Voxamin XR

Maprotiline Hydrochloride is indicated in-

• Obsessive-Compulsive Disorder
• Depressive illness
• Panic Disorder
• Eating Disorders
• Chronic Tension Headache

The exact mechanism of action of fluvoxamine has not been fully determined but appears to be linked to its inhibition of CNS neuronal uptake of serotonin. Fluvoxamine blocks the reuptake of serotonin at the serotonin reuptake pump of the neuronal membrane, enhancing the actions of serotonin on 5HT1A autoreceptors. Studies have also demonstrated that fluvoxamine has virtually no affinity for α1- or α2-adrenergic, β-adrenergic, muscarinic, dopamine D2, histamine H1, GABA-benzodiazepine, opiate, 5-HT1, or 5-HT2 receptors, despite having an affinity for binding to σ1 receptors.

Drugs Inhibiting or Metabolized by Cytochrome P450: Fluvoxamine inhibits several cytochrome P450 isoenzymes (CYP1A2, CYP2C9, CYP3A4, and CYP2C19).

Carbamazepine: Elevated carbamazepine levels and symptoms of toxicity with coadministration (7.2).

Sumatriptan: Rare postmarketing reports of weakness, hyperreflexia, and incoordination following use of an SSRI and sumatriptan. Monitor appropriately if concomitant treatment is clinically warranted.

Tacrine: Coadministration increased tacrine C max and AUC five- and eight-fold and caused nausea, vomiting, sweating, and diarrhea.

Tricyclic Antidepressants (TCAs): Coadministration significantly increased plasma TCA levels. Use caution; monitor plasma TCA levels; reduce TCA dose if indicated.

Tryptophan: Severe vomiting with coadministration.

Diltiazem: Bradycardia with coadministration.

Propranolol or metoprolol: Reduce dose if coadministered and titrate more cautiously

Most common reactions in controlled trials with adult OCD and depression patients (incidence ≥5% and at least twice that for placebo) were nausea, somnolence, insomnia, asthenia, nervousness, dyspepsia, abnormal ejaculation, sweating, anorexia, tremor, and vomiting. Using the above rule, the following events were also identified: anorgasmia, decreased libido, dry mouth, rhinitis, taste perversion, and urinary frequency in patients with OCD; and agitation, depression, dysmenorrhea, flatulence, hyperkinesia, and rash in pediatric patients with OCD.

Consider both potential risks and benefits when treating a pregnant woman. Infants exposed to SSRIs late in pregnancy have developed various complications and may be at risk for persistent pulmonary hypertension of the newborn (PPHN). Fluvoxamine is secreted in human breast milk.

Fluvoxamine Maleate should be used with caution in patients with a history of mania, seizures, suicide, concomitant ECT, cardiac disease, diabetes mellitus, angle-closure glaucoma, history of bleeding disorders (especially gastrointestinal bleeding), hepatic and renal impairment. Fluvoxamine maleate may also impair the performance of skilled tasks (driving).

SSRIs & related anti-depressant drugs

Keep below 30°C temperature, away from light & moisture. Keep out of the reach of children.