Fluvoxamine for Early Treatment of COVID-19: What You Should Know

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from Washington University in St. Louis

What did we find?

  • Adults recently diagnosed with COVID-19 (less than 7 days) who took fluvoxamine for up to 15 days, did not show clinical deterioration.
  • Clinical deterioration is the combination of shortness of breath and hypoxia (decrease in oxygen), which are signs of damage to the lungs.
  • This deterioration occurs in about 10% of people who initially have mild symptoms. It can lead to hospitalization and need for a ventilator.

You can learn more about the study on our recent segment on 60 Minutes: 60 Minutes: Finding a possible early treatment for COVID-19 in a 40-year-old antidepressant

You can read more information about this study at JAMA: The Journal of the American Medical Association

We are leading a new study testing fluvoxamine for COVID, that recruits throughout the United States; anyone recently COVID+ can enroll here: https://stopcovidtrial.wustl.edu/

More information about our new study: https://www.cnn.com/2021/01/11/health/fluvoxamine-covid-19-treatment-study/index.html

Other recent news stories about fluvoxamine and COVID:

https://www.latimes.com/california/story/2021-02-03/can-common-antidepressant-help-covid-19-fight

https://www.sciencenews.org/article/covid-19-coronavirus-antidepressant-fluvoxamine-treatment

What is fluvoxamine?

Fluvoxamine is a commonly-used medication worldwide since the 1990s.  It is used for depression and anxiety and belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs), which include drugs like Prozac and Paxil.  Unlike these drugs, though, fluvoxamine has a strong effect on the sigma-1 receptor.

Why might fluvoxamine help against COVID?

We believe this may be an anti-inflammatory effect.  Some people with initially mild COVID-19 develop lung damage because of inflammation (the body’s response to infection).  It was because of this effect that we tested fluvoxamine for COVID-19. Fluvoxamine has a strong effect on the sigma-1 receptor, which controls inflammation. 

Is fluvoxamine safe?
 

Yes, when it is used correctly, fluvoxamine is safe.  In our initial study, people started fluvoxamine at 50mg on the first night, then increased to 100mg twice daily.  Later in the 15-day course, some patients increased to 100mg three times daily as tolerated.  Fluvoxamine can cause side effects such as nausea, dizziness, and changes in sleep like insomnia.  However, these side effects are usually mild and go away. 

Have any other studies examined fluvoxamine for COVID?

Yes.  There was a large outbreak at Golden Gate Race Track in California. The track physician, David Seftel, offered fluvoxamine to people who were COVID positive.  He found that none of those who took fluvoxamine developed serious COVID, vs. 12.5% of those who declined to take it.  He also found a faster resolution of the illness in those who took fluvoxamine.  This observation is now published: https://academic.oup.com/ofid/advance-article/doi/10.1093/ofid/ofab050/6124100?searchresult=1

Also, a large observational study in Paris found that SSRI antidepressants, especially fluoxetine (which is similar to fluvoxamine), were associated with reduced risk for severe COVID: https://www.nature.com/articles/s41380-021-01021-4

Other studies are now testing fluvoxamine as well.  You can find a list of these studies at https://clinicaltrials.gov/ct2/results?recrs=&cond=Covid19&term=fluvoxamine&cntry=&state=&city=&dist=

Who should be taking fluvoxamine if they get sick with COVID-19?

It is important to note that our findings with fluvoxamine have not yet been replicated in a large randomized controlled trial.  However, fluvoxamine is a safe drug when prescribed correctly (see below), and many doctors are interested in prescribing it now.  We cannot advise for or against it. Still, for those using fluvoxamine as a potential early treatment for COVID-19 , we recommend starting it at 100mg twice daily and then reducing it to 50mg if there are problematic side effects (about 25% of people develop nausea, which is mild though annoying for some).  We do not think that increasing the dose to 300mg is necessary for its effect.  We understand that some physicians are using a lower dose of 50mg twice daily to try to minimize nausea that can occur.

Three important issues:

  • First, patients should avoid caffeine while taking fluvoxamine. It prevents the body from properly metabolizing caffeine, making it stay in the system 5 times as long as expected.  This is not dangerous but can cause insomnia and jitteriness.  If they must have caffeine,  they should limit their intake to ½ of a small cup of coffee, or one can of soda, or one tea, in the morning.  They can return to their regular caffeine intake once they have stopped taking fluvoxamine.
  • Second, fluvoxamine affects the metabolism of some drugs.  In particular, people taking theophylline, clozapine, olanzapine, or tizanidine should either avoid fluvoxamine or talk to their doctor about how to avoid a dangerous drug interaction (e.g., by reducing or minimizing the drug). 
  • Finally, fluvoxamine is an antidepressant. People with psychiatric conditions such as bipolar disorder or who already take psychiatric medications such as antidepressants or mood stabilizers should talk with their doctor before taking fluvoxamine.

Who should take fluvoxamine if they get sick with COVID-19?

Unfortunately, we cannot answer that yet.  This was the first study to demonstrate fluvoxamine’s effect, and we need to confirm the finding with a second study.

We have not studied fluvoxamine for people who test positive for the virus but have no symptoms, those who have not tested positive, or those who have had COVID-19 but are not in the early or acute phase of the illness.

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