Fluvoxamine is an OCD drug in our hands, and we do not think it is special there. It is still the usual switch after one or two failed SSRIs, and its broad CYP inhibition is both its main hazard and the reason it gets paired with clomipramine.
When we reach for it
We reserve it pretty much for OCD, and we do not think it is that special for OCD, even though some people do.
“Luvox, Fluvoxamine, pretty much I reserve for OCD. I also don't think it's that special for OCD, even though some people do”
30:56Treating Depression: Practical Tips & Pearls for Anti-Depressant MedicationsJan 2025 Across studies it does not look more effective for OCD, yet when a patient with OCD has failed one or two SSRIs, we go to it anyway. Practice runs ahead of belief here.
“I don't believe that's more effective across studies. Yet, when my patient with OCD has failed one or two SSRIs, I go to Lubox. Oh, yeah. So it's like I don't believe in it, but I still practice it”
17:24Practical OCD Psychopharmacology: Evidence‑Based (& Non Evidence-Based) Medication ApproachAug 2025
Where it fits in OCD
Start with an SSRI such as sertraline. With a partial response, consider raising it to a supratherapeutic dose; if you want to switch, fluvoxamine is the usual switch.
“let's say you start off with a Zoloft. And if you have a partial response, you can consider raising to a super therapeutic dose. Yeah. If you feel like you want to switch for whatever reason, then I typically switch to Luvox”
18:18Practical OCD Psychopharmacology: Evidence‑Based (& Non Evidence-Based) Medication ApproachAug 2025
Drug interactions
It inhibits CYP1A2 especially, and then basically all the others: 2C9, 2C19 and 3A4.
“it inhibits especially CYP1A2 and then basically all of them, 2C9, 2C19, CYP3A4. I think it was studied a little bit for like COVID”
36:46Antidepressant Tier List: Psychiatrists Rank Depression Medications for MDDMay 2026 Its CYP1A2 inhibition is the rationale for pairing it with clomipramine: it raises the ratio of serotonergic clomipramine and, in theory, gives more of the serotonergic activity that helps OCD.
“fluvoxamine is a CYP1A2 inhibitor. So if you inhibit CYP1A2, you're going to increase the ratio of the serotonergic clomipramine and theoretically get more of that serotonergic activity that's better for OCD”
28:58Practical OCD Psychopharmacology: Evidence‑Based (& Non Evidence-Based) Medication ApproachAug 2025
It also comes up on
- OCDClomipramine and Luvox are still within the primary treatment arm. For augmentation, go from least harmful to most harmful.
- AugmentationOrder augmentation from least harmful to most harmful. In OCD, clomipramine and fluvoxamine still belong in the primary treatment arm, not the add-on list.
- ClozapineStrong CYP1A2 inhibitors can raise levels 5 to 10 times. The big ones are ciprofloxacin and fluvoxamine.
- Drug interactionsStrong CYP1A2 inhibitors can raise clozapine levels 5 to 10 times. The ones we worry about are ciprofloxacin and fluvoxamine.
From these episodes
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.