(2) = 7.43, df = 2, P = 0.006). The Met/Met effect was not observed in response at 4th week (for all SSRI treatments) or in remission at 12th week (citalopram treatment). CONCLUSIONS COMT gene could have a small and indirect effect of clinical response to SSRIs by slowing-down the antidepressant action along the follow-up, basically in citalopram treatment.
Collapse
Affiliation(s)
- Bárbara Arias
- Unitat d'Antropologia, Departament de Biologia Animal, Facultat de Biologia, Universitat de Barcelona, Diagonal 645, 08028 Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
OBJECTIVE Few of the increasing number of pediatric clinical trials of selective serotonin reuptake inhibitors (SSRIs) in children have been evaluated for level of blindness of investigators, children, and parents. The success of the masking procedures used in a double-blind, pediatric trial of fluvoxamine in children was examined. METHOD Clinical evaluators, parents, and children were asked to guess individual treatment assignment at the end of an 8-week, placebo-controlled trial of fluvoxamine conducted in 128 outpatients (6-17 years of age) with anxiety disorders. The relationship between treatment attribution and improvement status or presence of adverse events was examined. RESULTS The rate of correct guesses was significantly greater than chance among clinical evaluators (78%), parents (81%), and children (67%) (for all, p < 0.001). Attribution to fluvoxamine was associated with presence of clinical improvement, and attribution to placebo with lack of improvement (p < 0.001) in both the fluvoxamine and placebo group. There was no association between presence of adverse events and direction of the guess. Accuracy of the guess did not improve with time. CONCLUSIONS The tendency to attribute improvement to active treatment and lack of improvement to placebo was consistent across investigators, parents, and children and was applied regardless of actual treatment received by the patient. Adverse events did not influence treatment attribution.
Collapse
|
48
|
Suzuki Y, Sawamura H, Someya T. [Molecular pharmacogenetic study on antipsychotic-drug therapy responders with depression or schizophrenia]. Seishin Shinkeigaku Zasshi 2006; 108:633-41. [PMID: 16910543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
|
49
|
Gothelf D, Rubinstein M, Shemesh E, Miller O, Farbstein I, Klein A, Weizman A, Apter A, Yaniv I. Pilot study: fluvoxamine treatment for depression and anxiety disorders in children and adolescents with cancer. J Am Acad Child Adolesc Psychiatry 2005; 44:1258-62. [PMID: 16292117 DOI: 10.1097/01.chi.0000181042.29208.eb] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the safety, tolerability, and benefit of fluvoxamine for the treatment of major depressive disorder or anxiety disorders in children and adolescents with cancer. METHOD The study was conducted from 2001 to 2004 at a pediatric hematology-oncology center. Fifteen children and adolescents with cancer were treated with fluvoxamine 100 mg/day in an open prospective 8-week trial. Safety and tolerability were evaluated at baseline and at weeks 4 and 8 by blood tests and the Side Effects Checklist. Clinical benefit was assessed with the Clinical Global Impressions-Improvement, the Children's Depression Rating Scale-Revised, and the Pediatric Anxiety Rating Scale. RESULTS Fluvoxamine was well tolerated by all subjects. Psychiatric symptoms improved significantly. CONCLUSIONS In this open trial, fluvoxamine appeared to be well tolerated and was associated with a promising reduction in the depression and anxiety symptoms of pediatric patients with cancer.
Collapse
Affiliation(s)
- Doron Gothelf
- Feinberg Department of Child Psychiatry, Schneider Children's Medical Center of Israel, Petah Tiqwa, Israel.
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Wohlreich MM, Mallinckrodt CH, Watkin JG, Wilson MG, Greist JH, Delgado PL, Fava M. Immediate switching of antidepressant therapy: results from a clinical trial of duloxetine. Ann Clin Psychiatry 2005; 17:259-68. [PMID: 16402760 DOI: 10.1080/10401230500296402] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Approximately half of all treated depressed patients fail to show adequate response to their initially prescribed antidepressant medication. Switching to another medication represents one possible next-step approach for nonresponsive or partially responsive patients. However, specific techniques for switching between antidepressants have not been well studied. We examined the efficacy and tolerability associated with a switch from a selective serotonin reuptake inhibitor (SSRI) or venlafaxine to duloxetine. METHODS All patients met criteria for major depressive disorder as defined in DSM-IV. Patients (N = 88) exhibiting suboptimal response or poor tolerability to their current antidepressant medication (citalopram <or=40 mg/d, escitalopram <or=20 mg/d, fluvoxamine <or=150 mg/d, paroxetine <or=40 mg/d, sertraline <or=150 mg/d, or venlafaxine <or=150 mg/d) were switched to duloxetine 60 mg once-daily (QD) without intermediate tapering or titration ("switching" group). A comparator group (N = 67), comprising patients not currently receiving antidepressant medication, initiated duloxetine therapy at 60 mg QD ("initiating" group). Safety assessments included comparisons of discontinuation rates, treatment-emergent adverse events, and changes in vital signs. Efficacy measures included the HAMD(17), Hamilton Anxiety Scale (HAMA), and the Clinical Global Impression of Severity (CGI-S) scale. RESULTS The efficacy of duloxetine in switched patients did not differ significantly from that observed in untreated patients initiating duloxetine therapy (mean changes: HAMD(17) total score: -12.3 vs. -12.6; HAMA: -9.36 vs. -9.55, CGI-S: -1.94 vs. -2.12, respectively). However, the rate of discontinuation due to adverse events among patients switched to duloxetine was significantly lower than that in patients initiating duloxetine therapy (4.5% vs. 17.9%, p = .008). Treatment-emergent adverse events occurring in >or=10% of patients in both treatment groups were nausea, headache, dry mouth, insomnia, and diarrhea. Patients switched to duloxetine reported significantly lower rates of nausea and fatigue compared with patients initiating duloxetine. CONCLUSIONS In this study, the efficacy of duloxetine in switched patients was comparable to that observed in patients initiating duloxetine therapy. Immediate switching from an SSRI or venlafaxine to duloxetine (60 mg QD) was well tolerated.
Collapse
|