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Luvox is a serotonin-specific medication that works by blocking the reuptake of the neurotransmitter serotonin back into brain cells, thereby increasing its levels in the brain. OCD, depression, and other mental
disorders may be caused by abnormally low levels of serotonin. This abnormality may in turn produce changes
in affected areas of the brain, resulting in psychiatric symptoms such as depression or anxiety. The presumed
action of Luvox and other selective serotonin reuptake inhibitors (SSRIs) is to increase serotonin levels, which
may help to restore those areas of the brain to normal functioning. OCD may also be successfully treated with
other SSRIs as well as the tricyclic antidepressant (TCA) Anafranil (clomipramine).
Dosing Information
The recommended starting dose of Luvox is 50 mg as a single bedtime dose. The dose is increased weekly in increments of 25–50 mg. The maximum dosage should not exceed 300 mg/day. When dosages are greater than 100 mg/day, Luvox should be taken twice a day, in either equally divided doses or with the larger dose at bedtime. The inconvenience of twice-daily dosing may be circumvented by switching to Luvox CR, which can be administered as a single dose at bedtime. Seniors and people with severe and chronic illness may require lower dosages (50–100 mg/day) than the average person. In treating children (ages 8–17 years) with OCD, the recommended starting dose is 25 mg administered as a single bedtime dose. The dose is increased by 25 mg every 4–7 days until clinical response is achieved. Generally, the dosage for children up to 11 years old should not exceed 200 mg/day, whereas adolescents may require a maximum dosage of 300 mg/day, similar to the average adult. Girls, in general, may require lower dosages.
Side effects
The most frequently reported side effects with Luvox are gastrointestinal disturbance, principally nausea, vomiting, indigestion, diarrhea, or loose stools. Nervousness, jitteriness, and trouble sleeping are other commonly reported side effects. Occasionally, individuals may experience headaches, sleepiness, and excessive sweating. Luvox may induce sexual dysfunction in both men and women. The sexual side effects reported are delayed orgasm in women and retarded ejaculation in men. Some people may experience decreased desire or lack of interest in sexual activity. However, the adverse effects on sexual function with Luvox are generally less frequent than with Prozac or Paxil. Patients should discuss these side effects with their physician, especially if they continue to be bothersome 3–4 weeks after the medication is started. If a rash or any other severe symptoms develop, patients should contact their physician immediately.
Possible Drug Interactions
The combined use of Luvox with certain other medications may result in adverse drug interactions, because one medication may alter the blood levels of the other. The clinically significant drug interactions reported with Luvox are summarized in the table on the next page.
Coumadin (warfarin) Luvox may increase Coumadin levels and its anticoagulant effects, resulting in bleeding; Coumadin therapy should be monitored closely when starting any SSRI. Tricyclic antidepressants (TCAs) Luvox may increase the levels of TCAs and the potential for toxicity. Clozaril (clozapine) Luvox may increase the levels of Clozaril and increase its potential for adverse side effects. Theophylline Luvox may elevate levels of theophylline and cause toxicity; consequently, theophylline levels should be monitored closely. Tegretol (carbamazepine) Luvox may increase levels of Tegretol, possibly resulting in toxicity. Smoking Smoking may lower blood levels and decrease the effectiveness of Luvox. Smokers may require higher doses than nonsmokers.
Other medications, including herbal supplements (such as St. John’s wort), that boost serotonin may result in excessive levels of that neurotransmitter when combined with Luvox and produce a toxic syndrome known as serotonin syndrome. The early signs of serotonin syndrome are restlessness, confusion, tremors, flushing, and involuntary muscle jerks. If the medications are not stopped, the individual may develop more life-threatening complications resulting in muscle disorders, high fever, respiratory problems, clotting problems, and destruction of red blood cells that may lead to acute renal failure. Hence, patients taking Luvox should be alert to the possible signs of serotonin syndrome, which require immediate medical attention and discontinuation of the serotonin-boosting medications. Antidepressants known as monoamine oxidase inhibitors (MAOIs) should not be taken together with Luvox, because the combination may potentially produce a toxic reaction that includes elevated temperature, high blood pressure, and extreme excitation and agitation. Patients should consult their physician or pharmacist before taking any new medications, including over-the-counter medications and herbal supplements, with Luvox. Patients taking Luvox should avoid alcohol or should consume it in moderation because the combination may worsen depression.
Precautions
Most cases of major depression can be treated successfully, usually with medication, psychotherapy, or both. The combination of psychotherapy and antidepressants is very effective in treating moderate to severe depression. The medications improve mood, sleep, energy, and appetite while therapy strengthens coping skills, deals with possible underlying issues, and improves thought patterns and behavior.
In general, antidepressants alone help about 60%–70% of those taking them. Although a few individuals may experience some improvement from antidepressants by the end of the first week, most people do not see significant benefits from their antidepressants until after 3–4 weeks, and it can sometimes take as long as 8 weeks for the medication to produce its full effects. Thus it is critical that patients continue to take their antidepressant long enough for the medication to be beneficial and that patients not get discouraged and stop their medication prematurely if they do not feel better immediately. In short-term studies, antidepressants were found to increase the risk of suicidal thinking and behavior in children and adolescents with major depression and other psychiatric disorders. The FDA requires the prescriber to warn of this risk in children and adolescents when starting antidepressant therapy. According to the FDA findings, the risk of suicidal thoughts and behaviors associated with antidepressants is age-related. This phenomenon tends to occur in the younger population and is most likely to occur early in the course of treatment. In adults over 24 years of age, there did not appear to be an increased risk of suicidality with antidepressants compared with placebo. In patients over age 65, the findings showed that antidepressants had a “protective effect” against suicidal thoughts and behavior. Other studies have found that when more people in a community are taking antidepressants, the suicide rate is lower. The risk of suicide is inherent in depression and may persist until the individual responds to treatment. After starting or changing antidepressant therapy, the person, especially a child or adolescent, should be closely observed for worsening signs of depression, and the family or caregiver should communicate any concerns to the physician.
Dosing Information
The recommended starting dose of Luvox is 50 mg as a single bedtime dose. The dose is increased weekly in increments of 25–50 mg. The maximum dosage should not exceed 300 mg/day. When dosages are greater than 100 mg/day, Luvox should be taken twice a day, in either equally divided doses or with the larger dose at bedtime. The inconvenience of twice-daily dosing may be circumvented by switching to Luvox CR, which can be administered as a single dose at bedtime. Seniors and people with severe and chronic illness may require lower dosages (50–100 mg/day) than the average person. In treating children (ages 8–17 years) with OCD, the recommended starting dose is 25 mg administered as a single bedtime dose. The dose is increased by 25 mg every 4–7 days until clinical response is achieved. Generally, the dosage for children up to 11 years old should not exceed 200 mg/day, whereas adolescents may require a maximum dosage of 300 mg/day, similar to the average adult. Girls, in general, may require lower dosages.
Side effects
The most frequently reported side effects with Luvox are gastrointestinal disturbance, principally nausea, vomiting, indigestion, diarrhea, or loose stools. Nervousness, jitteriness, and trouble sleeping are other commonly reported side effects. Occasionally, individuals may experience headaches, sleepiness, and excessive sweating. Luvox may induce sexual dysfunction in both men and women. The sexual side effects reported are delayed orgasm in women and retarded ejaculation in men. Some people may experience decreased desire or lack of interest in sexual activity. However, the adverse effects on sexual function with Luvox are generally less frequent than with Prozac or Paxil. Patients should discuss these side effects with their physician, especially if they continue to be bothersome 3–4 weeks after the medication is started. If a rash or any other severe symptoms develop, patients should contact their physician immediately.
Possible Drug Interactions
The combined use of Luvox with certain other medications may result in adverse drug interactions, because one medication may alter the blood levels of the other. The clinically significant drug interactions reported with Luvox are summarized in the table on the next page.
Coumadin (warfarin) Luvox may increase Coumadin levels and its anticoagulant effects, resulting in bleeding; Coumadin therapy should be monitored closely when starting any SSRI. Tricyclic antidepressants (TCAs) Luvox may increase the levels of TCAs and the potential for toxicity. Clozaril (clozapine) Luvox may increase the levels of Clozaril and increase its potential for adverse side effects. Theophylline Luvox may elevate levels of theophylline and cause toxicity; consequently, theophylline levels should be monitored closely. Tegretol (carbamazepine) Luvox may increase levels of Tegretol, possibly resulting in toxicity. Smoking Smoking may lower blood levels and decrease the effectiveness of Luvox. Smokers may require higher doses than nonsmokers.
Other medications, including herbal supplements (such as St. John’s wort), that boost serotonin may result in excessive levels of that neurotransmitter when combined with Luvox and produce a toxic syndrome known as serotonin syndrome. The early signs of serotonin syndrome are restlessness, confusion, tremors, flushing, and involuntary muscle jerks. If the medications are not stopped, the individual may develop more life-threatening complications resulting in muscle disorders, high fever, respiratory problems, clotting problems, and destruction of red blood cells that may lead to acute renal failure. Hence, patients taking Luvox should be alert to the possible signs of serotonin syndrome, which require immediate medical attention and discontinuation of the serotonin-boosting medications. Antidepressants known as monoamine oxidase inhibitors (MAOIs) should not be taken together with Luvox, because the combination may potentially produce a toxic reaction that includes elevated temperature, high blood pressure, and extreme excitation and agitation. Patients should consult their physician or pharmacist before taking any new medications, including over-the-counter medications and herbal supplements, with Luvox. Patients taking Luvox should avoid alcohol or should consume it in moderation because the combination may worsen depression.
Precautions
Most cases of major depression can be treated successfully, usually with medication, psychotherapy, or both. The combination of psychotherapy and antidepressants is very effective in treating moderate to severe depression. The medications improve mood, sleep, energy, and appetite while therapy strengthens coping skills, deals with possible underlying issues, and improves thought patterns and behavior.
In general, antidepressants alone help about 60%–70% of those taking them. Although a few individuals may experience some improvement from antidepressants by the end of the first week, most people do not see significant benefits from their antidepressants until after 3–4 weeks, and it can sometimes take as long as 8 weeks for the medication to produce its full effects. Thus it is critical that patients continue to take their antidepressant long enough for the medication to be beneficial and that patients not get discouraged and stop their medication prematurely if they do not feel better immediately. In short-term studies, antidepressants were found to increase the risk of suicidal thinking and behavior in children and adolescents with major depression and other psychiatric disorders. The FDA requires the prescriber to warn of this risk in children and adolescents when starting antidepressant therapy. According to the FDA findings, the risk of suicidal thoughts and behaviors associated with antidepressants is age-related. This phenomenon tends to occur in the younger population and is most likely to occur early in the course of treatment. In adults over 24 years of age, there did not appear to be an increased risk of suicidality with antidepressants compared with placebo. In patients over age 65, the findings showed that antidepressants had a “protective effect” against suicidal thoughts and behavior. Other studies have found that when more people in a community are taking antidepressants, the suicide rate is lower. The risk of suicide is inherent in depression and may persist until the individual responds to treatment. After starting or changing antidepressant therapy, the person, especially a child or adolescent, should be closely observed for worsening signs of depression, and the family or caregiver should communicate any concerns to the physician.
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